Conceptions of learning research: variations amongst French and Swedish nurses. A phenomenographic study.

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Dupin, Cécile Marie; Larsson, Maria; Dariel, Odessa; Debout, Christophe; Rothan-Tondeur, Monique

2015-01-01

The development of nursing research capacity and interactions with cultural and structural issues is at various stages throughout Europe. This process appears to be remarkably similar irrespective of the country. Sweden has developed this capacity since the 1990s, whereas France is experiencing a transition. Nevertheless, knowledge about how nurses conceive their learning about nursing research and transitioning toward being researchers is scarce. The aim of this study was to explore French and Swedish RNs' conceptions of research education and educational passage toward research and to describe how learning research contributes to the understanding of their norms and practices. A phenomenographic approach was used to understand and describe the qualitatively different ways in which French and Swedish RNs conceive research and its apprenticeship. A purposive maximum variation sampling of five French and five Swedish Nurse Researchers with PhDs. Individual in-depth interviews conducted in France and Sweden between November 2012 and March 2013 were analysed using phenomenography. The analysis revealed one main category, "Organisational factors to sustain individual apprenticeship". Three descriptive categories have emerged from the data and its variations amongst French and Swedish nurses: (1) entrance into research--modes of commitment; (2) nurses' engagement--the need for dedicated support; and (3) research as the means to resolve nursing situations. This study demonstrates how registered nurses have integrated nursing and researcher roles following different efficient paths. Education in nursing research is part of the strategy needed for the development of nursing research and is supported by the integration of research and practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Use of the ICU Nurse-Physician Questionnaire (ICU N-P-Q): testing reliability and validity in neonatal intensive care units in Japan.

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Sasaki, Hatoko; Yonemoto, Naohiro; Mori, Rintaro; Nishida, Toshihiko; Kusuda, Satoshi; Nakayama, Takeo

2016-05-09

Although communication among health providers has become a critical part of improving quality of care, few studies on this topic have been conducted in Japan. This study aimed to examine the reliability and validity of the Intensive Care Unit Nurse-Physician Questionnaire (ICU N-P-Q) for use among nurses and physicians in neonatal ICUs (NICUs) in Japan. A Japanese translation of the ICU N-P-Q was administered to physicians and nurses working at 40 NICUs across Japan, which were participating in the Improvement of NICU Practice and Team Approach Cluster randomized controlled trial (INTACT). We used the principal components analysis to evaluate the factor structure of the instruments. Convergent validity was assessed by examining correlations between the subscales of Communication and Conflict Management of the ICU N-P-Q and the subscales and total score of the Nurse-Physician Collaboration Scale (NPCS). Correlations between the subscales of Communication and Conflict Management by correlation with scales that refer to performance, including Job Satisfaction and Unit Effectiveness, were calculated to test the criterion validity. In total, 2006 questionnaires were completed by 316 physicians and 1690 nurses. The exploratory factor analysis revealed 15 factors in the physicians' questionnaire and 12 in the nurses' questionnaire. Convergent validity was confirmed, except for 'Between-group Accuracy' and 'Cooperativeness' in the physicians' scale, and for 'Between-group Accuracy' and 'Sharing of Patient Information' in the nurses' scale. Correlations between the subscales of communication and outcomes were confirmed in the nurses' questionnaire but were not fully supported in the physicians' questionnaire. Although the psychometric property behaved somewhat differently by occupation, the present findings provide preliminary support for the utility of the common item structure with the original scale, to measure the degree and quality of communication and collaboration

The effect of chronotype on sleepiness, fatigue, and psychomotor vigilance of ICU nurses during the night shift.

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Reinke, Laurens; Özbay, Yusuf; Dieperink, Willem; Tulleken, Jaap E

2015-04-01

In general, sleeping and activity patterns vary between individuals. This attribute, known as chronotype, may affect night shift performance. In the intensive care unit (ICR), night shift performance may impact patient safety. We have investigated the effect of chronotype and social demographics on sleepiness, fatigue, and night shift on the performance of nurses. This was a prospective observational cohort study which assessed the performance of 96 ICU night shift nurses during the day and night shifts in a mixed medical-surgical ICU in the Netherlands. We determined chronotype and assessed sleeping behaviour for each nurse prior to starting shift work and before free days. The level of sleepiness and fatigue of nurses during the day and night shifts was determined, as was the effect of these conditions on psychomotor vigilance and mathematical problem-solving. The majority of ICU nurses had a preference for early activity (morning chronotype). Compared to their counterparts (i.e. evening chronotypes), they were more likely to nap before commencing night shifts and more likely to have young children living at home. Despite increased sleepiness and fatigue during night shifts, no effect on psychomotor vigilance was observed during night shifts. Problem-solving accuracy remained high during night shifts, at the cost of productivity. Most of the ICU night shift nurses assessed here appeared to have adapted well to night shift work, despite the high percentage of morning chronotypes, possibly due to their 8-h shift duration. Parental responsibilities may, however, influence shift work tolerance.

Effort-Reward Imbalance and Burnout Among ICU Nursing Staff: A Cross-Sectional Study.

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Padilla Fortunatti, Cristobal; Palmeiro-Silva, Yasna K

Occupational stress is commonly observed among staff in intensive care units (ICUs). Sociodemographic, organizational, and job-related factors may lead to burnout among ICU health workers. In addition, these factors could modify the balance between efforts done and rewards perceived by workers; consequently, this imbalance could increase levels of emotional exhaustion and depersonalization and decrease a sense of personal accomplishment. The purpose of this study was to analyze the relationship between effort-reward imbalance and burnout dimensions (emotional exhaustion, depersonalization, and personal accomplishment) among ICU nursing staff in a university hospital in Santiago, Chile. A convenience sample of 36 registered nurses and 46 nurse aides answered the Maslach Burnout Inventory and Effort-Reward Imbalance Questionnaire and provided sociodemographic and work-related data. Age and effort-reward imbalance were significantly associated with emotional exhaustion in both registered nurses and nurse aides; age was negatively correlated with emotional exhaustion, whereas effort-reward imbalance was positively correlated. Age was negatively associated with depersonalization. None of the predictors were associated with personal accomplishment. This study adds valuable information about relationships of sociodemographic factors and effort-reward imbalance and their impact on dimensions of burnout, particularly on emotional exhaustion.

[The impact of the visit of nursing on the necessities of the host families of ICU].

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Simoni, Rosemary Cristina Marques; Silva, Maria Júlia Paes da

2012-10-01

Study of a quantitative approach that aimed to implement the Visiting Nurse ICU adult and check and meet the main needs for information and verbalized by host families. After approval of the CEP of the HU-USP was asked if the family would like to receive some information on the part of nursing. All family members wanted to receive information from nurses in three visits with each family. The themes of doubt among the most familiar were the patient's clinical state and discharged from the ICU. We found that the average number of questions decreased from the first to third visit. The Visiting Nurse attended the main needs of the host family information and answering your questions about the nursing care provided to patients. It was also observed that the doubts and anxieties of family members decreased during the day, emphasizing the need that contact of Nurses and Families.

Level of Knowledge and Attitude of ICU Nurses toward Organ Donation and the Related Factors: A Systematic Review

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Zohre Najafi

2017-12-01

Full Text Available Introduction: Nurses play a key role in the process of organ donation and transplantation, and previous studies have widely addressed the level of knowledge and attitude of intensive care unit (ICU nurses in this regard. Considering the direct correlation between the positive attitude of the healthcare team, especially nurses, and the level of consent on organ donation, knowledge and attitude of nurses are important factors that have been assessed in several studies. However, no definite conclusions have been drawn in this regard. The present study aimed to evaluate the knowledge and attitude of ICU nurses toward organ donation and the related factors.Methods: A systematic review was conducted via searching in databases such as ProQuest, Medscape, MedlinePlus, MagIran, PubMed, and ScienceDirect to identify the articles published during 1990-2015 using keywords such as knowledge, attitude, organ donation, and nurses.Result: Awareness and knowledge are the main determinants of attitude in nurses, which should be applied in order to foster positive attitudes in the process of organ donation. Furthermore, extensive clinical knowledge should be acquired on organ donation and communication skills by ICU nurses through proper training programs.Conclusion: According to the results, using standard guidelines or scheduled training programs in nursing schools could improve the level of knowledge in nurses, which in turn enhances nursing performance. In addition, our findings indicated that positive attitude and knowledge of nurses could largely infleunce the viewpoint of families toward organ donation.

DELIRIUM RELATED DISTRESS EXPERIENCED BY PATIENTS, CAREGIVERS AND NURSING STAFF IN A MEDICAL INTENSIVE CARE UNIT (ICU

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Ayush Kumar Jayaswal

2018-03-01

Full Text Available BACKGROUND Delirium, a common neuropsychiatric syndrome in intensive care settings is a distressing experience for the patient, caregivers and nursing staff. Research on delirium experience has been scant and unsystematic. We set out to explore the extent of recall of delirium, differential distress it had on patients, caregivers and nursing staff and the extent to which it impacted recognition across the motoric subtypes. MATERIALS AND METHODS A prospective study was carried out on all consecutively admitted patients in the medical ICU of a tertiary care teaching hospital. Patients diagnosed with delirium using Confusion Assessment Method for ICU (CAM-ICU were administered the Richmond Agitation Sedation Scale (RASS for differentiating the motor subtypes (hypoactive, hyperactive, mixed. Distress was assessed using the Delirium Experience Questionnaire (DEQ. RESULTS Of the 88 patients (31.43% who developed delirium, 60.2% recalled their experience. Recall was highest in the hyperactive subtype. 76% of patients, 94.3% of caregivers and 31.8% of nursing staff reported severe levels of distress. Motoric subtypes did not impact on the distress levels experienced by the patients or their caregivers, but influenced it significantly in the nursing staff (highest in hyperactive, least in hypoactive. Identification of delirium by nursing staff (13.4% was significantly influenced by the motor subtypes (highest in hyperactive, least in hypoactive. Linear regression analysis revealed that distress of ICU staff (F=1.36, p=0.018 and not the motoric subtypes (F=1.36, p=0.262 significantly predicted recognition of delirium. CONCLUSIONS Most patients who develop delirium and their caregivers experience high levels of distress. Under-recognition is significantly influenced by the distress it causes the ICU staff than the motor subtype of delirium.

The Swedish version of the Frommelt Attitude Toward Care of the Dying scale: aspects of validity and factors influencing nurses' and nursing students' attitudes.

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Henoch, Ingela; Browall, Maria; Melin-Johansson, Christina; Danielson, Ella; Udo, Camilla; Johansson Sundler, Annelie; Björk, Maria; Ek, Kristina; Hammarlund, Kina; Bergh, Ingrid; Strang, Susann

2014-01-01

Nurses' attitudes toward caring for dying persons need to be explored. The Frommelt Attitude Toward Care of the Dying (FATCOD) scale has not previously been used in Swedish language. The objectives of this study were to compare FATCOD scores among Swedish nurses and nursing students with those from other languages, to explore the existence of 2 subscales, and to evaluate influences of experiences on attitudes toward care of dying patients. A descriptive, cross-sectional, and predictive design was used. The FATCOD scores of Swedish nurses from hospice, oncology, surgery clinics, and palliative home care and nursing students were compared with published scores from the United States, Israel, and Japan. Descriptive statistics, t tests, and factor and regression analyses were used. The sample consisted of 213 persons: 71 registered nurses, 42 enrolled nurses, and 100 nursing students. Swedish FATCOD mean scores did not differ from published means from the United States and Israel, but were significantly more positive than Japanese means. In line with Japanese studies, factor analyses yielded a 2-factor solution. Total FATCOD and subscales had low Cronbach α's. Hospice and palliative team nurses were more positive than oncology and surgery nurses to care for dying patients. Although our results suggest that the Swedish FATCOD may comprise 2 distinct scales, the total scale may be the most adequate and applicable for use in Sweden. Professional experience was associated with nurses' attitudes toward caring for dying patients. Care culture might influence nurses' attitudes toward caring for dying patients; the benefits of education need to be explored.

Examining perception of job satisfaction and intention to leave among ICU nurses in China

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Hong Tao

2015-06-01

Conclusions: For ICU nurses in China, sources of job dissatisfaction are potentially remedied with simple interventions. Adequate staffing is necessary but not sufficient for a positive work environment. Administrators should address the factors that directly affect their nurses' levels of job satisfaction, as it will ultimately result in less staff turnover and greater patient care.

Botulism in the ICU: Nursing care plan.

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Zariquiey-Esteva, G; Galeote-Cózar, D; Santa-Candela, P; Castanera-Duro, A

Botulism is a rare disease in Europe, caused by the bacterium Clostridium botulinum, notifiable, non-transmissible person-to-person and potentially fatal (between 5 and 10%) if not treated quickly. The favourable opinion of the Clinical Research Ethics Committee was obtained. We present the nursing care plan of a 49-year-old man with a diagnosis of bacterial intoxication caused by Clostridium botulinum, secondary to ingestion of beans in poor condition, who was admitted to the ICU for a total of 35 days. Holistic nursing evaluation during the first 24hours, with prioritisation of the systems that were deteriorating fastest: neurological and respiratory. Nine diagnoses were prioritised according to the NANDA taxonomy: Risk for allergy response, Ineffective breathing pattern, impaired oral mucous membrane, Impaired physical mobility, Risk for disuse syndrome, Risk for dysfunctional gastrointestinal motility, Impaired urinary elimination, Risk for acute confusion and Risk for caregiver role strain. The nursing care plan, standardised and organised with the NANDA taxonomy and prioritised with the outcome-present state-test (OPT) model, guaranteed the best care based on evidence, as the NOC scores improvement demonstrated. It was impossible to compare the nursing intervention with other case reports. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

Male ICU nurses' experiences of taking care of dying patients and their families: a gender analysis.

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Wu, Tammy W; Oliffe, John L; Bungay, Vicky; Johnson, Joy L

2015-01-01

Male intensive care unit (ICU) nurses bring energy and expertise along with an array of beliefs and practices to their workplace. This article investigates the experiences of male ICU nurses in the context of caring for dying patients and their families. Applying a gender analysis, distilled are insights to how masculinities inform and influence the participants' practices and coping strategies. The findings reveal participants draw on masculine ideals of being a protector and rational in their decisive actions toward meeting the comfort needs of dying patients and their families. Somewhat paradoxically, most participants also transgressed masculine norms by outwardly expressing their feelings and talking about emotions related to these experiences. Participants also reported renewed appreciation of their life and their families and many men chronicled recreational activities and social connectedness as strategies for coping with workplace induced stresses. The findings drawn from this study can guide both formal and informal support services for men who are ICU nurses, which in turn might aid retention of this subgroup of workers. © The Author(s) 2014.

Swedish Nursing Students' Perceptions of the Concept of Health: A Phenomenographic Study

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Skär, Lisa; Söderberg, Siv

2016-01-01

Objectives: Health is a central and important concept in nursing and nursing education, and has been theorised about in both positive and negative terms. The purpose of this study was to explore Swedish nursing students' perceptions of the concept of health. Design: A phenomenographic research approach was used to understand how nursing students…

ICU nurses and physicians dialogue regarding patients clinical status and care options-a focus group study.

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Kvande, Monica; Lykkeslet, Else; Storli, Sissel Lisa

2017-12-01

Nurses and physicians work side-by-side in the intensive care unit (ICU). Effective exchanges of patient information are essential to safe patient care in the ICU. Nurses often rate nurse-physician communication lower than physicians and report that it is difficult to speak up, that disagreements are not resolved and that their input is not well received. Therefore, this study explored nurses' dialogue with physicians regarding patients' clinical status and the prerequisites for effective and accurate exchanges of information. We adopted a qualitative approach, conducting three focus group discussions with five to six nurses and physicians each (14 total). Two themes emerged. The first theme highlighted nurses' contributions to dialogues with physicians; nurses' ongoing observations of patients were essential to patient care discussions. The second theme addressed the prerequisites of accurate and effective dialogue regarding care options, comprising three subthemes: nurses' ability to speak up and present clinical changes, establishment of shared goal and clinical understanding, and open dialogue and willingness to listen to each other. Nurses should understand their essential role in conducting ongoing observations of patients and their right to be included in care-related decision-making processes. Physicians should be willing to listen to and include nurses' clinical observations and concerns.

THE IMPLEMENTATION OF THE SYSTEMATIZATION OF NURSING ICU - NEONATAL HOSPITAL REGIONAL DE CÁCERES-MT

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Eliene de Souza Porto

2013-01-01

Full Text Available The study aimed to analyze the implementation of the Nursing Care System (NCS in the ICU - Neonatal Hospital Regional de Cáceres Dr. Anthony Fontes - HRCAF. This is an exploratory qualitative approach with descriptive profile of the case study. Data were collected through interviews with five nurses from ICU - Neonatal, using as research instrument, a questionnaire containing open and closed questions and analyzing a chart. The results showed that nurses know and realize the importance of NCS as a methodological tool that guides the practice of care and as professional recognition, although not held by all. The analysis of the records showed that there Systematization of Nursing Care at this clinic. Of the 707 days analyzed records there were only 30 (4.25% Nursing Research, none (0.0% record Diagnosis and Planning, 57 (8.26% days with record Deployment, Assessment and 23 record (3.24% in which its registered nursing care, assistance totaling 15.55% recorded in medical records. With the completion of this study, it was noted that the SAE often becomes impossible in practice of nursing because of various difficulties such as lack of time, lack of human resources, work overload, and the generic form organizational structure.

Nurses' leadership styles in the ICU: association with personal and professional profile and workload.

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Balsanelli, Alexandre Pazetto; Cunha, Isabel Cristina Kowal Olm; Whitaker, Iveth Yamaguchi

2009-01-01

This study aims to explore the association between nurses' leadership styles and personal and professional nursing profile and workload. The sample consisted of seven nurses and seven nursing technicians who were grouped into pairs. At the end of three months, nurses were queried regarding what leadership style would be adopted when the nursing technician under their evaluation delivered care to patients admitted to the ICU. Relevant data was analyzed by applying descriptive statistics, Tukey's multiple comparison test and Student's t-test (pleadership styles chosen by nurses (p>0.05). The determine, persuade, and share leadership styles prevailed. However, whenever the nursing workload peaked, the determine and persuade styles were used (p<0.05).

Nurses' perceptions of communication training in the ICU.

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Radtke, Jill V; Tate, Judith A; Happ, Mary Beth

2012-02-01

To describe the experience and perceptions of nurse study participants regarding a communication intervention (training and communication tools) for use with nonspeaking, critically ill patients. Small focus groups and an individual interview were conducted with six critical care nurses. Transcripts were analysed using qualitative content analysis and constant comparison. Two ICUs within a large, metropolitan medical centre in western Pennsylvania, United States of America. Critical care nurses' evaluations of (1) a basic communication skills training programme (BCST) and (2) augmentative and alternative communication strategies (AAC) introduced during their study participation. Six main categories were identified in the data: (1) communication value/perceived competence; (2) communication intention; (3) benefits of training; (4) barriers to implementation; (5) preferences/utilisation of strategies; and 6) leading-following. Perceived value of and individual competence in communication with nonspeaking patients varied. Nurses prioritised communication about physical needs, but recognised complexity of other intended patient messages. Nurses evaluated the BCST as helpful in reinforcing basic communication strategies and found several new strategies effective. Advanced strategies received mixed reviews. Primary barriers to practise integration included patients' mental status, time constraints, and the small proportion of nurses trained or knowledgeable about best patient communication practices in the ICU. The results suggest that the communication skills training programme could be valuable in reinforcing basic/intuitive communication strategies, assisting in the acquisition of new skills and ensuring communication supply availability. Practice integration will most likely require unit-wide interdisciplinary dissemination, expert modelling and reinforcement. Copyright © 2011 Elsevier Ltd. All rights reserved.

Ten Australian ICU nurses' perceptions of organisational restructuring.

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Wynne, Rochelle

2004-02-01

The Australian healthcare system underwent radical reform in the 1990s as economic rationalist policies were embraced. As a result, there was significant organisational restructuring within hospitals. Traditional indicators, such as nursing absenteeism and attrition, increase during times of organisational change. Despite this, nurses' views of healthcare reform are under-represented in the literature and little is known about the impact of organisational restructuring on perceived performance. This study investigated the perceived impact of organisational restructuring on a group of intensive care unit (ICU) nurses' workplace performance. It employed a qualitative approach to collect data from a purposive sample of clinical nurses. The primary method of data collection was semi-structured interviews. Content analysis generated three categories of data. Participants identified constant pressure, inadequate communication and organisational components of restructuring within the hospital as issues that had a significant impact on their workplace performance. They perceived organisational restructuring was poorly communicated, and this resulted in an environment of constant pressure. Organisational components of restructuring included the subcategories of specialised service provision and an alternative administrative structure that had both positive and negative ramifications for performance. To date, there has been little investigation of nurses' perceptions of organisational restructure or the impact this type of change has in the clinical domain. Participants in this study believed reorganisation was detrimental to quality care delivery in intensive care, as a result of fiscal constraint, inadequate communication and pressure that influenced their workplace performance.

The visibility of QSEN competencies in clinical assessment tools in Swedish nurse education.

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Nygårdh, Annette; Sherwood, Gwen; Sandberg, Therese; Rehn, Jeanette; Knutsson, Susanne

2017-12-01

Prospective nurses need specific and sufficient knowledge to be able to provide quality care. The Swedish Society of Nursing has emphasized the importance of the six quality and safety competencies (QSEN), originated in the US, in Swedish nursing education. To investigate the visibility of the QSEN competencies in the assessment tools used in clinical practice METHOD: A quantitative descriptive method was used to analyze assessment tools from 23 universities. Teamwork and collaboration was the most visible competency. Patient-centered care was visible to a large degree but was not referred to by name. Informatics was the least visible, a notable concern since all nurses should be competent in informatics to provide quality and safety in care. These results provide guidance as academic and clinical programs around the world implement assessment of how well nurses have developed these essential quality and safety competencies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Extent and application of ICU diaries in Germany in 2014

DEFF Research Database (Denmark)

Nydahl, Peter; Knueck, Dirk; Egerod, Ingrid

2015-01-01

in keeping ICU diaries. CONCLUSION: Six years after the introduction of ICU diaries, ICU nurses in Germany are becoming familiar with the concept. Nursing shortage and bureaucratic challenges have impeded the process of implementation, but the adaption of ICU diaries to German conditions appears......, newsletters, newspapers, lectures and publications in German nursing journals. AIM: The aim of the study was to update our knowledge of the extent and application of ICU diaries in Germany in 2014. DESIGN: The study had a prospective mixed methods multicenter design. METHOD: All 152 ICUs in the two German...... of Germany had implemented diaries and three units were planning to do so. Interviews were conducted with nurses at 14 selected ICUs. Informants reported successful adaption of the diary concept to their culture, but variability in application. No units were identified where all nursing staff participated...

Virtual rapid response: the next evolution of tele-ICU.

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Hawkins, Carrie L

2012-01-01

The first of its kind in the Veterans Affairs (VA) system, the Denver VA Medical Center's tele-intensive care unit (ICU) program is unique because it is entirely nurse driven. A nontraditional tele-ICU model, the program was tailored to meet the needs of rural veterans by using critical care nursing expertise in Denver, Colorado. An experienced CCRN-certified nurse manages the system 24 hours a day, 7 days a week, from Eastern Colorado Health Care System. The virtual ICU provides rapid response interventions through virtual technology. This tele-ICU technology allows for a "virtual handshake" by nursing staff at the start of the shift and a report on potential patient issues. Clinical relationships have been strengthened between all 5 VA facilities in the Rocky Mountain Region, increasing the likelihood of early consultation at the onset of clinical decline of a patient. In addition, the tele-ICU nurse is available for immediate nursing consultation and support, coordinates point-to-point virtual consultation between physicians at the rural sites and specialists in Denver, and assists in expediting critical care transfers. The primary objectives for the tele-ICU program include improving quality and access of care to critical care services in rural sites, reducing community fee basis costs and frequency of transfers, and increasing collaboration and collegiality among nursing and medical staff in all Region 19's medical centers.

[Identification and mapping of prescribed nursing actions for patients in an adult ICU].

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Salgado, Patricia Oliveira; Tannure, Meire Chucre; Oliveira, Cleydson Rodrigues; Chianca, Tânia Couto Machado

2012-01-01

Descriptive study that aimed to identify nursing actions prescribed by nurses in the medical records of patients admitted to an Intensive Care Unit (ICU) for adults, in Belo Horizonte (MG), the terms used, their frequency and map the actions to the Theory of Basic Human Needs and NIC interventions. It was obtained a sample of 44 patient records. It was identified 2,260 nursing actions. After exclusion of repetitions, it was found 124 different actions. All nursing actions have been mapped to physiological needs and also to NIC interventions. It was obtained 100% of agreement among experts in the validation of the mapping process. It is suggested that similar studies in ICUs from other locations and different contexts / specialties should be driven to identify nursing actions developed and its evolution.

Swedish nurses' perceptions of influencers on patient advocacy: a phenomenographic study.

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Josse-Eklund, Anna; Jossebo, Marie; Sandin-Bojö, Ann-Kristin; Wilde-Larsson, Bodil; Petzäll, Kerstin

2014-09-01

A limited number of studies have shown that patient advocacy can be influenced by both facilitators and barriers which can encourage and discourage nurses to act as patient advocates. This study's aim was to describe Swedish nurses' perceptions of influencers on patient advocacy. Interviews with 18 registered nurses from different Swedish clinical contexts were analysed using the phenomenographic method. Ethical revisions were made in accordance with national legislation and guidelines by committees for research ethics at Karlstad University. Three levels of hierarchically related influencers on patient advocacy were found in the descriptive categories. The fundamental influencer, the nurse's character traits, was described in the perceptions that advocacy is influenced by nurse's having a moral compass, having control over the care situation, being protective and feeling secure as a nurse. The second most vital influencer, the nurse's bond with the patient, was expressed in the perceptions of knowing the patient and feeling empathy for the patient. The third level of influencers, the organisational conditions, was described in the perceptions that the organisational structures and organisational culture influence patient advocacy. The results correspond with findings from earlier research but add an understanding that influencers on patient advocacy exist at three hierarchically related levels. The nurse's character traits are the fundamental influencer to patient advocacy, but in order to be comfortable and secure when advocating for patients, nurses also need to be familiar with both the patient and the situation. A supposition could be that all influencers interact, which needs to be further addressed in future studies. © The Author(s) 2014.

Nursing care of the family before and after a death in the ICU--an exploratory pilot study.

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Bloomer, Melissa J; Morphet, Julia; O'Connor, Margaret; Lee, Susan; Griffiths, Debra

2013-02-01

This qualitative descriptive study was undertaken in two metropolitan ICUs utilising focus groups to describe the ways in which ICU nurses care for the families of dying patients during and after the death. Participants shared their perspectives on how they care for families, their concerns about care, and detailed the strategies they use to provide timely and person-centred family care. Participants identified that their ICU training was inadequate in equipping them to address the complex care needs of families leading up to and following patient deaths, and they relied on peer mentoring and role-modelling to improve their care. Organisational constraints, practices and pressures impacting on the nurse made 'ideal' family care difficult. They also identified that a lack of access to pastoral care and social work after hours contributed to their concerns about family care. Participants reported that they valued the time nurses spent with families, and the importance of ensuring families spent time with the patient, before and after death. Copyright © 2012 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Fathers' involvement in Swedish child health care - the role of nurses' practices and attitudes.

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Massoudi, Pamela; Wickberg, Birgitta; Hwang, C Philip

2011-03-01

To investigate how nurses in Swedish child health care perceived working with fathers, and to what extent they offered support to, and included fathers in clinical encounters. A random sample of all nurses in Swedish child health care, 499 nurses, were asked to complete a postal questionnaire. The response rate was 70%. Data were analysed with content analysis, the chi-square test and logistic regression models. Almost all of the nurses found working with fathers positive. Fathers' participation in child health care was much lower than that of mothers'. Almost 90% of the nurses estimated that it rarely came to their attention that a father was distressed, and less than one of five nurses had offered supportive counselling to any distressed father in the previous year. Nurses with regular supervision on mental health issues and nurses with a paediatric specialization were more likely to offer supportive counselling to fathers. Approximately 50% of the nurses had an ambivalent attitude towards fathers' caring capacity when compared to that of mothers. Fathers received less support from child health nurses, and many nurses were ambivalent about fathers' caring abilities. Methods need to be developed to involve both parents in child health care. © 2010 The Author(s)/Acta Paediatrica © 2010 Foundation Acta Paediatrica.

The effects of teaching stress management skills on the quality of life in ICU nurses

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FARIBA GHODSBIN

2013-07-01

Full Text Available Introduction: Job stress is one of the main factors in decreasing productivity in organizations and the leading cause of psychosomatic disorders in personnel. Since job stress of nurses working in Intensive Care Units (ICUs is considered as an important segment in health and medical systems, it significantly affects the quality of care and the nurse’s quality of life. To this end, the purpose of this research is to examine the effects of teaching stress management skills on the quality of life of the nurses working at ICU of the hospitals affiliated to Shiraz University of Medical Sciences. Methods: The subjects of the study consisted of 60 ICU nurses with the average stress score in Osipow job stress exam working at the hospitals affiliated to Shiraz University of Medical Sciences. The subjects were randomly assigned to two groups (30 in the case and 30 in the control group. The intervention was performed as a teaching stress management workshop for eight hours throughout two-days (four hours per day, and the nurses were followed up for two months. The data were collected through a two part questionnaire including demographic characteristics and WHO Quality of life BREF and were analyzed in SPSS software using paired t test, and t-test. Results: The findings showed that the nurses of both the case and control groups were homogeneous considering the demographic data such as age, sex, marital status, number of children, shift position, job satisfaction, number of working hours per week, work experience and the amount of income. Moreover, there was no significant difference between the mean score of the life quality before the intervention in both groups. But after the intervention, a significant increase was revealed in the mean score of the life quality of the case group as compared to that of the control group (P<0.0001. Conclusion: The findings revealed the efficacy of the stress management workshop in improving the life quality of ICU

Relationship between ICU nurses' moral distress with burnout and anticipated turnover.

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Shoorideh, Foroozan Atashzadeh; Ashktorab, Tahereh; Yaghmaei, Farideh; Alavi Majd, Hamid

2015-02-01

Moral distress is one of intensive care unit nurses' major problems, which may happen due to various reasons, and has several consequences. Due to various moral distress outcomes in intensive care unit nurses, and their impact on nurses' personal and professional practice, recognizing moral distress is very important. The aim of this study was to determine correlation between moral distress with burnout and anticipated turnover in intensive care unit nurses. This study is a descriptive-correlation research. A total of 159 intensive care unit nurses were selected from medical sciences universities in Iran. Data collection instruments included "demographic questionnaire," "ICU Nurses' Moral Distress Scale," "Copenhagen Burnout Inventory" and "Hinshaw and Atwood Turnover Scale." Data analysis was done by using SPSS19. Informed consent from samples and research approval was obtained from Shahid Beheshti Medical Sciences University Research Ethics Board in Tehran. The findings showed intensive care unit nurses' moral distress and anticipated turnover was high, but burnout was moderate. The results revealed that there was a positive statistical correlation between intensive care unit nurses' age, their work experience and the fraction of nurses' number to number of intensive care unit beds with their moral distress and burnout. However, there were no correlation between gender, marriage status, educational degree and work shift and moral distress. Some of the findings of this research are consistent with other studies and some of them are inconsistent. Similarly, moral distress with burnout and anticipated turnover did not have statistical correlation. However, a positive correlation was found between burnout and anticipated turnover. The results showed that increase in the recruitment of young nurses, and nursing personnel, and diminishing intensive care unit nurses' moral distress, burnout and their turnover intention are essential. © The Author(s) 2014.

Handing over patients from the ICU to the general ward

DEFF Research Database (Denmark)

Bunkenborg, Gitte; Bitsch Hansen, Tina; Hølge-Hazelton, Bibi

2017-01-01

AIM: To explore nursing practice and perception of engaging in communicative interaction when handing over multi-morbid patients from the ICU to general medical or surgical wards. BACKGROUND: Communication failures impose risks to patient safety. ICU and general ward nurses communicate in writing...... focused ethnography was applied to the study. METHODS: Participant observation of 22 clinical situations of handing over patients from the ICU to general wards was conducted in November and December 2015, followed by five focus group interviews, three interviews with general ward nurses and two with ICU...... towards patient status and the handing over process" emerged from observation notes. From transcribed focus group interviews, the theme "Balancing and negotiating when passing on, consuming and adapting knowledge" was identified. CONCLUSION: A lack of shared goals regarding handing over patients from...

Animal Welfare and Economic Aspects of Using Nurse Sows in Swedish Pig Production

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Karin Alvåsen

2017-12-01

Full Text Available The number of born piglets per litter has increased in Swedish pig industry, and farmers are struggling to improve piglet survival. A common practice is to make litters more equally sized by moving piglets from large litters to smaller to make sure that all piglets get an own teat to suckle. Litter equalization is not always enough, as many sows have large litters and/or damaged teats, which results in an insufficient number of available teats. One way to solve this problem is to use nurse sows. A nurse sow raises, and weans, her own piglets before receiving a foster litter. The objectives of this study were to address how the use of nurse sows affects the welfare of sows and piglets and to explore how it impacts the contribution margin of pig production in Sweden. A literature search was made to investigate welfare aspects on sows and piglets. As there were few published studies on nurse sows, an expert group meeting was organized. In order to explore the impact on the contribution margin of pig production, a partial budgeting approach with stochastic elements was used for a fictive pig farm. Standard templates for calculating costs and benefits were supplemented with figures from existing literature and the gathered expert opinions. In Sweden, the minimum suckling period is 28 days while published studies involving nurse sows, all from outside of Sweden, weaned the piglets at 21 days. A Swedish nurse sow will thus get longer lactation period which might increase the risk of poor body condition, damaged teats, and shoulder ulcers. This indicates a reduced welfare of the sow and may lead to impaired fertility and increased culling risk. On the other hand, the piglet mortality could be reduced with the use of nurse sows, but the separation and mixing of piglets could be stressful. The partial budgeting suggested that the nurse sow system is slightly more profitable (+6,838 Swedish krona per farrowing group during one dry and one lactation

The effect of chronotype on sleepiness, fatigue, and psychomotor vigilance of ICU nurses during the night shift

OpenAIRE

Reinke, Laurens; Ozbay, Yusuf; Dieperink, Willem; Tulleken, Jaap E.

2015-01-01

Purpose In general, sleeping and activity patterns vary between individuals. This attribute, known as chronotype, may affect night shift performance. In the intensive care unit (ICR), night shift performance may impact patient safety. We have investigated the effect of chronotype and social demographics on sleepiness, fatigue, and night shift on the performance of nurses. Methods This was a prospective observational cohort study which assessed the performance of 96 ICU night shift nurses duri...

The effect of education on the nursing care quality of patients who are under mechanical ventilation in ICU ward

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Sahar Geravandi

2018-02-01

Full Text Available Nurses have the most important role among health care workers (HCWs in each hospital (Aiken et al., 2008 [1]. Nurses education can lead to the improvement of nursing care If is implemented and designed based on nurses’ needs and proper principles (Aiken et al., 2008 [1]. Nowadays, increased quality of the treatment and increase the chances of survival of patients with acute respiratory failure are very important (Teixeira et al., 2013 [2]. Nursing care plan in ICU patients is one of the important elements in nursing care, and one of the main strategies is promotion of education level. Nurses due to longtime relationship with nursing staff in 24 hours and use of multiple roles of education have excellent position in evaluating educational needs and performing clinical educator roles. The effect of education on the nursing care quality of patients who were under mechanical ventilation (UMV in intensive care unit (ICU ward of Razi hospital is evaluated during 2015. The present study is descriptive-analytical and semi experimental research. Research statistical population included 30 nurses. In this paper, the effects of communication with the patient, correct suctioning, compliance of aseptic techniques, the correct discharge of tube cuff, chest physiotherapy, the correct change positions, health food gavage, prevent of foot drop, oral hygiene, the eyes hygiene and protect the cornea have been studied. After completion of the questionnaires by patients, the obtained coded data were fed into EXCEL. Reliability was confirmed with coefficient Alfa 0.86 and the result of software and techniques were entered to SPSS for statistics and analysis. Keywords: Education, Nurse, Intensive care unit, Mechanical ventilation, Nursing care, Iran

Verbal and social interactions in Swedish forensic psychiatric nursing care as perceived by the patients and nurses.

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Rask, Mikael; Brunt, David

2006-06-01

Patients and nurses in a Swedish forensic psychiatric unit filled in a questionnaire Verbal and Social Interactions designed to survey patients' and nurses' views on the frequency and importance of nursing interactions in forensic psychiatric care. The patients perceived the 'supportive/encouraging interactions' and the 'reality orientation interactions' as the most frequent interactions and the 'supportive/encouraging interactions' and the 'social skills training' as the most important interactions. The nurses perceived the 'supportive/encouraging interactions' and the 'practical skills training' as the most frequent and the 'supportive/encouraging interactions', 'interpretative interactions' and the 'practical skills training' as the most important interactions. There were significant differences between patients' and nurses' perceptions about the frequency of all the different groups of interactions, but greater agreement as to the importance. In general, the patients perceived that the interactions occurred less frequently than the nurses. The differences between patients' and nurses' perceptions on the interactions as well as the clinical implications of these differences are discussed.

Using Nurse Ratings of Physician Communication in the ICU To Identify Potential Targets for Interventions To Improve End-of-Life Care.

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Ramos, Kathleen J; Downey, Lois; Nielsen, Elizabeth L; Treece, Patsy D; Shannon, Sarah E; Curtis, J Randall; Engelberg, Ruth A

2016-03-01

Communication among doctors, nurses, and families contributes to high-quality end-of-life care, but is difficult to improve. Our objective was to identify aspects of communication appropriate for interventions to improve quality of dying in the intensive care unit (ICU). This observational study used data from a cluster-randomized trial of an interdisciplinary intervention to improve end-of-life care at 15 Seattle/Tacoma area hospitals (2003-2008). Nurses completed surveys for patients dying in the ICU. We examined associations between nurse-assessed predictors (physician-nurse communication, physician-family communication) and nurse ratings of patients' quality of dying (nurse-QODD-1). Based on 1173 nurse surveys, four of six physician-nurse communication topics were positively associated with nurse-QODD-1: family questions, family dynamics, spiritual/religious issues, and cultural issues. Discussions between nurses and physicians about nurses' concerns for patients or families were negatively associated. All physician-family communication ratings, as assessed by nurses, were positively associated with nurse-QODD-1: answering family's questions, listening to family, asking about treatments patient would want, helping family decide patient's treatment wishes, and overall communication. Path analysis suggested overall physician-family communication and helping family incorporate patient's wishes were directly associated with nurse-QODD-1. Several topics of physician-nurse communication, as rated by nurses, were associated with higher nurse-rated quality of dying, whereas one topic, nurses' concerns for patient or family, was associated with poorer ratings. Higher nurse ratings of physician-family communication were uniformly associated with higher quality of dying, highlighting the importance of this communication. Physician support of family decision making was particularly important, suggesting a potential target for interventions to improve end-of-life care.

Job satisfaction among Swedish mental health nursing personnel: Revisiting the two-factor theory.

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Holmberg, Christopher; Caro, Jino; Sobis, Iwona

2018-04-01

Swedish mental health-care services are experiencing a critical shortage of nursing personnel. Researchers suggest that this shortage is due to low levels of job satisfaction. Job satisfaction is frequently studied with the assistance of Herzberg's two-factor theory, and this theory has foremost been explored with studies using quantitative methods. The purpose of the present study was to provide a better understanding of Herzberg's theory in relation to job satisfaction among Swedish mental health nursing personnel within inpatient psychiatric care while using qualitative methodology. This explorative study was based on semistructured interviews with 25 nursing personnel. Qualitative content analysis of interview transcripts identified three main categories: (i) respondents' perception of their work duties, which was perceived as important, meaningful, and demanding; (ii) respondents' relations with colleagues and supervisors, which provided valuable support in everyday work; and (iii) the way the respondents experienced their professional role as mental health nurses, which was described as unclear and vague. Job satisfaction primarily stemmed from working for patients and with other professionals, but their perceived limited progression of responsibilities discouraged a career in the profession. Herzberg's theory proved useful in exploring job satisfaction in this setting, but the findings partly contradict the basic tenets of the theory. Career advancements and incentives, such as salary and compensation, were perceived as lacking, which negatively influenced job satisfaction. Ward managers should establish clinical ladder programmes to recognize and motivate the continuing professional development of nurses. This needs to be coupled with monetary incentives, and linked with increased clinical authority. © 2017 Australian College of Mental Health Nurses Inc.

The role of ICT in nursing practice: an integrative literature review of the Swedish context.

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Fagerström, Cecilia; Tuvesson, Hanna; Axelsson, Lisa; Nilsson, Lina

2017-09-01

The Swedish healthcare system employs information and communication technologies (ICT) in nursing practice to meet quality-, security- and efficiency-related demands. Although ICT is integrated with nursing practices, nurses do not always feel that they are convenient to use it. We need to improve our knowledge of the role of ICT in healthcare environments and so we decided to complement existing experience of how ICT influences nursing practice. This study aimed to review and synthesise the available literature on the role of ICT in nursing practice in Swedish healthcare settings. To consolidate previous studies based on diverse methodologies, an integrative literature review was carried out. Three databases were used to search for literature, 20 articles met the inclusion criteria. The literature review indicates that ICT integration into nursing practice is a complex process that impacts nurses' communication and relationships in patient care, working conditions, and professional identities and development. Nurses are found to express ambiguous views on ICT as a usable service in their everyday practice since it impacts both positively and negatively. Although ICT cannot replace physical presence, it can be considered a complementary service that gives rise to improved patient care. However, nonverbal communication cues may be missed when ICT is used as mediating tool and ICT can be limiting because it is not always designed to meet nurse and patient needs. The meaning of an encounter appears to change when ICT is used in nursing practice, not only for patient relationships but also for interpersonal communication. © 2016 Nordic College of Caring Science.

Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management.

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Öberg, Ulrika; Orre, Carl Johan; Isaksson, Ulf; Schimmer, Robyn; Larsson, Håkan; Hörnsten, Åsa

2017-09-28

Nurses have expressed doubts about the ongoing digitalisation of Swedish primary health care. Given the potential role of eHealth in primary health care, including supporting interactive self-management for people with chronic conditions, it is important to highlight nurses' experiences. This study is part of a larger project aimed at implementing person-centred interactive self-management support (iSMS) in primary health care. The aim of this study was to describe Swedish primary healthcare nurses' perceptions of using digital eHealth systems and services to support patient self-management. Focus group interviews were conducted with primary healthcare nurses (n = 20). The interview transcriptions were analysed using qualitative content analysis. Three themes emerged from the content analysis: caregiving in the midst of digital chaos; a lack of overview and control in daily work; and mixed feelings towards digitalisation. Each theme was subdivided into three subthemes. The results of this study provide insight into a number of concerns that stand in the way of success when it comes to the implementation and use of digital technology. If nurses are to adapt to the new policies and practices that accompany the current digitalised development in Swedish primary health care, the concept of a nurse's traditional work role needs to be amended in terms of the scope of work tasks and established views of traditional nursing. The study also highlights the need for more research to enable eHealth systems/services to be designed to fulfil multiple requirements. The digitised systems should be a tool for achieving good quality self-management support as well as giving the primary healthcare nurses adequate resources to support patients' self-management while still maintaining the values associated with person-centred care. © 2017 Nordic College of Caring Science.

The Burnout on Nurses in ICU, Emergency and Surgery at Teaching Hospital Mazandaran University of Medical Sciences and Relationship with Perceived Stress

OpenAIRE

MK Fakhri; A Aslipoor

2015-01-01

Abstract Introduction: Nursing Profession is stressful and the stress of the job, it will eventually cause burnout but people's different perception of stressful event can adjust this relation. The purpose of study is to assessment burnout on nurses in ICU, emergency and surgical and relationship with perceived stress. Methods: This is a descriptive analytically cross-sectional study. The population of study were all male and female nurses who are working in 4 teaching hospitals which ...

The Staff Nurse Clinical Leader at the Bedside: Swedish Registered Nurses’ Perceptions

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Inga E. Larsson

2016-01-01

Full Text Available Registered nurses at the bedside are accountable for and oversee completion of patient care as well as directly leading and managing the provision of safe patient care. These nurses have an informal leadership role that is not associated with any given position. Leadership is a complex and multifaceted concept and its meaning is unclear, especially in the staff nurse context. The aim was to describe registered nurses’ perceptions of what it entails to be the leader at the bedside in inpatient physical care. A phenomenographic approach was employed. Interviews were performed with Swedish registered nurses (n=15. Five descriptive categories were identified: demonstrating clinical knowledge, establishing a good atmosphere of collaboration, consciously structuring the work in order to ensure patients’ best possible nursing care, customized presence in the practical work with patients according to predetermined prerequisites, and monitoring coworkers’ professional practice. Registered nurses informal role as leader necessitates a social process of deliberate effort to attain and maintain leader status and authority. Participants used deliberate communicative approaches and interactive procedures. Leader principles grounded in the core values of the nursing profession that ensure nursing values and person-centered attributes were a key aspect.

Perceived Nonbeneficial Treatment of Patients, Burnout, and Intention to Leave the Job Among ICU Nurses and Junior and Senior Physicians.

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Schwarzkopf, Daniel; Rüddel, Hendrik; Thomas-Rüddel, Daniel O; Felfe, Jörg; Poidinger, Bernhard; Matthäus-Krämer, Claudia T; Hartog, Christiane S; Bloos, Frank

2017-03-01

Perceiving nonbeneficial treatment is stressful for ICU staff and may be associated with burnout. We aimed to investigate predictors and consequences of perceived nonbeneficial treatment and to compare nurses and junior and senior physicians. Cross-sectional, multicenter paper-pencil survey on personal and work-related characteristics, perceived nonbeneficial treatment, burnout, and intention to leave the job. Convenience sample of 23 German ICUs. ICU nurses and physicians. None. A total of 847 questionnaires were returned (51% response); 778 had complete data for final multivariate analyses. Nonbeneficial treatment was in median perceived "sometimes." Adjusted for covariates, it was perceived more often by nurses and junior physicians (both p ≤ 0.001 in comparison to senior physicians), while emotional exhaustion was highest in junior physicians (p ≤ 0.015 in comparison to senior physicians and nurses), who also had a higher intention to leave than nurses (p = 0.024). Nonbeneficial treatment was predicted by high workload and low quality collaboration with other departments (both p ≤ 0.001). Poor nurse-physician collaboration predicted perception of nonbeneficial treatment among junior physicians and nurses (both p ≤ 0.001) but not among senior physicians (p = 0.753). Nonbeneficial treatment was independently associated with the core burnout dimension emotional exhaustion (p ≤ 0.001), which significantly mediated the effect between nonbeneficial treatment and intention to leave (indirect effect: 0.11 [95% CI, 0.06-0.18]). Perceiving nonbeneficial treatment is related to burnout and may increase intention to leave. Efforts to reduce perception of nonbeneficial treatment should improve the work environment and should be tailored to the different experiences of nurses and junior and senior physicians.

Caregiving to patients who are culturally diverse by Swedish last-year nursing students.

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Lundberg, Pranee C; Bäckström, Josefin; Widén, Sarah

2005-07-01

With Leininger's theory of cultural care diversity and universality as a framework, the aim of this study was to describe Swedish last-year nursing students' experiences of caregiving to patients who are culturally diverse. The students participated voluntarily, 107 by completing a questionnaire with open-ended questions and 15 by participating in in-depth semistructured interviews. Three categories of experience were identified by use of qualitative method, namely, cultural awareness, cultural insufficiency, and cultural curiosity. The students were found to be on the level of Leininger's first phase of transcultural knowledge. It is concluded that cultural sensitivity should be promoted by integrating transcultural concepts into the curricula on all levels of nursing education and by offering special courses on transcultural nursing to nursing students and health care providers.

Using Gamification Combined with Indoor Location to Improve Nurses' Hand Hygiene Compliance in an ICU Ward.

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Lapão, Luís Velez; Marques, Rita; Gregório, João; Pinheiro, Fernando; Póvoa, Pedro; Mira da Silva, Miguel

2016-01-01

Healthcare acquired infections are among the biggest unsolved problems in healthcare, implying an increasing number of deaths, extra-days of hospital stay and hospital costs. Performing hand hygiene is a simple and inexpensive prevention measure, but healthcare workers compliance with it is still far from optimal. Recognized hurdles are lack of time, forgetfulness, wrong technique and lack of motivation. This study aims at exploring gamification to promote nurses' HH compliance self-awareness and action. Real-time data collected from an indoor location system will provide feedback information to a group of nurses working in an ICU ward. In this paper both the research's motivation and methods is presented, along with the first round of results and its discussion.

Monitoring costs in the ICU: a search for a pertinent methodology.

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Reis Miranda, D; Jegers, M

2012-10-01

Attempts to determine costs in the intensive care unit (ICU) were not successful until now, as they failed to detect differences of costs between patients. The methodology and/or the instruments used might be at the origin of this failure. Based on the results of the European ICUs studies and on the descriptions of the activities of care in the ICU, we gathered and analysed the relevant literature concerning the monitoring of costs in the ICU. The aim was to formulate a methodology, from an economic perspective, in which future research may be framed. A bottom-up microcosting methodology will enable to distinguish costs between patients. The resulting information will at the same time support the decision-making of top management and be ready to include in the financial system of the hospital. Nursing staff explains about 30% of the total costs. This relation remains constant irrespective of the annual nurse/patient ratio. In contrast with other scoring instruments, the nursing activities score (NAS) covers all nursing activities. (1) NAS is to be chosen for quantifying nursing activities; (2) an instrument for measuring the physician's activities is not yet available; (3) because the nursing activities have a large impact on total costs, the standardisation of the processes of care (following the system approach) will contribute to manage costs, making also reproducible the issue of quality of care; (4) the quantification of the nursing activities may be the required (proxy) input for the automated bottom-up monitoring of costs in the ICU. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

Influence of Emotion Management on ICU Nurses' Experience of Practice Environment%情绪管理对ICU护士执业环境感受的影响研究

Institute of Scientific and Technical Information of China (English)

林周; 郑超

2016-01-01

目的将情绪管理手段运用到现有的ICU管理中，通过测量ICU护士执业环境感受的变化，探讨情绪管理对ICU护士执业环境感受的影响，从而为临床护理管理实践提供参考。方法2014年10月至2015年4月，对本院106名ICU护士实施情绪管理，并采用护理人员执业环境感受问卷在实施情绪管理前后进行测评。结果实施情绪管理后，ICU护士执业环境感受较之前有所提高（116.01±10.294），差异具有统计学意义（P0.05）。结论实施情绪管理对ICU护士执业环境的评价具有积极、正向的作用，可以帮助ICU护士正确面对周围环境，并采取有效的应对措施进行情感抒发，增进上下级的沟通和信任，提升个人学习水平和业务能力。%Objective Through applying emotional management methods to ICU management and measuring ICU nurses' experience of practice environment, discussed the effect of emotional management on ICU nurses' experience of practice environment so as to provide a practical reference for clinical nursing management.Methods From April 2014 to October 2015, 106 ICU nurses in the 2nd Affiliated Hospital of Wenzhou Medical University were implemented with emotional management. The nurses took practice environment perception questionnaire before and after the implementation of emotion management.Results After the implementation of emotion management, ICU nurses' experience of practice environment increased compared with that before (116.01±10.294) with statistical difference (P 0.05).Conclusion Implementation of emotional management has positive role for evaluation of ICU nurses' comments on practice environment, which is conductive for them to facing the surroundings and taking effective measures to deal with their emotion problems. It could enhance on the communication and trust between nurses and their leaders and improved their professional proficiency and learning ability.

Metaphorical expressions used in Swedish news media narratives to portray the shortage of nurses and their working conditions.

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Blomberg, Helena; Stier, Jonas

2016-02-01

The aim of the study is to uncover and reveal how nurses as a profession and their working conditions are dramatized and portrayed in Swedish media narratives about the shortage of nurses. The media is an arena where stakeholders can air their views of the healthcare sector in general and the situation for nurses in particular. The focus in this study is the debate in Sweden on the shortage of nurses. Qualitative discursive study. A discourse analysis of media narratives about nurses and their working conditions published in several Swedish newspapers from 2009-2014. 1779 articles were included in the study. A selection (113 articles) of these articles was further analysed using a qualitative discursive psychological approach. Nurses are portrayed as being good, concerned about and critical of healthcare managers and politicians for not taking action. The accused actors justify their actions by partially accepting or displacing responsibility. The shortage of nurses is framed as a social problem - a threat to patients' safety. Seven different types of metaphorical expression frame the problem as inevitable, beyond control, abstract, an individual and collegial problem and nurses as replaceable. In addition, nurses and patients are dehumanized and no-one is held responsible. This study analyses the role of the media in emphasizing the seriousness or obscurity of the problem and possible solutions to it. Alternative narratives are needed to re-frame the nursing shortage and to find sustainable solutions. © 2015 John Wiley & Sons Ltd.

Measuring tele-ICU impact: does it optimize quality outcomes for the critically ill patient?

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Goran, Susan F

2012-04-01

To determine the relationship between tele-ICU (intensive care unit) implementations and improvement in quality measures and patient outcomes. Tele-ICUs were designed to leverage scarce critical-care experts and promised to improve patient quality. Abstracts and peer-reviewed articles were reviewed to identify the associations between tele-ICU programmes and clinical outcomes, cost savings, and customer satisfaction. Few peer-reviewed studies are available and many variables in each study limit the ability to associate study conclusions to the overall tele-ICU programme. Further research is required to explore the impact of the tele-ICU on patient/family satisfaction. Research findings are highly dependent upon the level of ICU acceptance. The tele-ICU, in collaboration with the ICU team, can be a valuable tool for the enhancement of quality goals although the ability to demonstrate cost savings is extremely complex. Studies clearly indicate that tele-ICU nursing vigilance can enhance patient safety by preventing potential patient harm. Nursing managers and leaders play a vital part in optimizing the quality role of the tele-ICU through supportive modelling and the maximization of ICU integration. © 2012 Blackwell Publishing Ltd.

The Nurse Watch: Design and Evaluation of a Smart Watch Application with Vital Sign Monitoring and Checklist Reminders.

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Bang, Magnus; Solnevik, Katarina; Eriksson, Henrik

Computerized wearable devices such as smart watches will become valuable nursing tools. This paper describes a smart-watch system developed in close collaboration with a team of nurses working in a Swedish ICU. The smart-watch system provides real-time vital-sign monitoring, threshold alarms, and to-do reminders. Additionally, a Kanban board, visualized on a multitouch screen provides an overview of completed and upcoming tasks. We describe an approach to implement automated checklist systems with smart watches and discuss aspects of importance when implementing such memory and attention support. The paper is finalized with an in-development formative evaluation of the system.

Relationship between TISS and ICU cost.

Science.gov (United States)

Dickie, H; Vedio, A; Dundas, R; Treacher, D F; Leach, R M

1998-10-01

To determine whether the therapeutic intervention scoring system (TISS) reliably reflects the cost of the overall intensive care unit (ICU) population, subgroups of that population and individual ICU patients. Prospective analysis of individual patient costs and comparison with TISS. Adult, 12 bedded general medical and surgical ICU in a university teaching hospital. Two hundred fifty-seven consecutive patients including 52 coronary care (CCU), 99 cardiac surgery (CS) and 106 general ICU (GIC) cases admitted to the ICU during a 12-week period in 1994. A total of 916 TISS-scored patient days were analysed A variable cost (VC) that included consumables and service usage (nursing, physiotherapy, radiology and pathology staff costs) for individual patients was measured daily. Nursing costs were calculated in proportion to a daily nursing dependency score. A fixed cost (FC) was calculated for each patient to include medical, technical and clerical salary costs, capital equipment depreciation, equipment and central hospital costs. The correlation between cost and TISS was analysed using regression analysis. For the whole group (n = 257) the average daily FC was pound sterling 255 and daily VC was pound sterling 541 (SEM 10); range pound sterling 23-pound sterling 2,806. In the patient subgroups average daily cost (FC + VC) for CCU was pound sterling 476 (SEM 17.5), for CS pound sterling 766 (SEM 13.8) and for GIC pound sterling 873 (SEM 13.6). In the group as a whole, a strong correlation was demonstrated between VC and the TISS for each patient day (r = 0.87, p < 0.001) and this improved further when the total TISS score was compared with the total VC of the entire patient episode (r = 0.93, p < 0.001). This correlation was maintained in CCU, CS and GIC patient cohorts with only a small median difference between actual and predicted cost (2.2 % for GIC patients). However, in the individual patient, the range of error was up to +/- 65 % of the true variable cost. For the

How to develop a tele-ICU model?

Science.gov (United States)

Rogove, Herb

2012-01-01

The concept of the tele-ICU (intensive care unit) is about 30 years old and more hospitals are utilizing it to cover multiple hospitals in their system or for hospitals that lack on-site critical care coverage such as in the rural setting. Doing a needs analysis, picking the appropriate committee to oversee development of the correct model, choosing quality metrics to measure, and designing an implementation plan that has a timeline is how the process should begin. Research including visitation to established programs and connecting with professional societies are helpful. Developing both a business and financial plan will optimize the value of a tele-ICU program. The innovative ICU nursing director will help to integrate a telemedicine program seamlessly with the on-site program to insure a successful program that benefits patients, their families, the ICU staff, and the hospital.

Reflexology versus Swedish Massage to Reduce Physiologic Stress and Pain and Improve Mood in Nursing Home Residents with Cancer: A Pilot Trial

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Nancy A. Hodgson

2012-01-01

Full Text Available Objective. The purpose of this pilot study was to investigate and compare the effects of reflexology and Swedish massage therapy on physiologic stress, pain, and mood in older cancer survivors residing in nursing homes. Methods. An experimental, repeated-measures, crossover design study of 18 nursing home residents aged 75 or over and diagnosed with solid tumor in the past 5 years and following completion of cancer treatments. The intervention tested was 20 minutes of Swedish Massage Therapy to the lower extremities, versus 20 minute Reflexology, using highly specified protocols. Pre- and post-intervention levels of salivary cortisol, observed affect, and pain were compared in the Swedish Massage Therapy and Reflexology conditions. Results. Both Reflexology and Swedish Massage resulted in significant declines in salivary cortisol and pain and improvements in mood. Conclusions. Preliminary data suggest that studies of Swedish Massage Therapy and Reflexology are feasible in this population of cancer survivors typically excluded from trials. Both interventions were well tolerated and produced measurable improvements in outcomes. Further research is needed to explore the mechanisms underlying the potential benefits of these CAM modalities in this patient population.

Exploring performance obstacles of intensive care nurses.

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Gurses, Ayse P; Carayon, Pascale

2009-05-01

High nursing workload, poor patient safety, and poor nursing quality of working life (QWL) are major issues in intensive care units (ICUs). Characteristics of the ICU and performance obstacles may contribute to these issues. The goal of this study was to comprehensively identify the performance obstacles perceived by ICU nurses. We used a qualitative research design and conducted semi-structured interviews with 15 ICU nurses of a medical-surgical ICU. Based on this qualitative study and a previously reported quantitative study, we identified seven main types of performance obstacles experienced by ICU nurses. Obstacles related to the physical environment (e.g., noise, amount of space), family relations (e.g., distractions caused by family, lack of time to spend with family), and equipment (e.g., unavailability, misplacement) were the most frequently experienced performance obstacles. The qualitative interview data provided rich information regarding the factors contributing to the performance obstacles. Overall, ICU nurses experience a variety of performance obstacles in their work on a daily basis. Future research is needed to understand the impact of performance obstacles on nursing workload, nursing QWL, and quality and safety of care.

Association between burnout syndrome, harmful use of alcohol and smoking in nursing in the ICU of a university hospital.

Science.gov (United States)

Fernandes, Larissa Santi; Nitsche, Maria José Trevizani; Godoy, Ilda de

2018-01-01

The article aims to determine the presence of burnout syndrome among professionals in the field of Nursing in the Intensive Care Unit in a university hospital and a possible association with consumption of alcohol and tobacco. Participants were 160 nursing professionals from 04 intensive care unit of a university hospital in the period from March 2013 to February 2014. We used a structured questionnaire, plus the smoking history, Maslach Burnout Inventory, Alcohol Use Disorders Identification Test, Fagerström Dependence Questionnaire and the measurement of carbon monoxide. We used Fisher's chi-square or Fisher exact test. Syndrome was found in 34 professionals, most of them female, married and young adults. 18 professionals reported being smokers. 6,4% of Nursing Assistants, 50% Practical Nurses and Nurses 71,4% drank moderate; 5,4% Nursing Assistant and 14,3% Nurses scored default risk drinking and only 01 Practical Nurses had possible alcohol dependence. There was a positive association of the syndrome with smoking in 01 ICU. Final considerations: Hospital Intensive Care services need assistance from the managers of services for the purpose of caring for the health of their caregivers.

Privacy at end of life in ICU: A review of the literature.

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Timmins, Fiona; Parissopoulos, Stelios; Plakas, Sotirios; Naughton, Margaret T; de Vries, Jan Ma; Fouka, Georgia

2018-06-01

To explore the issues surrounding privacy during death in ICU. While the provision of ICU care is vital, the nature and effect of the potential lack of privacy during death and dying in ICUs have not been extensively explored. A literature search using CINAHL and Pubmed revealed articles related to privacy, death and dying in ICU. Keywords used in the search were "ICU," "Privacy," "Death" and "Dying." A combination of these terms using Boolean operators "or" or "and" revealed a total of 23 citations. Six papers were ultimately deemed suitable for inclusion in the review and were subjected to code analysis with Atlas.ti v8 QDA software. The analysis of the studies revealed eight themes, and this study presents the three key themes that were found to be recurring and strongly interconnected to the experience of privacy and death in ICU: "Privacy in ICU," "ICU environment" and "End-of-Life Care". Research has shown that patient and family privacy during the ICU hospitalisation and the provision of the circumstances that lead to an environment of privacy during and after death remains a significant challenge for ICU nurses. Family members have little or no privacy in shared room and cramped waiting rooms, while they wish to be better informed and involved in end-of-life decisions. Hence, death and dying for many patients takes place in open and/or shared spaces which is problematic in terms of both the level of privacy and respect that death ought to afford. It is best if end-of-life care in the ICU is planned and coordinated, where possible. Nurses need to become more self-reflective and aware in relation to end-of-life situations in ICU in order to develop privacy practices that are responsive to family and patient needs. © 2018 John Wiley & Sons Ltd.

Effect of therapeutic Swedish massage on anxiety level and vital signs of Intensive Care Unit patients.

Science.gov (United States)

Alves da Silva, Tatiana; Stripari Schujmann, Debora; Yamada da Silveira, Leda Tomiko; Caromano, Fátima Aparecida; Fu, Carolina

2017-07-01

To evaluate how Swedish massage affects the level of anxiety and vital signs of Intensive Care Unit (ICU) patients. Quasi-experimental study. ICU patients, 18-50 years old, cooperative, respiratory and hemodynamic stable, not under invasive mechanical ventilation. allergic to massage oil, vascular or orthopedic post-operative, skin lesions, thrombosis, fractures. A 30-min Swedish massage was applied once. arterial pressure, heart rate, respiratory rate, S-STAI questionnaire. Timing of evaluation: pre-massage, immediately post-massage, 30 min post-massage. Comparison: T-test, corrected by Bonferroni method, level of significance of 5%, confidence interval of 95%. 48 patients included, 30 (62.5%) female, mean age 55.46 (15.70) years old. Mean S-STAI pre-massage: 42.51 (9.48); immediately post-massage: 29.34 (6.37); 30 min post-massage: 32.62 (8.56), p < 0.001 for all comparison. Mean vital signs achieved statistical significance between pre-massage and immediately post-massage. Swedish massage reduced anxiety of ICU patients immediately and 30 min post-massage. Vital signs were reduced immediately post-massage. Copyright © 2016 Elsevier Ltd. All rights reserved.

Using Chest Vibration Nursing Intervention to Improve Expectoration of Airway Secretions and Prevent Lung Collapse in Ventilated ICU Patients: A Randomized Controlled Trial

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Yu-Chih Chen

2009-06-01

Conclusion: The results suggest that chest vibration may contribute to expectoration and thus improve lung collapse among ventilated patients in an ICU. Chest vibration nursing intervention is a safe and effective alternative pulmonary clearance method and can be used on patients who are on ventilators in ICUs.

Use of Augmentative and Assistive Communication Strategies by Family Members in the ICU

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Broyles, Lauren M.; Tate, Judith A.; Happ, Mary Beth

2013-01-01

Background Very little is known about patient-family communication during critical illness and mechanical ventilation in the intensive care unit (ICU), including the use of augmentative and alternative communication (AAC) tools and strategies during patient-family communication. Objectives The study objectives were to identify (1) which AAC tools families use with nonspeaking ICU patients and how they are used, and (2) what families and nurses say about patient-family communication with nonspeaking patients in the ICU. Methods A qualitative secondary analysis was conducted of existing data from a clinical trial testing interventions to improve nurse-patient communication in the ICU. Narrative study data (field notes, intervention logs, nurse interviews) from 127 critically ill adults were reviewed for evidence of family involvement with AAC tools. Qualitative content analysis was applied for thematic description of family and nurse accounts of patient-family communication. Results Family involvement with AAC tools was evident in 44% (n= 41/93) of the patients completing the parent study protocol. Spouses/significant others communicated with patients most often. Writing was the most frequently used tool. Main themes describing patient-family communication included: (1) Families as unprepared and unaware; (2) Family perceptions of communication effectiveness; (3) Nurses deferring to or guiding patient-family communication; (4) Patient communication characteristics; and (5) Family experience and interest with AAC tools. Conclusions Families are typically unprepared for the communication challenges of critical illness, and often “on their own” in confronting them. Assessment by skilled bedside clinicians can reveal patient communication potential and facilitate useful AAC tools and strategies for patients and families. PMID:22381993

[Integration of a hospital pharmacist in the ICU].

Science.gov (United States)

Moch, C; Pivot, C; Floccard, B; Rimmelé, T; Paillet, C

2014-03-01

The French regulatory system strongly encourages strict regulation of health products' production and distribution, especially concerning risk management and economic aspects. An ICU is an unusual environment for a local pharmacy practice (a nurse for every 2.5 patients, continuous adaptation of therapeutics…). However, a literature review reports interesting data concerning risk management and economics. This article aims to relate the experience of a pharmacist integration in a French teaching hospital ICU (half-time position). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

PENGETAHUAN DAN SIKAP PERAWAT TENTANG MOBILISASI DINI PASIEN DI ICU RSUD PANEMBAHAN SENOPATI BANTUL YOGYAKARTA

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Muhamat Nofiyanto

2017-04-01

Full Text Available ABSTRACT Background: Early mobilization is necessary in critically ill patients in Intensive Care Unit (ICU to prevent hypovolemia which endangers patient’s life. The role of nurses in early mobilization is important by providing explanations and motivating patients to achieve the purpose of healing. Guidance and intensive intervention from nurses can reduce the recurrence of disease. Objective: To investigate the level of knowledge and attitude of nurses on patients early mobilization in ICU of RSUD Panembahan Senopati Bantul. Method: A descriptive, cross sectional study, was applied on 20 nurses in ICU of RSUD Panembahan Senopati Bantul. Univariate data analysis was administered to characteristics of respondents, knowledge, attitudes, and cross-tabulations. Result: Most of nurses have good level of knowledge (70%, and on attitude domain, most nurses are being supportive (75% in terms of early mobilization to patients. Nurses whose age are 22-35 years old (10%, male (10%, have been working for 1 month up to 5 years (10%, have background of 3 years diploma in nursing (10% fall into poor knowledge category. Similar characteristics contribute to attitude domain where nurses whose age are 22-35 years old (25%, male (15%, have been working for 1 month up to 5 years (25%, have background of 3 years diploma in nursing (35% are placed into unsupportive category. Conclusion: The level of knowledge of nurses on patients early mobilization is in good category where the attitude is in supportive category.

Turnover intention among intensive care unit nurses in Alexandria, Egypt.

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Mosallam, Rasha; Hamidi, Samer; Elrefaay, Manal

2015-06-01

Given the difficulty in recruiting new nurses, it is imperative to retain those already in the profession. This cross-sectional study explored the relationship of demographic and work-related factors, burnout, conflict management and relationship between nurses and physicians on turnover intentions among ICU nurses in eight major hospitals in Alexandria, Egypt. Data on burnout, conflict management, nurse-physician communication, and turnover intention were collected by surveying 100 nurses in eight hospitals in Alexandria governorate. All nurses at the ICU of selected hospitals were approached (n=100) and a 47-item Likert scale questionnaire was administered to explore the factors affecting the turnover intention of ICU nurses in Alexandria. ICU nurses exhibited a mean score for turnover intention of 3.23 (mean score percentage 65.0%). There was a moderately positive statistically significant correlation between turnover intention and emotional exhaustion (r=0.29, Pturnover intention were emotional exhaustion and age. Nurses turnover intention at the ICU of the selected hospitals is high and is significantly associated with nurses' emotional exhaustion, poor nurse-physician communication, and nurses age.

Swedish Child Health Care nurses conceptions of overweight in children: a qualitative study.

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Isma, Gabriella E; Bramhagen, Ann-Cathrine; Ahlstrom, Gerd; Ostman, Margareta; Dykes, Anna-Karin

2012-06-14

Registered Sick Children's Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives childhood obesity. The aim of this study was to elucidate the conceptions of childhood overweight, including obesity, among nurses working in Child Health Care. A qualitative study using a phenomenographic approach, based on open-ended interviews with 18 Child Health Care nurses (CHC-nurses) strategically selected from 17 Child Health Care Centres in the southern part of Sweden. Four categories of description emerged from the data: Perception of childhood overweight changes, Overweight in younger children a neglected concern, Overweight a delicate issue and Importance of family lifestyle. The participating CHC-nurses conceived overweight in children, primarily obesity in children to be an extensive and serious problem which affects children, families and the surrounding society. Overweight in children was further perceived as a consequence of their parent's lifestyle and their awareness of the problem, which was considered by the CHC-nurses as a sensitive and a provoking issue. It was also perceived that overweight in children is not taken seriously during the pre-school period and that concerns regarding overweight in younger children were mainly about the appearance and not the health of the child. The CHC-nurses perceived that the proportion of overweight children has increased, which Swedish society and the CHC-nurses have adapted to. This adaptation makes it difficult for CHC-nurses to define those children who are overweight. CHC-nurses provide a comprehensive and complex picture of childhood overweight, which includes several difficulties dealing with this issue. Attention to CHC-nurse's conceptions of overweight in children is important since it can affect

Family-centered end-of-life care in the ICU.

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Wiegand, Debra L; Grant, Marian S; Cheon, Jooyoung; Gergis, Mary A

2013-08-01

Families of older adults are intricately involved in the end-of-life decision-making process for a family member with a serious illness in the intensive care unit (ICU) setting. However, families are not always as involved and as informed as they would like to be. Creating a culture that assesses family needs and supports families is an important component of family-centered care. There are several strategies that nurses and other members of the interdisciplinary team can use to promote family-centered end-of-life care in the ICU. Nurses can get to know the family by spending time talking with them, assessing them, seeking to understand their perspectives on their family member's condition, and discussing previously verbalized patient wishes for care. This article offers strategies nurses can use to help guide the family through the end-of-life decision-making process, support families as difficult and complex decisions are made in collaboration with the health care team, and prepare families for the dying process. Copyright 2013, SLACK Incorporated.

One-Year Outcome of Geriatric Hip-Fracture Patients following Prolonged ICU Treatment

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Daphne Eschbach

2016-01-01

Full Text Available Purpose. Incidence of geriatric fractures is increasing. Knowledge of outcome data for hip-fracture patients undergoing intensive-care unit (ICU treatment, including invasive ventilatory management (IVM and hemodiafiltration (CVVHDF, is sparse. Methods. Single-center prospective observational study including 402 geriatric hip-fracture patients. Age, gender, the American Society of Anesthesiologists (ASA classification, and the Barthel index (BI were documented. Underlying reasons for prolonged ICU stay were registered, as well as assessed procedures like IVM and CVVHDF. Outcome parameters were in-hospital, 6-month, and 1-year mortality and need for nursing care. Results. 15% were treated > 3 days and 68% 3d cohort were significantly increased (p=0.001. Most frequent indications were cardiocirculatory pathology followed by respiratory failure, renal impairment, and infection. 18% of patients needed CVVHDF and 41% IVM. In these cohorts, 6-month mortality ranged > 80% and 12-month mortality > 90%. 100% needed nursing care after 6 and 12 months. Conclusions. ICU treatment > 3 days showed considerable difference in mortality and nursing care needed after 6 and 12 months. Particularly, patients requiring CVVHDF or IVM had disastrous long-term results. Our study may add one further element in complex decision making serving this vulnerable patient cohort.

Nurses' and physicians' perceptions of Confusion Assessment Method for the intensive care unit for delirium detection

DEFF Research Database (Denmark)

Oxenbøll-Collet, Marie; Egerod, Ingrid; Christensen, Vibeke

2018-01-01

of this study was to identify nurses' and physicians' perceived professional barriers to using the CAM-ICU in Danish ICUs. Methods: This study uses a qualitative explorative multicentre design using focus groups and a semi-structured interview guide. Five focus groups with nurses (n=20) and four with physicians......-ICU screening affected nursing care, clinical judgment and professional integrity; (2) Instrument reliability: nurses and physicians expressed concerns about CAM-ICU assessment in non-sedated patients, patients with multi-organ failure or patients influenced by residual sedatives/opioids; and (3) Clinical...... consequence: after CAM-ICU assessment, physicians lacked evidence-based treatment options, and nurses lacked physician acknowledgment and guidelines for disclosing CAM-ICU results to patients. Conclusion: In this study, ICU nurses and physicians raised a number of concerns regarding the use of the CAM...

Introduction of Tele-ICU in rural hospitals: Changing organisational culture to harness benefits.

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Goedken, Cassie Cunningham; Moeckli, Jane; Cram, Peter M; Reisinger, Heather Schacht

2017-06-01

This study evaluates rural hospital staff perceptions of a telemedicine ICU (Tele-ICU) before and after implementation. We conducted a longitudinal qualitative study utilising semistructured group or individual interviews with staff from three rural ICU facilities in the upper Midwest of the United States that received Tele-ICU support. Interviews occurred pre-implementation and at two time points post-implementation. Interviews were conducted with: ICU administrators (n=6), physicians (n=3), nurses (n=9), respiratory therapists (n=5) and other (n=1) from July 2011 to May 2013. Transcripts were analysed for thematic content. Overall, rural ICU staff viewed Tele-ICU as a welcome benefit for their facility. Major themes included: (1) beneficial where recruitment and retention of staff can be challenging; (2) extra support for day shifts and evening, night and weekend shifts; (3) reduction in the number of transfers larger tertiary hospitals in the community; (4) improvement in standardisation of care; and (5) organisational culture of rural ICUs may lead to under-utilisation. ICU staff at rural facilities view Tele-ICU as a positive, useful tool to provide extra support and assistance. However, more research is needed regarding organisational culture to maximise the potential benefits of Tele-ICU in rural hospitals. Published by Elsevier Ltd.

Swedish Child Health Care nurses conceptions of overweight in children: a qualitative study

Science.gov (United States)

2012-01-01

Background Registered Sick Children’s Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives childhood obesity. The aim of this study was to elucidate the conceptions of childhood overweight, including obesity, among nurses working in Child Health Care. Method A qualitative study using a phenomenographic approach, based on open-ended interviews with 18 Child Health Care nurses (CHC-nurses) strategically selected from 17 Child Health Care Centres in the southern part of Sweden. Results Four categories of description emerged from the data: Perception of childhood overweight changes, Overweight in younger children a neglected concern, Overweight a delicate issue and Importance of family lifestyle. The participating CHC-nurses conceived overweight in children, primarily obesity in children to be an extensive and serious problem which affects children, families and the surrounding society. Overweight in children was further perceived as a consequence of their parent’s lifestyle and their awareness of the problem, which was considered by the CHC-nurses as a sensitive and a provoking issue. It was also perceived that overweight in children is not taken seriously during the pre-school period and that concerns regarding overweight in younger children were mainly about the appearance and not the health of the child. The CHC-nurses perceived that the proportion of overweight children has increased, which Swedish society and the CHC-nurses have adapted to. This adaptation makes it difficult for CHC-nurses to define those children who are overweight. Conclusion CHC-nurses provide a comprehensive and complex picture of childhood overweight, which includes several difficulties dealing with this issue. Attention to CHC-nurse’s conceptions of overweight in

Assessment of delirium in ICU patients : A literature review

NARCIS (Netherlands)

Lisette Schoonhoven; Peter Pickkers; Mark van den Boogaard

2010-01-01

A psycho-organic disorder such as delirium is a frequently occurring and serious disorder especially on Intensive Care units. Nowadays, more attention is paid to this problem by physicians, nurses and by researchers, but assessment of delirium in all ICU patients is still not common practice. If

Editor's Choice - Prolonged ICU Length of Stay after AAA Repair: Analysis of Time Trends and Long-term Outcome.

Science.gov (United States)

Gavali, H; Mani, K; Tegler, G; Kawati, R; Covaciu, L; Wanhainen, A

2017-08-01

The aim of the study was to investigate the frequency and outcome of prolonged intensive care unit (ICU) length of stay (LOS) after abdominal aortic aneurysm (AAA) repair in the endovascular era. All patients operated on for AAA between 1999 and 2013 at Uppsala University hospital were identified. Data were retrieved from the Swedish Vascular registry, the Swedish Intensive Care registry, the National Population registry, and case records. Prolonged ICU LOS was defined as ≥ 48 h during the primary hospital stay. Patients surviving ≥ 48 h after AAA surgery were included in the analysis. A total of 725 patients were identified, of whom 707 (97.5%) survived ≥ 48 h; 563 (79.6%) underwent intact AAA repair and 144 (20.4%) ruptured AAA repair. A total of 548 patients (77.5%) required AAA repairs in 1999 to 7.3% in 2013 (p < .001) whereas the use of endovascular aortic repair (EVAR) increased from 6.9% in 1999 to 78.0% in 2013 (p < .001). The 30 day survival rate was 98.2% for those with < 48 h ICU stay versus 93.0% for 2-6 days versus 81.8% for ≥ 7 days (p < .001); the corresponding 90 day survival was 97.1% versus 86.1% versus 63.6% (p < .001) respectively. For patients surviving 90 days after repair, there was no difference in long-term survival between the groups. During the period of progressively increasing use of EVAR, a simultaneous significant reduction in frequency of prolonged ICU LOS occurred. Although prolonged ICU LOS was associated with a high short-term mortality, long-term outcome among those surviving the initial 90 days was less affected. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Correlation between workplace and occupational burnout syndrome in nurses.

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Ahmadi, Omid; Azizkhani, Reza; Basravi, Monem

2014-01-01

This study was conducted to determine the effect of nurses' workplace on burnout syndrome among nurses working in Isfahan's Alzahra Hospital as a reference and typical university affiliated hospital, in 2010. In this cross-sectional study, 100 nurses were randomly selected among those working in emergency, orthopedic, dialysis wards and intensive care unit (ICU). Required data on determination of occupational burnout rate among the nurses of these wards were collected using Maslach Burnout Inventory (MBI) standard and validated questionnaire. Nurses were selected using simple random sampling. The multivariate ANOVA analysis showed that occupational burnout mean values of nurses working in orthopedic and dialysis wards were significantly less than those of nurses working in emergency ward and ICU (P = 0.01). There was also no significant difference between occupational burnout mean values of nurses working in emergency ward and ICU (P > 0.05). t-test showed that there was a difference between occupational burnout values of men and women, as these values for women were higher than those of men (P = 0.001). Results showed that occupational burnout mean values of nurses working in emergency ward and ICU were significantly more than those of nurses working in orthopedic and dialysis wards.

综合性护理对ICU患儿应激程度及家长满意度的影响%Effect of comprehensive nursing care on the stress of chiIdren in ICU and satisfaction of their parents

Institute of Scientific and Technical Information of China (English)

薛焕芹

2014-01-01

目的：探讨综合性护理对ICU患儿应激程度及家长满意度的影响。方法：将ICU 60例患儿随机分为观察组和对照组各30例，对照组采用常规护理，观察组采用综合性护理；比较两组患儿的护理效果。结果：观察组应激性高血糖的发生率低于对照组，血糖恢复正常的时间、危重病情好转时间、ICU停留时间均短于对照组，病死率显著低于对照组，昏迷的疗效高于对照组（ P%Objective:To investigate the effect of comprehensive nursing care on the stress of children in ICU and satisfaction of their parents. Methods:60 children in ICU were randomly divided into the observation group and the control group(30 cases in each group). The routine nursing care was taken in the control group and the comprehensive nursing care was adopted in the observation group. The nursing effects were compared between the two groups. Results:The incidence of stress hyperglycemia was less,the time of blood glucose returned to normal and the length of stay in ICU was shorter,the improvement of critical conditions of the children and the curative effect of coma was better and the fatality rate was significantly lower in the observation group than the control group(P﹤0. 05);the satisfaction rate of the parents with nursing care was higher in the observation group than the control group(P﹤0. 05). Conclusion:The comprehen-sive nursing care can reduce the stress level of children in ICU,promote the improvement of conditions of the children,decrease the fatality rate and improve the satisfaction of their parents.

Correlation between workplace and occupational burnout syndrome in nurses

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Omid Ahmadi

2014-01-01

Full Text Available Background: This study was conducted to determine the effect of nurses′ workplace on burnout syndrome among nurses working in Isfahan′s Alzahra Hospital as a reference and typical university affiliated hospital, in 2010. Materials and Methods: In this cross-sectional study, 100 nurses were randomly selected among those working in emergency, orthopedic, dialysis wards and intensive care unit (ICU. Required data on determination of occupational burnout rate among the nurses of these wards were collected using Maslach Burnout Inventory (MBI standard and validated questionnaire. Nurses were selected using simple random sampling. Results: The multivariate ANOVA analysis showed that occupational burnout mean values of nurses working in orthopedic and dialysis wards were significantly less than those of nurses working in emergency ward and ICU (P0 = 0.01. There was also no significant difference between occupational burnout mean values of nurses working in emergency ward and ICU ( P > 0.05. t-test showed that there was a difference between occupational burnout values of men and women, as these values for women were higher than those of men (P = 0.001. Conclusion: Results showed that occupational burnout mean values of nurses working in emergency ward and ICU were significantly more than those of nurses working in orthopedic and dialysis wards.

Implementation of ICU palliative care guidelines and procedures: a quality improvement initiative following an investigation of alleged euthanasia.

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Kuschner, Ware G; Gruenewald, David A; Clum, Nancy; Beal, Alice; Ezeji-Okoye, Stephen C

2009-01-01

Ethical conflicts are commonly encountered in the course of delivering end-of-life care in the ICU. Some ethical concerns have legal dimensions, including concerns about inappropriate hastening of death. Despite these concerns, many ICUs do not have explicit policies and procedures for withdrawal of life-sustaining treatments. We describe a US Office of Inspector General (OIG) investigation of end-of-life care practices in our ICU. The investigation focused on care delivered to four critically ill patients with terminal diseases and an ICU nurse's concern that the patients had been subjected to euthanasia. The OIG investigation also assessed the validity of allegations that patient flow in and out of our ICU was inappropriately influenced by scheduled surgeries and that end-of-life care policies in our ICU were not clear. Although the investigation did not substantiate the allegations of euthanasia or inappropriate ICU patient flow, it did find that the policies that discuss end-of-life care issues were not clear and allowed for wide-ranging interpretations. Acting on the OIG recommendations, we developed a quality improvement initiative addressing end-of-life care in our ICU, intended to enhance communication and understanding about palliative care practices in our ICU, to prevent ethical conflicts surrounding end-of-life care, and to improve patient care. The initiative included the introduction of newly developed ICU comfort care guidelines, a physician order set, and a physician template note. Additionally, we implemented an educational program for ICU staff. Staff feedback regarding the initiative has been highly favorable, and the nurse whose concerns led to the investigation was satisfied not only with the investigation but also the policies and procedures that were subsequently introduced in our ICU.

Evaluation of an integrated graphical display to promote acute change detection in ICU patients

Science.gov (United States)

Anders, Shilo; Albert, Robert; Miller, Anne; Weinger, Matthew B.; Doig, Alexa K.; Behrens, Michael; Agutter, Jim

2012-01-01

Objective The purpose of this study was to evaluate ICU nurses’ ability to detect patient change using an integrated graphical information display (IGID) versus a conventional tabular ICU patient information display (i.e. electronic chart). Design Using participants from two different sites, we conducted a repeated measures simulator-based experiment to assess ICU nurses’ ability to detect abnormal patient variables using a novel IGID versus a conventional tabular information display. Patient scenarios and display presentations were fully counterbalanced. Measurements We measured percent correct detection of abnormal patient variables, nurses’ perceived workload (NASA-TLX), and display usability ratings. Results 32 ICU nurses (87% female, median age of 29 years, and median ICU experience of 2.5 years) using the IGID detected more abnormal variables compared to the tabular display [F (1,119)=13.0, p < 0.05]. There was a significant main effect of site [F (1, 119)=14.2], with development site participants doing better. There were no significant differences in nurses’ perceived workload. The IGID display was rated as more usable than the conventional display, [F (1, 60)=31.7]. Conclusion Overall, nurses reported more important physiological information with the novel IGID than tabular display. Moreover, the finding of site differences may reflect local influences in work practice and involvement in iterative display design methodology. Information displays developed using user-centered design should accommodate the full diversity of the intended user population across use sites. PMID:22534099

Developing a Mobility Protocol for Early Mobilization of Patients in a Surgical/Trauma ICU

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Meg Zomorodi

2012-01-01

Full Text Available As technology and medications have improved and increased, survival rates are also increasing in intensive care units (ICUs, so it is now important to focus on improving the patient outcomes and recovery. To do this, ICU patients need to be assessed and started on an early mobility program, if stable. While the early mobilization of the ICU patients is not without risk, the current literature has demonstrated that patients can be safely and feasibly mobilized, even while requiring mechanical ventilation. These patients are at a high risk for muscle deconditioning due to limited mobility from numerous monitoring equipment and multiple medical conditions. Frequently, a critically ill patient only receives movement from nurses; such as, being turned side to side, pulled up in bed, or transferred from bed to a stretcher for a test. The implementation of an early mobility protocol that can be used by critical care nurses is important for positive patient outcomes minimizing the functional decline due to an ICU stay. This paper describes a pilot study to evaluate an early mobilization protocol to test the safety and feasibility for mechanically ventilated patients in a surgical trauma ICU in conjunction with the current unit standards.

Survey of Extent of Translation of Oral Healthcare Guidelines for ICU Patients into Clinical Practice by Nursing Staff

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Vivek Agarwal

2017-01-01

Full Text Available Nosocomial infections in critically ill/ventilated patients result from bacterial load in oropharyngeal regions. Oral decontamination serves as the easiest effective means of controlling infections. Knowledge, attitude, and practices followed by healthcare personnel in intensive care settings need to be assessed to implement concrete measures in health-care. Survey questionnaire was constructed and implemented following its validation on seventy nursing and paramedical staff working in government and private intensive care units throughout Lucknow city. 21-item questionnaire consisted of three parts of seven questions each. 78% of respondents had knowledge regarding oral care and its importance in critical settings but 44% of respondents considered it to be unpleasant task. 36% of respondents claimed to have provided oral care to all patients in ICU. Uniform guidelines for translation of oral healthcare in ICU settings are not being implemented. Previous studies in literature from various geographic diverse regions also point out to similar lacunae. Based on present survey, most respondents were aware of importance of oral care with protocols covered in academic curriculum. Attitude towards oral care is positive but respondents feel a need for specialised training. Practice for oral care is not sufficient and needs improvement and proper implementation.

Interprofessional collaboration in the ICU: how to define?

Science.gov (United States)

Rose, Louise

2011-01-01

The intensive care unit (ICU) is a dynamic, complex and, at times, highly stressful work environment that involves ongoing exposure to the complexities of interprofessional team functioning. Failures of communication, considered examples of poor collaboration among health care professionals, are the leading cause of inadvertent harm across all health care settings. Evidence suggests effective interprofessional collaboration results in improved outcomes for critically ill patients. One recent study demonstrated a link between low standardized mortality ratios and self-identified levels of collaboration. The aim of this paper is to discuss determinants and complexities of interprofessional collaboration, the evidence supporting its impact on outcomes in the ICU, and interventions designed to foster better interprofessional team functioning. Elements of effective interprofessional collaboration include shared goals and partnerships including explicit, complementary and interdependent roles; mutual respect; and power sharing. In the ICU setting, teams continually alter due to large staff numbers, shift work and staff rotations through the institution. Therefore, the ideal 'unified' team working together to provide better care and improve patient outcomes may be difficult to sustain. Power sharing is one of the most complex aspects of interprofessional collaboration. Ownership of specialized knowledge, technical skills, clinical territory, or even the patient, may produce interprofessional conflict when ownership is not acknowledged. Collaboration by definition implies interdependency as opposed to autonomy. Yet, much nursing literature focuses on achievement of autonomy in clinical decision-making, cited to improve job satisfaction, retention and patient outcomes. Autonomy of health care professionals may be an inappropriate goal when striving to foster interprofessional collaboration. Tools such as checklists, guidelines and protocols are advocated, by some, as ways

Burnout syndrome indices in Greek intensive care nursing personnel.

Science.gov (United States)

Karanikola, Maria N K; Papathanassoglou, Elizabeth D E; Mpouzika, Meropi; Lemonidou, Chrysoula

2012-01-01

Burnout symptoms in Greek intensive care unit (ICU) nurses have not been explored adequately. The aim of this descriptive, correlational study was to investigate the prevalence and intensity of burnout symptoms in Greek ICU nursing personnel and any potential associations with professional satisfaction, as well as with demographic, educational, and vocational characteristics. Findings showed that the overall burnout level reported by Greek ICU nursing personnel was at a moderate to high degree. The most pronounced symptom of burnout was depersonalization, whereas emotional exhaustion was found to be a strong predictor of job satisfaction. This is a factor connected with the nurses' intention to quit the job. It appears that work factors have a more powerful influence over the development of burnout in comparison to personality traits.

The changing nature of ICU charge nurses' decision making: from supervision of care delivery to unit resource management.

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Miller, Anne; Buerhaus, Peter I

2013-01-01

Recent findings that variations in nursing workload may affect inpatient outcomes now highlight nurse workload management and the need for an updated analysis of the role of the charge nurse (CN). Observational data for eight CNs, each at one of eight ICUs in a not-for-profit Level 1 Trauma Center, coded to capture interprofessional interactions, decision making, team coordination phases, and support tools. A researcher shadowed each participant for 12 hours. Each shift began and ended with a face-to-face handoff that included summaries of each patient's condition; the current bed census; anticipated admissions, discharges, and transfers; and the number of nurses available to work the current and coming two shifts. The researcher, using a notebook, recorded the substantive content of all work conversations initiated by or directed to the CN from physicians, staff nurses, allied health workers, other employees, and patients/families. The tools used to support conversations were collected as blank forms or computer screen prints and annotated to describe how they were used, when, and for what purpose. Statistically significant three-way interactions suggest that CNs' conversations with colleagues depend on the team coordination phase and the decision-making level, and that the support tools that CNs use when talking to colleagues depend on the decision-making level and the team coordination phase. The role of ICU CNs appears to be continuing to evolve, now encompassing unit resource management in addition to supervising care delivery. Effective support tools, together with education that would enhance communication and resource management skills, will be essential to CNs' ability to support unit resilience and adaptability in an increasingly complex environment.

Intensive Care Nurses' Belief Systems Regarding the Health Economics: A Focused Ethnography.

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Heydari, Abbas; Vafaee-Najar, Ali; Bakhshi, Mahmoud

2016-09-01

Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses' beliefs and their effect on nurse's practices and behavior patterns regarding the health economics. In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994). Eight beliefs were found that gave meaning to ICU nurse's practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2.Monitoring and auditing improve consumption; 3.There is a fear of possible shortage in the future; 4.Supply and replacement of equipment is difficult; 5.Higher prices lead to more accurate consumption; 6.The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8.Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics. ICU nurses' belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the reforms in various aspects, such as the hospital

Translation and Testing of the Swedish Version of Iceland-Family Perceived Support Questionnaire With Parents of Children With Congenital Heart Defects.

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Bruce, Elisabeth; Dorell, Åsa; Lindh, Viveca; Erlingsson, Christen; Lindkvist, Marie; Sundin, Karin

2016-08-01

There is a need for a suitable instrument for the Swedish context that could measure family members' perceptions of cognitive and emotional support received from nurses. The purpose of this study was to translate and test the psychometric properties of the Swedish version of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ) and, further, to report perceptions of support from nurses by family members of children with congenital heart defects (CHDs). A sample of 97 parents of children with CHD, living in Sweden, completed the Swedish translation of ICE-FPSQ. The Swedish version of ICE-FPSQ was found to be reliable and valid in this context. Parents scored perceived family support provided by nurses working in pediatric outpatient clinics as low, which suggests that nurses in these outpatient contexts in Sweden offered family nursing only sparingly. © The Author(s) 2016.

Role-based support for intensive care nursing : A designer's perspective

NARCIS (Netherlands)

Melles, M.

2011-01-01

Design goals and design directions are formulated for the (digital) support of non-technical nursing tasks and skills in the intensive care unit (ICU), such as organizing work, evaluating care, coping with stress and dealing with poor team dynamics. A conceptual framework for ICU nursing was

Evaluation of Mental Workload among ICU Ward's Nurses

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Mohsen Mohammadi

2015-12-01

Conclusion: Various performance obstacles are correlated with nurses' workload, affirms the signifi­cance of nursing work system characteristics. Interventions are recommended based on the results of this study in the work settings of nurses in ICUs.

Teamwork as a nursing competence at Intensive Care Units

Directory of Open Access Journals (Sweden)

Silvia Helena Henriques Camelo

2013-03-01

Full Text Available Objective. The aim in this study was to identify how Intensive Care Unit nurses perceive professional competences in thecare team. Methodology. Qualitative multiple case study with an exploratory focus. The sample consisted of 24 nurses from Intensive Care Units (ICU at two large hospitals. To collect the information, direct observation and - structured, non-structuredand participant - interviews were used. Results. Ninety-six percent of the participants were women, 79% were less than 40 years old, and 63% possessed less than five years of professional experience in ICU. Data analysis revealed three study categories: teamwork as a nursing management tool, improving teamwork, and interpersonal communication for teamwork. Conclusion. At the ICU where the nurses work, a teamwork strategy is observed, which demands cooperation and participation by other disciplines.

Tele-ICU "myth busters".

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Venditti, Angelo; Ronk, Chanda; Kopenhaver, Tracey; Fetterman, Susan

2012-01-01

Tele-intensive care unit (ICU) technology has been proven to bridge the gap between available resources and quality care for many health care systems across the country. Tele-ICUs allow the standardization of care and provide a second set of eyes traditionally not available in the ICU. A growing body of literature supports the use of tele-ICUs based on improved outcomes and reduction in errors. To date, the literature has not effectively outlined the limitations of this technology related to response to changes in patient care, interventions, and interaction with the care team. This information can potentially have a profound impact on service expectations. Some misconceptions about tele-ICU technology include the following: tele-ICU is "watching" 24 hours a day, 7 days a week; tele-ICU is a telemetry unit; tele-ICU is a stand-alone crisis intervention tool; tele-ICU decreases staffing at the bedside; tele-ICU clinical roles are clearly defined and understood; and tele-ICUs are not cost-effective to operate. This article outlines the purpose of tele-ICU technology, reviews outcomes, and "busts" myths about tele-ICU technology.

American Association of Critical-Care Nurses

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... Influencing Sleep in the ICU Explore Explore New Nurses Experienced Nurses Educators/Managers Advanced Practice Membership As a new ... More CSI Academy AACN CSI Academy develops staff nurses as leaders and change agents who drive improved ...

Exploring the role of the ICU nurse in the antimicrobial stewardship ...

African Journals Online (AJOL)

healthcare initiative to reduce antibiotic-selective pressure by promoting appropriate use ... This is especially important in an ICU, which has the highest proportion of patients ... of attention for both the researcher (JR) and the participants, and.

Early goal-directed nutrition in icU patients (EAT-ICU)

DEFF Research Database (Denmark)

Allingstrup, Matilde Jo; Kondrup, Jens; Wiis, Jørgen

2016-01-01

-energy nutrition based on measured requirements on short-term clinical outcomes and long-term physical quality of life in ICU patients. METHODS: The EAT-ICU trial is a single-centre, randomised, parallel-group trial with concealed allocation and blinded outcome assessment. A total of 200 consecutive, acutely...... admitted, mechanically ventilated intensive care patients will be randomised 1:1 to early goal-directed nutrition versus standard of care to show a potential 15% relative risk reduction in the primary outcome measure (physical function) at six months (two-sided significance level α = 0.05; power β = 80......%). Secondary outcomes include energy- and protein balances, metabolic control, new organ failure, use of life support, nosocomial infections, ICU- and hospital length of stay, mortality and cost analyses. CONCLUSION: The optimal nutrition strategy for ICU patients remains unsettled. The EAT-ICU trial...

Delirium assessment in intensive care units: practices and perceptions of Turkish nurses.

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Özsaban, Aysel; Acaroglu, Rengin

2016-09-01

As delirium in intensive care unit (ICU) patients is a serious problem that can result in increased mortality and morbidity, routine delirium assessment of all ICU patients is recommended. The severity, duration and outcome of the syndrome are directly related to nurses' continuous assessment of patients for signs and symptoms of delirium. However, studies indicate that very few nurses monitor for delirium as a part of their daily practices. The aim of this study was to identify current practices and perceptions of intensive care nurses regarding delirium assessment and to examine the factors that affect these practices and perceptions. A descriptive, correlational study design was used. Data were collected from five Turkish public hospitals using a structured survey questionnaire. The study sample comprised 301 nurses who agreed to participate. Data were analysed using descriptive statistics. More than half of the nurses performed delirium assessments. However, the proportion of nurses who use delirium assessment tools was quite low. Almost all of the nurses perceived delirium as a problem and serious problem for ICU patients. The patient group least monitored for delirium was that of unconscious patients. Statistically significant differences were found in the proportion of nurses who assessed delirium symptoms and whose care delivery system was patient-centred and perceived delirium as a serious problem. While a majority of ICU nurses perceived delirium as a problem and serious problem, the proportion of those who perform routine delirium assessments was less. It was found that delirium assessment practices of nurses were affected from their perceptions of delirium and the implementation of patient-centred care delivery. It is essential to develop strategies to encourage ICU nurses to perform delirium assessments through the use of delirium assessment tools. © 2015 British Association of Critical Care Nurses.

Ward nurses' experiences of the discharge process between intensive care unit and general ward.

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Kauppi, Wivica; Proos, Matilda; Olausson, Sepideh

2018-05-01

Intensive care unit (ICU) discharges are challenging practices that carry risks for patients. Despite the existing body of knowledge, there are still difficulties in clinical practice concerning unplanned ICU discharges, specifically where there is no step-down unit. The aim of this study was to explore general ward nurses' experiences of caring for patients being discharged from an ICU. Data were collected from focus groups and in-depth interviews with a total of 16 nurses from three different hospitals in Sweden. An inductive qualitative design was chosen. The analysis revealed three themes that reflect the challenges in nursing former ICU patients: a vulnerable patient, nurses' powerlessness and organizational structure. The nurses described the challenge of nursing a fragile patient based on several aspects. They expressed feeling unrealistic demands when caring for a fragile former ICU patient. The demands were related to their own profession and knowledge regarding how to care for this group of patients. The organizational structure had an impact on how the nurses' caring practice could be realized. This evoked ethical concerns that the nurses had to cope with as the organization's care guidelines did not always favour the patients. The structure of the organization and its leadership appear to have a significant impact on the nurses' ability to offer patients the care they need. This study sheds light on the need for extended outreach services and intermediate care in order to meet the needs of patients after the intensive care period. © 2018 British Association of Critical Care Nurses.

RESOURCE MANAGEMENT AMONG INTENSIVE CARE NURSES: AN ETHNOGRAPHIC STUDY.

Science.gov (United States)

Heydari, Abbas; Najar, Ali Vafaee; Bakhshi, Mahmoud

2015-12-01

Nurses are the main users of supplies and equipment applied in the Intensive Care Units (ICUs) which are high-priced and costly. Therefore, understanding ICU nurses' experiences about resource management contributes to the better control of the costs. This study aimed to investigate the culture of nurses' working environment regarding the resource management in the ICUs in Iran. In this study, a focused ethnographic method was used. Twenty-eight informants among ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations as a participant observer was used for data gathering. Data analysis was performed using the methods described by Miles and Huberman (1994). Two main themes describing the culture of ICU nurses regarding resource management included (a) consumption monitoring and auditing, and (b) prudent use. The results revealed that the efforts for resource management are conducted in the conditions of scarcity and uncertainty in supply. ICU nurses had a sense of futurism in the supply and use of resources in the unit and do the planning through taking the rules and guidelines as well as the available resources and their values into account. Improper storage of some supplies and equipment was a reaction to this uncertain condition among nurses. To manage the resources effectively, improvement of supply chain management in hospital seems essential. It is also necessary to hold educational classes in order to enhance the nurses' awareness on effective supply chain and storage of the items in the unit stock.

Real-time feedback for improving compliance to hand sanitization among healthcare workers in an open layout ICU using radiofrequency identification.

Science.gov (United States)

Radhakrishna, Kedar; Waghmare, Abijeet; Ekstrand, Maria; Raj, Tony; Selvam, Sumithra; Sreerama, Sai Madhukar; Sampath, Sriram

2015-06-01

The aim of this study is to increase hand sanitizer usage among healthcare workers by developing and implementing a low-cost intervention using RFID and wireless mesh networks to provide real-time alarms for increasing hand hygiene compliance during opportune moments in an open layout Intensive Care Unit (ICU). A wireless, RFID based system was developed and implemented in the ICU. The ICU beds were divded into an intervention arm (n = 10) and a control arm (n = 14). Passive RFID tags were issued to the doctors, nurses and support staff of the ICU. Long range RFID readers were positioned strategically. Sensors were placed beneath the hand sanitizers to record sanitizer usage. The system would alert the HCWs by flashing a light if an opportune moment for hand sanitization was detected. A significant increase in hand sanitizer use was noted in the intervention arm. Usage was highest during the early part of the workday and decreased as the day progressed. Hand wash events per person hour was highest among the ancilliary staff followed by the doctors and nurses. Real-time feedback has potential to increase hand hygiene compliance among HCWs. The system demonstrates the possibility of automating compliance monitoring in an ICU with an open layout.

MIMIC II: a massive temporal ICU patient database to support research in intelligent patient monitoring

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Saeed, M.; Lieu, C.; Raber, G.; Mark, R. G.

2002-01-01

Development and evaluation of Intensive Care Unit (ICU) decision-support systems would be greatly facilitated by the availability of a large-scale ICU patient database. Following our previous efforts with the MIMIC (Multi-parameter Intelligent Monitoring for Intensive Care) Database, we have leveraged advances in networking and storage technologies to develop a far more massive temporal database, MIMIC II. MIMIC II is an ongoing effort: data is continuously and prospectively archived from all ICU patients in our hospital. MIMIC II now consists of over 800 ICU patient records including over 120 gigabytes of data and is growing. A customized archiving system was used to store continuously up to four waveforms and 30 different parameters from ICU patient monitors. An integrated user-friendly relational database was developed for browsing of patients' clinical information (lab results, fluid balance, medications, nurses' progress notes). Based upon its unprecedented size and scope, MIMIC II will prove to be an important resource for intelligent patient monitoring research, and will support efforts in medical data mining and knowledge-discovery.

Intensive Care Nurses' Attitude on Palliative and End of Life Care.

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Tripathy, Swagata; Routray, Pragyan K; Mishra, Jagdish C

2017-10-01

Intensive Care Unit (ICU) nurses have a vital role in the implementation of end of life (EOL) care. There is limited data on the attitude of ICU nurses toward EOL and palliation. This study aimed to investigate knowledge, attitude, and beliefs of intensive care nurses in eastern India toward EOL. A self-administered questionnaire was distributed to delegates in two regional critical care nurses' training programs. Of 178 questionnaires distributed, 138 completed, with a response rate of 75.5*. About half (48.5*) had more than 1 year ICU experience. A majority (81.9*) agreed that nurses should be involved in and initiate (62.3*) EOL discussions. Terms "EOL care or palliative care in ICU" were new for 19.6*; 21* and 55.8* disagreed with allowing peaceful death in terminal patients and unrestricted family visits, respectively. Work experience was associated with wanting unrestricted family visitation, discontinuing monitoring and investigations at EOL, equating withholding and withdrawal of treatment, and being a part of EOL team discussions ( P = 0.005, 0.01, 0.01, and 0.001), respectively. Religiousness was associated with a greater desire to initiate EOL discussions ( P = 0.001). Greater emphasis on palliative care in critical care curriculum may improve awareness among critical care nurses.

Nurse-perceived barriers to effective communication regarding prognosis and optimal end-of-life care for surgical ICU patients: a qualitative exploration.

Science.gov (United States)

Aslakson, Rebecca A; Wyskiel, Rhonda; Thornton, Imani; Copley, Christina; Shaffer, Dauryne; Zyra, Marylou; Nelson, Judith; Pronovost, Peter J

2012-08-01

Integration of palliative care for intensive care unit (ICU) patients is important but often challenging, especially in surgical ICUs (SICUs), in part because many surgeons equate palliative care with terminal care and failure of restorative care. SICU nurses, who are key front-line clinicians, can provide insights into barriers for delivery of optimal palliative care in their setting. We developed a focus group guide to identify barriers to two key components of palliative care-optimal communication regarding prognosis and optimal end-of-life care-and used the tool to conduct focus groups of nurses providing bedside care in three SICUs at a tertiary care, academic, inner city hospital. Using content analysis technique, responses were organized into thematic domains that were validated by independent observers and a subset of participating nurses. Four focus groups included a total of 32 SICU nurses. They identified 34 barriers to optimal communication regarding prognosis, which were summarized into four domains: logistics, clinician discomfort with discussing prognosis, inadequate skill and training, and fear of conflict. For optimal end-of-life care, the groups identified 24 barriers in four domains: logistics, inability to acknowledge an end-of-life situation, inadequate skill and training, and cultural differences relating to end-of-life care. Nurses providing bedside care in SICUs identify barriers in several domains that may impede optimal discussions of prognoses and end-of-life care for patients with surgical critical illness. Consideration of these perceived barriers and the underlying SICU culture is relevant for designing interventions to improve palliative care in this setting.

The effect of nonpharmacological training on delirium identification and intervention strategies of intensive care nurses.

Science.gov (United States)

Öztürk Birge, Ayşegül; Tel Aydin, Hatice

2017-08-01

This study aims to investigate the effect of nonpharmacological intervention training on delirium recognition and the intervention strategies of intensive care (ICU) nurses. This is a quasi-experimental study conducted using a pretest-posttest design. The study sample included a total of 95 patients staying in the medical ICU of a university hospital and 19 nurses working in these units. The data were collected using the Patient and Nurse Introduction, Confusion Assessment Method for the ICU, and Delirium Risk Factors, and Non-pharmacological Interventions in Delirium Prevention Forms. Delirium was identified in 26.5% and 20.9% of the patients in the pre- and posttraining phase, respectively. Patients with delirium had a longer duration of stay in the ICU, lower mean Glasgow Coma Scale score and a higher number of medications in daily treatment (pdelirium increased 8.5-fold by physical restriction and 3.4-fold by the presence of hypo/hypernatremia. The delirium recognition rate of nurses increased from 7.7% to 33.3% in the post-training phase. Our study results show that training can increase the efficiency of ICU nurses in the management of delirium. Copyright © 2016 Elsevier Ltd. All rights reserved.

ICU Telemedicine Program Financial Outcomes.

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Lilly, Craig M; Motzkus, Christine; Rincon, Teresa; Cody, Shawn E; Landry, Karen; Irwin, Richard S

2017-02-01

ICU telemedicine improves access to high-quality critical care, has substantial costs, and can change financial outcomes. Detailed information about financial outcomes and their trends over time following ICU telemedicine implementation and after the addition of logistic center function has not been published to our knowledge. Primary data were collected for consecutive adult patients of a single academic medical center. We compared clinical and financial outcomes across three groups that differed regarding telemedicine support: a group without ICU telemedicine support (pre-ICU intervention group), a group with ICU telemedicine support (ICU telemedicine group), and an ICU telemedicine group with added logistic center functions and support for quality-care standardization (logistic center group). The primary outcome was annual direct contribution margin defined as aggregated annual case revenue minus annual case direct costs (including operating costs of ICU telemedicine and its related programs). All monetary values were adjusted to 2015 US dollars using Producer Price Index for Health-Care Facilities. Annual case volume increased from 4,752 (pre-ICU telemedicine) to 5,735 (ICU telemedicine) and 6,581 (logistic center). The annual direct contribution margin improved from $7,921,584 (pre-ICU telemedicine) to $37,668,512 (ICU telemedicine) to $60,586,397 (logistic center) due to increased case volume, higher case revenue relative to direct costs, and shorter length of stay. The ability of properly modified ICU telemedicine programs to increase case volume and access to high-quality critical care with improved annual direct contribution margins suggests that there is a financial argument to encourage the wider adoption of ICU telemedicine. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Developing the role of Swedish advanced practice nurse (APN) through a blended learning master's program: Consequences of knowledge organisation.

Science.gov (United States)

Bergström, Peter; Lindh, Viveca

2018-01-01

This paper reports on a research study conducted with a group of nurses in Sweden enrolled in a newly developed blended learning master's programme to become advanced practice nurses (APNs). As background, the paper presents the regional needs the programme is intended to address and describes how the programme was designed. The aim was to understand how, from students' perspective, the nurse master's programme structured knowledge for their future position as APNs. The research question focuses on how the master's programme prepares students by meeting their diverse needs for knowledge. Empirical material was collected at two times during the students' first and second years of study through semi-structured qualitative interviews. The findings highlight the process in which these master's students gained a more advanced identity of becoming APNs. This process demonstrates how students perceive their current position as nurses based on a discourse of knowledge in relation to the practical and theoretical knowledge they encounter in the master's programme. This article concludes by recommending that attention should be paid to developing APN role models in the current Swedish healthcare system. Copyright © 2017 Elsevier Ltd. All rights reserved.

Attitudes towards euthanasia among Greek intensive care unit physicians and nurses.

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Kranidiotis, Georgios; Ropa, Julia; Mprianas, John; Kyprianou, Theodoros; Nanas, Serafim

2015-01-01

To investigate the attitudes of Greek intensive care unit (ICU) medical and nursing staff towards euthanasia. ICU physicians and nurses deal with end-of-life dilemmas on a daily basis. Therefore, the exploration of their stances on euthanasia is worthwhile. This was a descriptive quantitative study conducted in three ICUs in Athens. The convenience sample included 39 physicians and 107 nurses. Of respondents, 52% defined euthanasia inaccurately, as withholding or withdrawal of treatment, while 15% ranked limitation of life-support among the several forms of euthanasia, together with active shortening of the dying process and physician - assisted suicide. Only one third of participants defined euthanasia correctly. While 59% of doctors and 64% of nurses support the legalization of active euthanasia, just 28% and 26% of them, respectively, agree with it ethically. Confusion prevails among Greek ICU physicians and nurses regarding the definition of euthanasia. The majority of staff disagrees with active euthanasia, but upholds its legalization. Copyright © 2015 Elsevier Inc. All rights reserved.

Training of nurses on Foley catheter insertion in intensive care unit patients: limits and possibilities

Directory of Open Access Journals (Sweden)

Magno Conceição Merces

2013-04-01

Full Text Available Backgound and Objectives: Nursing has an important role in urinary tract infection prevention and control. Urinary catheters insertion represents the local topography with the highest rate of hospital infection. Foley catheter placement is performed solely by the nurse and requires aseptic techniques during its performance, thus preventing risks to the patients. The study aimed to evaluate the training of nurses on Foley catheter insertion and point out limits and possibilities of this practice in patients at the Intensive Care Unit (ICU of Hospital Geral do Interior da Bahia (HGIB. Methods: This was a qualitative, exploratory and descriptive study. Data collection was carried out through semi-structured interviews. After data analysis, two categories were evaluated, namely: the training of nurses on Foley catheter insertion in ICU patients and the limits and possibilities of Foley catheter insertion practice by nurses in ICU patients. Bardin analysis was used for data analysis. Results: The study shows that the nurse’s practice on Foley catheter insertion in ICU patients is based on the use of aseptic techniques for urinary tract infection prevention, theoretical and practical knowledge on Foley catheter insertion in ICU patients, knowledge on urinary tract infections and associations with catheter insertion, whereas the limits and possibilities of Foley catheter insertion practice by nurses are understood through measures to minimize the risk of hospital infection caused by long-term catheter use in the ICU. Nurses point out that the risks of hospital infection are inherent to long-term catheter use. This is an important fact, as the knowledge or its absence may constitute a limit or possibility for Foley catheter insertion practice by the nurse in ICU patients. Conclusion: Nurses must seek the systematization of knowledge, which warrants support for the team, as well as information, safety and prompt care, allowing the reduction of urinary

A gap between need and reality: neonatal nursing staff requirements on a German intensive care unit

Directory of Open Access Journals (Sweden)

Christian Patry

2014-03-01

Full Text Available Recently, new staffing rules for neonatal nurses in intensive care units (ICU were issued in Germany, using categories of care of the British Association of Perinatal Medicine as blueprint. Neonates on intensive care require a nurse-to-patient ratio of 1:1, on intensive surveillance (high dependency care of 1:2. No requirements exist for special care, transitional care, and pediatric ICU patients. Using these rules, nursing staff requirement was calculated over a period of 31 consecutive days once a day in a combined pediatric and neonatal ICU of a metropolitan academic medical center in south-west Germany. Each day, 18.9±0.98 patients (mean±standard deviation were assessed (14.26±1.21 neonatal, 4.65±0.98 pediatric. Among neonates, 9.94±2.56 received intensive therapy, 3.77±1.85 intensive surveillance, and 0.65±0.71 special care. Average nursing staff requirement was 12.10±1.81 full time equivalents (FTE per shift. Considering additional pediatric patients in the ICU and actual nursing staff availability (8.97±0.87 FTE per shift, this ICU seems understaffed.

[Investigation of doctors' and nurses' perceptions and implementation of delirium management in intensive care unit].

Science.gov (United States)

Luo, H B; Wang, X T; Tang, B; Zhu, Z N; Guo, H L; Li, Z Z; Sun, J H; Liu, D W

2017-12-01

Objective: To investigate doctors' and nurses' perceptions and implementation of delirium management in intensive care unit. Methods: A total of 197 doctors and nurses in 2 general ICUs and 3 special ICUs at Peking Union Medical College Hospital finished a self-designed questionnaire of delirium management. Results: There were 47 males and 150 females, 43 doctors and 154 nurses who participated in the survey.One hundred and twenty five participators were from general ICU and the others from special ICU. The ICU staff had a significant difference on the perceptions and implementation of delirium management( P delirium assessment" ( P delirium management,especially in special ICUs. Delirium management should be included as a routine care in ICU to improve patients' outcome.

Nursing and Patients with Delirium: a Literature Review

Directory of Open Access Journals (Sweden)

Ángela María Henao-Castaño

2014-04-01

Full Text Available Objective. This work sought to analyze the scientific production regarding delirium in patients in Intensive Care Units (ICU. Synthesis. Delirium (cognitive alteration occurs in acute and fluctuating manner in patients in ICU. It is a risk factor for mortality and prolonged stay in ICU. Its diagnosis is derived from an objective assessment with widely disseminated validated instruments, available in Spanish and other languages. Strategies to prevent delirium in ICU are documented. Conclusion. Implementation of these strategies to prevent, monitor, and control delirium in patients hospitalized in ICU must be a priority of nursing research in our setting.

The perceived meaning of a (wholistic view among general practitioners and district nurses in Swedish primary care: a qualitative study

Directory of Open Access Journals (Sweden)

Borgquist Lars

2007-03-01

Full Text Available Abstract Background The definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. The meaning of holism in international literature differs between medicine and nursing. The question is, if the difference is due to different educational traditions. Due to the uncertainties in defining holism and a holistic view we wished to study, in depth, how holism is perceived by doctors and nurses in their clinical work. Thus, the aim was to explore the perceived meaning of a holistic view among general practitioners (GPs and district nurses (DNs. Methods Seven focus group interviews with a purposive sample of 22 GPs and 20 nurses working in primary care in two Swedish county councils were conducted. The interviews were transcribed verbatim and analysed using qualitative content analysis. Results The analysis resulted in three categories, attitude, knowledge, and circumstances, with two, two and four subcategories respectively. A professional attitude involves recognising the whole person; not only fragments of a person with a disease. Factual knowledge is acquired through special training and long professional experience. Tacit knowledge is about feelings and social competence. Circumstances can either be barriers or facilitators. A holistic view is a strong motivator and as such it is a facilitator. The way primary care is organised can be either a barrier or a facilitator and could influence the use of a holistic approach. Defined geographical districts and care teams facilitate a holistic view with house calls being essential, particularly for nurses. In preventive work and palliative care, a holistic view was stated to be specifically important. Consultations and communication with the patient were seen as important tools. Conclusion 'Holistic view' is multidimensional, well implemented and very much alive among both

The effect of nursing participation in the design of a critical care information system: a case study in a Chinese hospital.

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Qin, Yanhong; Zhou, Ranyun; Wu, Qiong; Huang, Xiaodi; Chen, Xinli; Wang, Weiwei; Wang, Xun; Xu, Hua; Zheng, Jing; Qian, Siyu; Bai, Changqing; Yu, Ping

2017-12-06

Intensive care information systems (ICIS) are continuously evolving to meet the ever changing information needs of intensive care units (ICUs), providing the backbone for a safe, intelligent and efficient patient care environment. Although beneficial for the international advancement in building smart environments to transform ICU services, knowledge about the contemporary development of ICIS worldwide, their usage and impacts is limited. This study aimed to fill this knowledge gap by researching the development and implementation of an ICIS in a Chinese hospital, nurses' use of the system, and the impact of system use on critical care nursing processes and outcomes. This descriptive case study was conducted in a 14-bed Respiratory ICU in a tertiary hospital in Beijing. Participative design was the method used for ICU nurses, hospital IT department and a software company to collaboratively research and develop the ICIS. Focus group discussions were conducted to understand the subjective perceptions of the nurses toward the ICIS. Nursing documentation time and quality were compared before and after system implementation. ICU nursing performance was extracted from the annual nursing performance data collected by the hospital. A participative design process was followed by the nurses in the ICU, the hospital IT staff and the software engineers in the company to develop and implement a highly useful ICIS. Nursing documentation was fully digitized and was significantly improved in quality and efficiency. The wrong data, missing data items and calculation errors were significantly reduced. Nurses spent more time on direct patient care after the introduction of the ICIS. The accuracy and efficiency of medication administration was also improved. The outcome was improvement in ward nursing performance as measured by ward management, routine nursing practices, disinfection and isolation, infection rate and mortality rate. Nurses in this ICU unit in China actively

Beyond Pain: Nurses' Assessment of Patient Suffering, Dignity, and Dying in the Intensive Care Unit.

Science.gov (United States)

Su, Amanda; Lief, Lindsay; Berlin, David; Cooper, Zara; Ouyang, Daniel; Holmes, John; Maciejewski, Renee; Maciejewski, Paul K; Prigerson, Holly G

2018-06-01

Deaths in the intensive care unit (ICU) are increasingly common in the U.S., yet little is known about patients' experiences at the end of life in the ICU. The objective of this study was to determine nurse assessment of symptoms experienced, and care received by ICU patients in their final week, and their associations with nurse-perceived suffering and dignity. From September 2015 to March 2017, nurses who cared for 200 ICU patients who died were interviewed about physical and psychosocial dimensions of patients' experiences. Medical chart abstraction was used to document baseline patient characteristics and care. The patient sample was 61% males, 70.2% whites, and on average 66.9 (SD 15.1) years old. Nurses reported that 40.9% of patients suffered severely and 33.1% experienced severe loss of dignity. The most common symptoms perceived to contribute to suffering and loss of dignity included trouble breathing (44.0%), edema (41.9%), and loss of control of limbs (36.1%). Most (n = 9) remained significantly (P dignity (AOR 3.15). Use of feeding tube was associated with severe loss of dignity (AOR 3.12). Dying ICU patients are perceived by nurses to experience extreme indignities and suffer beyond physical pain. Attention to symptoms such as dyspnea and edema may improve the quality of death in the ICU. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Who wants to work with older people? Swedish student nurses' willingness to work in elderly care--a questionnaire study.

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Carlson, Elisabeth; Idvall, Ewa

2015-07-01

The aging population is a globally recognized challenge for the health care service. The growing number of older people will probably lead to increased demands for nurses working in elderly care. Clinical practice has been shown to have an impact on how student nurses perceive a particular field of nursing. To compare perceptions of the clinical learning environment in nursing homes among students considering a career in aged care or not, and to examine the difference in age, gender and previous working experience as health care assistants in elderly care between the two groups. This was a cross-sectional study using the Swedish version of the Clinical Learning Environment and Nurse Teacher evaluation scale. Consecutive sampling was performed over three semesters from September 2011 to December 2012. The survey was conducted with 183 student nurses. Mann-Whitney U-test was used to examine differences in relation to two groups namely student nurses who did or did not consider to work in elderly care. A chi-square test of independence was performed to examine the difference in age, gender and previous working experience between the two groups. The analysis leaned towards an overall positive evaluation of the clinical learning environment with more positive values for students considering a career. There were no significant differences between younger students (18-23) and older students (24-50) regarding willingness to work in elderly care or not. Neither was any significant difference displayed between students, based on gender nor for previous work experience. Age, gender and previous work experiences as health care assistants did not impact on students' willingness to work in elderly care. Future studies need to acknowledge the complexity of why student nurses choose a particular pathway in nursing by longitudinal studies following cohorts of students during the course of the nursing programme. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Systematic Review of the Liaison Nurse Role on Patient's Outcomes after Intensive Care Unit Discharge.

Science.gov (United States)

Tabanejad, Zeinab; Pazokian, Marzieh; Ebadi, Abbas

2014-10-01

This review focuses on the impact of liaison nurse in nursing care of patient after ICU discharge on patient's outcomes, compared with patients that are not taken care of by liaison nurses. The role of the ICU liaison nurse has transpired to solve the gap between intensive care unit and wards. Therefore, we aimed to review the outcomes of all studies in this field. A systematic review of intervention studies between 2004 and 2013 was undertaken using standard and sensitive keywords such as liaison nurse, intensive care unit, and patient outcomes in the following databases: Science direct, PubMed, Scopus, Ovid, Oxford, Wiley, Scholar, and Mosby. Then, the articles which had the inclusion criteria after quality control were selected for a systematic review. From 662 retrieved articles, six articles were analyzed in a case study and four articles showed a statistically significant effect of the liaison nurse on the patient's outcomes such as reducing delays in patient discharge, effective discharge planning, improvement in survival for patients at the risk for readmission. Liaison nurses have a positive role on the outcomes of patients who are discharged from the ICU and more research should be done to examine the exact function of liaison nurses and other factors that influence outcomes in patients discharged from ICU.

Barriers to intensive care unit nurses' autonomy in Iran: A qualitative study.

Science.gov (United States)

AllahBakhshian, Maryam; Alimohammadi, Nasrollah; Taleghani, Fariba; Nik, Ahmadreza Yazdan; Abbasi, Saeed; Gholizadeh, Leila

The acute nature of the intensive care unit (ICU) environment necessitates that urgent clinical decisions are frequently made by the health care team. Therefore, it is important that critical care nurses have the authority to make decisions about their patient care. The purpose of this study was to explore perceived barriers to the practice of professional autonomy from the perspectives of ICU nurses in Iran. In this qualitative study, 28 critical care nurses were interviewed using a semistructured in-depth interview method. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. Data analysis led to identification of two main themes and five subthemes: (a) the profession-related barriers with two associated subthemes of "lack of capacity to exercise autonomy" and "lack of strong professional bodies"; (b) organizational barriers with the associated subthemes of "role ambiguity," "a directive rather than supportive workplace," and "lack of motivation." ICU nurses in Iran may face many challenges in gaining professional autonomy. The identified inter- and intraprofessional barriers to the exercise of autonomy need to be addressed to promote critical thinking, job satisfaction, and motivation of ICU nurses, which can in turn lead to improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical practices to promote sleep in the ICU

DEFF Research Database (Denmark)

Hofhuis, José G M; Rose, Louise; Blackwood, Bronagh

2018-01-01

PURPOSE: To describe sleep assessment and strategies to promote sleep in adult ICUs in ten countries. METHODS: Multicenter, self-administered survey sent to nurse managers. RESULTS: Response rate was 66% with 522 ICUs providing data. 'Lying quietly with closed eyes' was the characteristic most...... frequently perceived as indicative of sleep by >60% of responding ICUs in all countries except Italy. Few ICUs (9%) had a protocol for sleep management or used sleep questionnaires (1%). Compared to ICUs in Northern Europe, those in central Europe were more likely to have a sleep promoting protocol (p ....001), and to want to implement a protocol (p 80% of responding ICUs, the most common non-pharmacological sleep-promoting interventions were reducing ICU staff noise, light, and nurse interventions at night; only 18% used earplugs frequently. Approximately 50% of ICUs reported sleep medication...

Mechanical ventilation in the ICU- is there a gap between the time available and time used for nurse-led weaning?

Directory of Open Access Journals (Sweden)

Nilsen Odd

2008-12-01

Full Text Available Abstract Background Mechanical ventilation (MV is a key component in the care of critically ill and injured patients. Weaning from MV constitutes a major challenge in intensive care units (ICUs. Any delay in weaning may increase the number of complications and leads to greater expense. Nurse-led, protocol-directed weaning has become popular, but it remains underused. The aim of this study was to identify and quantify discrepancies between the time available for weaning and time actually used for weaning. Further, we also wished to analyse patient and systemic factors associated with weaning activity. Methods This retrospective study was performed in a 12-bed general ICU at a university hospital. Weaning data were collected from 68 adult patients on MV and recorded in terms of ventilator-shifts. One ventilator-shift was defined as an 8-hour nursing shift for one MV patient. Results Of the 2000 ventilator-shifts analysed, 572 ventilator-shifts were available for weaning. We found that only 46% of the ventilator shifts available for weaning were actually used for weaning. While physician prescription of weaning was associated with increased weaning activity (p Conclusion Our study identified a significant gap between the time available and time actually used for weaning. While various patient and systemic factors were linked to weaning activity, the most important factor in our study was whether the intensive care nurses made use of the time available for weaning.

ICU Director Data

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Ogbu, Ogbonna C.; Coopersmith, Craig M.

2015-01-01

Improving value within critical care remains a priority because it represents a significant portion of health-care spending, faces high rates of adverse events, and inconsistently delivers evidence-based practices. ICU directors are increasingly required to understand all aspects of the value provided by their units to inform local improvement efforts and relate effectively to external parties. A clear understanding of the overall process of measuring quality and value as well as the strengths, limitations, and potential application of individual metrics is critical to supporting this charge. In this review, we provide a conceptual framework for understanding value metrics, describe an approach to developing a value measurement program, and summarize common metrics to characterize ICU value. We first summarize how ICU value can be represented as a function of outcomes and costs. We expand this equation and relate it to both the classic structure-process-outcome framework for quality assessment and the Institute of Medicine’s six aims of health care. We then describe how ICU leaders can develop their own value measurement process by identifying target areas, selecting appropriate measures, acquiring the necessary data, analyzing the data, and disseminating the findings. Within this measurement process, we summarize common metrics that can be used to characterize ICU value. As health care, in general, and critical care, in particular, changes and data become more available, it is increasingly important for ICU leaders to understand how to effectively acquire, evaluate, and apply data to improve the value of care provided to patients. PMID:25846533

[Analysis of the intensity of professional collaboration among nurses in a critical care area].

Science.gov (United States)

Bengoechea Calpe, L; Marín Fernández, B; Regaira Martínez, E

2016-01-01

To analyse the intensity of professional collaboration (IPC) between the nurses in a multidisciplinary critical area (CA) and the relationship with the workplace "intensive care unit (ICU) and special hospitalisation area (SHA)", educational level, age, and years of professional activity in CA. A cross-sectional descriptive study was conducted with 57 nurses from CA, recording socio-demographic data: age, educational level, speciality titles, years of professional activity and workday type, years of professional activity in the CA, and involvement in scientific works. Tool: Intensity of Inter-professional Collaboration Questionnaire. SPSS 20.0. The study included a total of 47 nurses (ICU/SHA), with a mean age of 35.91 (9.59) years. Almost three-quarters (74.46%) were nursing graduates with a posgraduate in ICU. Median and interquartile range of professional experience was 14 and 14.50 years, respectively, and years working in CA was 8.50 and 16 years, respectively. Just over half of them (51.10%) worked part-time, and 61.70% participated in scientific works. The mean IPC score was 61.68 (6.84), with 57.40% providing values of high IPC. The relationship between the workplace (ICU/SHA) and educational level with IPC was not statistically significant (p>.05). There are statistical significant differences between IPC with age and years of professional activity in CA (p<.05). The present study demonstrates the existence of good IPC in the CA. Younger nurses obtain a better IPC score, as well as nurses who have been working for less time in CA. Nurses with a Degree or Masters have a higher level of IPC than the rest, as well as nurses who perform professional activity combining ICU and SHA. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

The perceived meaning of a (w)holistic view among general practitioners and district nurses in Swedish primary care: a qualitative study

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Strandberg, Eva Lena; Ovhed, Ingvar; Borgquist, Lars; Wilhelmsson, Susan

2007-01-01

Background The definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. The meaning of holism in international literature differs between medicine and nursing. The question is, if the difference is due to different educational traditions. Due to the uncertainties in defining holism and a holistic view we wished to study, in depth, how holism is perceived by doctors and nurses in their clinical work. Thus, the aim was to explore the perceived meaning of a holistic view among general practitioners (GPs) and district nurses (DNs). Methods Seven focus group interviews with a purposive sample of 22 GPs and 20 nurses working in primary care in two Swedish county councils were conducted. The interviews were transcribed verbatim and analysed using qualitative content analysis. Results The analysis resulted in three categories, attitude, knowledge, and circumstances, with two, two and four subcategories respectively. A professional attitude involves recognising the whole person; not only fragments of a person with a disease. Factual knowledge is acquired through special training and long professional experience. Tacit knowledge is about feelings and social competence. Circumstances can either be barriers or facilitators. A holistic view is a strong motivator and as such it is a facilitator. The way primary care is organised can be either a barrier or a facilitator and could influence the use of a holistic approach. Defined geographical districts and care teams facilitate a holistic view with house calls being essential, particularly for nurses. In preventive work and palliative care, a holistic view was stated to be specifically important. Consultations and communication with the patient were seen as important tools. Conclusion 'Holistic view' is multidimensional, well implemented and very much alive among both GPs and DNs. The word

Structure, process, and annual ICU mortality across 69 centers: United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study.

Science.gov (United States)

Checkley, William; Martin, Greg S; Brown, Samuel M; Chang, Steven Y; Dabbagh, Ousama; Fremont, Richard D; Girard, Timothy D; Rice, Todd W; Howell, Michael D; Johnson, Steven B; O'Brien, James; Park, Pauline K; Pastores, Stephen M; Patil, Namrata T; Pietropaoli, Anthony P; Putman, Maryann; Rotello, Leo; Siner, Jonathan; Sajid, Sahul; Murphy, David J; Sevransky, Jonathan E

2014-02-01

Hospital-level variations in structure and process may affect clinical outcomes in ICUs. We sought to characterize the organizational structure, processes of care, use of protocols, and standardized outcomes in a large sample of U.S. ICUs. We surveyed 69 ICUs about organization, size, volume, staffing, processes of care, use of protocols, and annual ICU mortality. ICUs participating in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study. Sixty-nine intensivists completed the survey. We characterized structure and process variables across ICUs, investigated relationships between these variables and annual ICU mortality, and adjusted for illness severity using Acute Physiology and Chronic Health Evaluation II. Ninety-four ICU directors were invited to participate in the study and 69 ICUs (73%) were enrolled, of which 25 (36%) were medical, 24 (35%) were surgical, and 20 (29%) were of mixed type, and 64 (93%) were located in teaching hospitals with a median number of five trainees per ICU. Average annual ICU mortality was 10.8%, average Acute Physiology and Chronic Health Evaluation II score was 19.3, 58% were closed units, and 41% had a 24-hour in-house intensivist. In multivariable linear regression adjusted for Acute Physiology and Chronic Health Evaluation II and multiple ICU structure and process factors, annual ICU mortality was lower in surgical ICUs than in medical ICUs (5.6% lower [95% CI, 2.4-8.8%]) or mixed ICUs (4.5% lower [95% CI, 0.4-8.7%]). We also found a lower annual ICU mortality among ICUs that had a daily plan of care review (5.8% lower [95% CI, 1.6-10.0%]) and a lower bed-to-nurse ratio (1.8% lower when the ratio decreased from 2:1 to 1.5:1 [95% CI, 0.25-3.4%]). In contrast, 24-hour intensivist coverage (p = 0.89) and closed ICU status (p = 0.16) were not associated with a lower annual ICU mortality. In a sample of 69 ICUs, a daily plan of care review and a lower bed-to-nurse ratio were both associated with a

Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool.

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Van den Bulcke, Bo; Piers, Ruth; Jensen, Hanne Irene; Malmgren, Johan; Metaxa, Victoria; Reyners, Anna K; Darmon, Michael; Rusinova, Katerina; Talmor, Daniel; Meert, Anne-Pascale; Cancelliere, Laura; Zubek, Làszló; Maia, Paolo; Michalsen, Andrej; Decruyenaere, Johan; Kompanje, Erwin J O; Azoulay, Elie; Meganck, Reitske; Van de Sompel, Ariëlla; Vansteelandt, Stijn; Vlerick, Peter; Vanheule, Stijn; Benoit, Dominique D

2018-02-23

Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU). To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates. Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups. Of 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner. The 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians' behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU

Effects of reflection on clinical decision-making of intensive care unit nurses.

Science.gov (United States)

Razieh, Shahrokhi; Somayeh, Ghafari; Fariba, Haghani

2018-07-01

Nurses are one of the most influential factors in overcoming the main challenges faced by health systems throughout the world. Every health system should, hence, empower nurses in clinical judgment and decision-making skills. This study evaluated the effects of implementing Tanner's reflection method on clinical decision-making of nurses working in an intensive care unit (ICU). This study used an experimental, pretest, posttest design. The setting was the intensive care unit of Amin Hospital Isfahan, Iran. The convenience sample included 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). This clinical trial was performed on 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). The nurses were selected by census sampling and randomly allocated to either the case or the control group. Data were collected using a questionnaire containing demographic characteristics and the clinical decision-making scale developed by Laurie and Salantera (NDMI-14). The questionnaire was completed before and one week after the intervention. The data were analyzed using SPSS 21.0. The two groups were not significantly different in terms of the level and mean scores of clinical decision-making before the intervention (P = 0.786). Based on the results of independent t-test, the mean score of clinical decision-making one week after the intervention was significantly higher in the case group than in the control group (P = 0.009; t = -2.69). The results of Mann Whitney test showed that one week after the intervention, the nurses' level of clinical decision-making in the case group rose to the next level (P = 0.001). Reflection could improve the clinical decision-making of ICU nurses. It is, thus, recommended to incorporate this method into the nursing curriculum and care practices. Copyright © 2018. Published by Elsevier Ltd.

Impact of follow-up consultations for ICU survivors on post-ICU syndrome

DEFF Research Database (Denmark)

Jensen, J. F.; Thomsen, Thordis; Overgaard, D

2015-01-01

/unpublished trials. Randomized controlled trials investigating post-ICU consultations in adults with outcomes such as quality of life (QOL), anxiety, depression, posttraumatic stress disorder (PTSD), physical ability, cognitive function, and return to work were included. Two reviewers extracted data and assessed...... ratio 0.49, 95 % CI 0.26-0.95). There was no effect on other outcomes. CONCLUSIONS: The evidence indicates that follow-up consultations might reduce symptoms of PTSD at 3-6 months after ICU discharge in ICU survivors, but without affecting QOL and other outcomes investigated. This review highlights...

Research nurses in New Zealand intensive care units: A qualitative descriptive study.

Science.gov (United States)

Mackle, Diane; Nelson, Katherine

2018-04-20

This study explored the role of the research nurse in New Zealand (NZ) Level III intensive care units (ICU). Little was known about this role in NZ prior to this study. To describe the role and responsibilities of NZ ICU research nurses. A qualitative, descriptive approach, using semi structured interviews was used. The study was conducted in six Level III ICUs throughout NZ that employed a research nurse. Interviews were conducted with research nurses (n = 11), principal investigators (n = 6) and nurse managers (n = 6), and the findings were triangulated. The views across all ICUs and stakeholders were generally similar, with differences only being in some operational areas. This study found that the primary role of the research nurse was trial management, where they coordinated all elements of trial conduct. Almost half of the research nurses were involved in trial design through their positions on management committees. Research nurses also played a vital role in patient and trial advocacy, and they bridged the knowledge gap by bringing research to staff nurses, patients and their families. The majority of research nurses reported to a nursing line manager, and had an informal accountability to the PI. The role of NZ ICU research nurses is similar to their international counterparts. This study provides clarity about the research nurse role and showcases their key contribution in ensuring that NZ ICUs undertake high quality research, thus contributing to potential improvements for future patients' outcomes. Copyright © 2018 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Critical care nurses' experiences of nursing mothers in an ICU after complicated childbirth.

Science.gov (United States)

Engström, Asa; Lindberg, Inger

2013-09-01

Providing nursing care for a critically ill obstetric patient or a patient who has just become a mother after a complicated birth can be a challenging experience for critical care nurses (CCNs). These patients have special needs because of the significant alterations in their physiology and anatomy together with the need to consider such specifics as breastfeeding and mother-child bonding. The aim with this study was to describe CCNs' experience of nursing the new mother and her family after a complicated childbirth. The design of the study was qualitative. Data collection was carried out through focus group discussions with 13 CCNs in three focus groups during spring 2012. The data were subjected to qualitative content analysis. The analysis resulted in the formulation of four categories: the mother and her vital functions are prioritized; not being responsible for the child and the father; an environment unsuited to the new family and collaboration with staff in neonatal and maternity delivery wards. When nursing a mother after a complicated birth the CCNs give her and her vital signs high priority. The fathers of the children or partners of the mothers are expected to take on the responsibility of caring for the newborn child and of being the link with the neonatal ward. It is suggested that education about the needs of new families for nursing care would improve the situation and have clinical implications. Whether the intensive care unit is always the best place in which to provide care for mothers and new families is debatable. © 2013 British Association of Critical Care Nurses.

Factors affecting the nurse-patients' family communication in intensive care unit of kerman: a qualitative study.

Science.gov (United States)

Loghmani, Laleh; Borhani, Fariba; Abbaszadeh, Abbas

2014-03-01

The communication between nurses and patients' families impacts patient well-being as well as the quality and outcome of nursing care, this study aimed to demonstrated the facilitators and barriers which influence the role of communication among Iranian nurses and families member in ICU. This study is a qualitative study with content analysis. Participants were eight registered nurses and ten of patients' families. Patients were admitted to the ICU of two large university hospitals in Kerman, Iran. We used non-structured interviews for data collection. All interviews were transcribed verbatim with a simultaneous, constant comparative analysis of the audio tapes. According to data analysis, facilitative factors between nurses and families' communication consisted of spiritual care, emotional support, Participation, notification and consultation and barriers that were misunderstandings regarding treatment, job and patient difficulties. The findings led into the recognition of the important barriers and facilitators in communication between ICU team and the family of the patients. By identification of the barriers and facilitators of communication, establishing new rules and using creative methods in education and establishing the communication of ICU team especially using patient-based approach we can have effective communication.

Universal Pressure Ulcer Prevention Bundle With WOC Nurse Support.

Science.gov (United States)

Anderson, Megan; Finch Guthrie, Patricia; Kraft, Wendy; Reicks, Patty; Skay, Carol; Beal, Alan L

2015-01-01

This study examined the effectiveness of a universal pressure ulcer prevention bundle (UPUPB) applied to intensive care unit (ICU) patients combined with proactive, semiweekly WOC nurse rounds. The UPUBP was compared to a standard guideline with referral-based WOC nurse involvement measuring adherence to 5 evidence-based prevention interventions and incidence of pressure ulcers. The study used a quasi-experimental, pre-, and postintervention design in which each phase included different subjects. Descriptive methods assisted in exploring the content of WOC nurse rounds. One hundred eighty-one pre- and 146 postintervention subjects who met inclusion criteria and were admitted to ICU for more than 24 hours participated in the study. The research setting was 3 ICUs located at North Memorial Medical Center in Minneapolis, Minnesota. Data collection included admission/discharge skin assessments, chart reviews for 5 evidence-based interventions and patient characteristics, and WOC nurse rounding logs. Study subjects with intact skin on admission identified with an initial skin assessment were enrolled in which prephase subjects received standard care and postphase subjects received the UPUPB. Skin assessments on ICU discharge and chart reviews throughout the stay determined the presence of unit-acquired pressure ulcers and skin care received. Analysis included description of WOC nurse rounds, t-tests for guideline adherence, and multivariate analysis for intervention effect on pressure ulcer incidence. Unit assignment, Braden Scale score, and ICU length of stay were covariates for a multivariate model based on bivariate logistic regression screening. The incidence of unit-acquired pressure ulcers decreased from 15.5% to 2.1%. WOC nurses logged 204 rounds over 6 months, focusing primarily on early detection of pressure sources. Data analysis revealed significantly increased adherence to heel elevation (t = -3.905, df = 325, P pressure ulcers (P pressure ulcers.

Factors that contribute to physician variability in decisions to limit life support in the ICU: a qualitative study.

Science.gov (United States)

Wilson, Michael E; Rhudy, Lori M; Ballinger, Beth A; Tescher, Ann N; Pickering, Brian W; Gajic, Ognjen

2013-06-01

Our aim was to explore reasons for physician variability in decisions to limit life support in the intensive care unit (ICU) utilizing qualitative methodology. Single center study consisting of semi-structured interviews with experienced physicians and nurses. Seventeen intensivists from medical (n = 7), surgical (n = 5), and anesthesia (n = 5) critical care backgrounds, and ten nurses from medical (n = 5) and surgical (n = 5) ICU backgrounds were interviewed. Principles of grounded theory were used to analyze the interview transcripts. Eleven factors within four categories were identified that influenced physician variability in decisions to limit life support: (1) physician work environment-workload and competing priorities, shift changes and handoffs, and incorporation of nursing input; (2) physician experiences-of unexpected patient survival, and of limiting life support in physician's family; (3) physician attitudes-investment in a good surgical outcome, specialty perspective, values and beliefs; and (4) physician relationship with patient and family-hearing the patient's wishes firsthand, engagement in family communication, and family negotiation. We identified several factors which physicians and nurses perceived were important sources of physician variability in decisions to limit life support. Ways to raise awareness and ameliorate the potentially adverse effects of factors such as workload, competing priorities, shift changes, and handoffs should be explored. Exposing intensivists to long term patient outcomes, formalizing nursing input, providing additional training, and emphasizing firsthand knowledge of patient wishes may improve decision making.

Supportive leadership in Swedish community night nursing.

Science.gov (United States)

Gustafsson, Christine; Fagerberg, Ingegerd; Asp, Margareta

2010-10-01

The aim of the present study was to examine the support night nurses' give to staff in community night nursing. Studies have shown that support given to staff is one of night registered nurses' (RNs') experiences of the meaning of caring. This support, that community RNs display for staff in night-time care, is sparsely described. All community night-duty nurses in a medium-sized municipal in Sweden participated in the present study. Thematic content analysis was used to analyse data from observations. The support given by RNs to staff is described using three themes: (1) a conditional supporting stance, (2) preparing propitious conditions for caring and (3) confidence in the abilities of individual staff members and adaptation to their individual needs. The results reveal that RNs consider support to staff in terms of nursing leadership. Out of 'concern for the staff' the RNs try to be there for them, which corresponds to nursing leadership. Such concern also arises from the RNs' awareness that by giving support to staff this affects the staffs' caring for older people. The current municipal social care organization of community nursing of older people in which RNs have extensive responsibilities with insufficient control, is a working condition with a risk for decreased quality of care and a high risk for work-related stress syndrome. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

A Systematic Review of the Liaison Nurse Role on Patient’s Outcomes after Intensive Care Unit Discharge

OpenAIRE

Tabanejad, Zeinab; Pazokian, Marzieh; Ebadi, Abbas

2014-01-01

Background: This review focuses on the impact of liaison nurse in nursing care of patient after ICU discharge on patient’s outcomes, compared with patients that are not taken care of by liaison nurses. The role of the ICU liaison nurse has transpired to solve the gap between intensive care unit and wards. Therefore, we aimed to review the outcomes of all studies in this field. Methods: A systematic review of intervention studies between 2004 and 2013 was undertaken using standard and sensitiv...

Job burnout among critical care nurses from 14 adult intensive care units in northeastern China: a cross-sectional survey

Science.gov (United States)

Zhang, Xiao-Chun; Huang, De-Sheng; Guan, Peng

2014-01-01

Objectives The shortage of qualified nurses is one of the critical challenges in the field of healthcare. Among the contributing factors, job burnout has been indicated as a risk factor for the intention to leave. The purpose of this study was to provide a better understanding of the local status and reference data for coping strategies for intensive care unit (ICU)-nurse burnout among Liaoning ICU nurses. Design Observational study. Setting 17 ICUs from 10 tertiary-level hospitals in Liaoning, China. Participants 431 ICU nurses from 14 ICUs nested in 10 tertiary-level hospitals in Liaoning, China, were invited during October and November 2010. Primary measures Burnout was measured using the 22-item Chinese version of Maslach Burnout Inventory-Health Service Survey (MBI-HSS) questionnaires. Results 14 ICUs responded actively and were included; the response rate was 87.7% among the 486 invited participants from these 17 ICUs. The study population was a young population, with the median age 25 years, IQR 23–28 years and female nurses accounted for the major part (88.5%). 68 nurses (16%) were found to have a high degree of burnout, earning high emotional exhaustion and depersonalisation scores together with a low personal accomplishment score. Conclusions The present study indicated a moderate distribution of burnout among ICU nurses in Liaoning, China. An investigation into the burnout levels of this population could bring more attention to ICU caregivers. PMID:24948747

Optimizing Oxygenation in the Mechanically Ventilated Patient: Nursing Practice Implications.

Science.gov (United States)

Barton, Glenn; Vanderspank-Wright, Brandi; Shea, Jacqueline

2016-12-01

Critical care nurses constitute front-line care provision for patients in the intensive care unit (ICU). Hypoxemic respiratory compromise/failure is a primary reason that patients require ICU admission and mechanical ventilation. Critical care nurses must possess advanced knowledge, skill, and judgment when caring for these patients to ensure that interventions aimed at optimizing oxygenation are both effective and safe. This article discusses fundamental aspects of respiratory physiology and clinical indices used to describe oxygenation status. Key nursing interventions including patient assessment, positioning, pharmacology, and managing hemodynamic parameters are discussed, emphasizing their effects toward mitigating ventilation-perfusion mismatch and optimizing oxygenation. Copyright © 2016 Elsevier Inc. All rights reserved.

The effect of massage therapy on occupational stress of Intensive Care Unit nurses.

Science.gov (United States)

Nazari, Fateme; Mirzamohamadi, Mojtaba; Yousefi, Hojatollah

2015-01-01

One of the main causes of stress in the lives of people is their jobs. Occupational stress is causing a wide range of significant issues in health and community services. Nursing is the most stressful profession in the health services. Massage therapy is one way of coping with stress. This study was conducted to determine the effect of massage therapy on stress in nurses. This study was a clinical trial on 66 male and female nurses working in intensive care units (dialysis, ICU, and CCU) of Isfahan University of Medical Sciences, Iran, in 2013. Participants were selected according to the aims and inclusion criteria of the study. Then, they were randomly divided into experimental and control groups. The Occupational Stress Inventory (OSI) (Osipow and Spokane, 1987) was completed by participants of the two groups before, immediately after, and 2 weeks after the intervention. General Swedish massage was performed on participants of the experimental group for 25 min in each session, twice a week for 4 weeks. Data were analyzed by descriptive and inferential statistics [Chi-square, t-test, and repeated measures analysis of variance (ANOVA)] using SPSS software. Results showed that the difference in overall mean occupation stress scores between experimental and control groups 2 weeks after the intervention was significant (P < 0.001). According to the results, it is recommended that massage, as a valuable noninvasive method, be used for nurses in intensive care units to reduce their stress, promote mental health, and prevent the decrease in quality of nursing work life.

An integrative review of supports, facilitators and barriers to patient-centred nursing in the intensive care unit.

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Jakimowicz, Samantha; Perry, Lin; Lewis, Joanne

2017-12-01

To systematically review the literature describing factors perceived by nurses as impacting the provision of patient-centred nursing in the intensive care unit. Patient-centred nursing in critical care differs from other healthcare areas, and the aggressive curative environment of the ICU has potential to compromise some of its elements. Understanding critical care, nurses' perceptions of promoting and deterrent factors may inform development of strategies to support effective patient-centred nursing and job satisfaction in this workforce. An integrative literature review. Whittemore and Knafl's method was used with "best-fit" framework synthesis. CINAHL, PsycINFO, Medline and EMBASE were searched for 2000-2016 literature using search terms drawn from the ICU patient-centred framework. In total, 3,079 papers were identified, with 23 retained after applying eligibility criteria. Five themes were identified: Nurse identity; Organisation; Communication; Relationships; and Ideology of ICU. Almost every theme and related categories referred to factors acting as barriers to patient-centred nursing in the ICU; only four referred to supports/facilitators. Findings showed that provision of patient-centred nursing may be compromised by some factors of the critical care environment, and illustrate the challenges and complexity of providing effective patient-centred nursing in this environment. Findings should be applied to address barriers and to enhance facilitators of effective patient-centred nursing in critical care. The emotional and physical demands of critical care nursing are major considerations; supporting these nurses to fulfil their challenging role may empower them in their professional quality of life and provide a basis for workforce retention as well as delivery of effective patient-centred nursing. Measures to enhance patient-centred nursing could promote critical care nurses' job satisfaction and workforce retention, and be applied more broadly and

Mapping VIPS Concepts for Nursing Interventions to the ISO Reference Terminology Model for Nursing Actions: A Collaborative Scandinavian Analysis

DEFF Research Database (Denmark)

Lauge Berring, Lene; Ehnfors, Margareta; Angermo, Lilly

2005-01-01

The aims of this study were to analyze the coherence between the concepts for nursing interventions in the Swedish VIPS model for nursing recording and the ISO Reference Terminology Model for Nursing Actions and to identify areas in the two models for further development. Seven Scandinavian experts...

Analysis of death anxiety levels in nursing staff of critical care units

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Mª Cristina Pascual Fernández

2011-01-01

Full Text Available When the patients are in the end-of-life, the cares would focus to favor a good death, for that reason the nursing staff must know how to integrate the death like a part of the life, being avoided that produces anxiety to them before the possibility of taking part its own fears to the death. The core of nursing staff in intensive care units is to maintain life of their patients, reason why the end-of life in them is not easy or natural.Objective: Evaluate the death anxiety levels in intensive care nursing staff.Material and method: An observational study was conducted descriptive cross hospital adult and Paediatric ICU General University Gregorio Marañón Hospital, through survey to nurses and auxiliary nurses of those units.The anxiety inventory was used to Death (Death Anxiety Inventory [DAI] for the assessment of anxiety before death. Outcomes: Paediatric ICU nurses have higher levels of anxiety that the adult ICU as well as the less experienced professionals and those declared not feel trained in the subject.Conclusions: Experience and the training are key elements that help professionals face to death, from management we must ensure that patients in stage terminal are served by professionals with this profile.

Intensive Care Unit Nurses' Beliefs About Delirium Assessment and Management.

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Oosterhouse, Kimberly J; Vincent, Catherine; Foreman, Marquis D; Gruss, Valerie A; Corte, Colleen; Berger, Barbara

2016-10-01

Delirium, the most frequent complication of hospitalized older adults, particularly in intensive care units (ICUs), can result in increased mortality rates and length of stay. Nurses are neither consistently identifying nor managing delirium in these patients. The purpose of this study was to explore ICU nurses' identification of delirium, actions they would take for patients with signs or symptoms of delirium, and beliefs about delirium assessment and management. In this cross-sectional study using qualitative descriptive methods guided by the theory of planned behavior, 30 ICU nurses' responses to patient vignettes depicting different delirium subtypes were explored. Descriptive and content analyses revealed that nurses did not consistently identify delirium; their actions varied in different vignettes. Nurses believed that they needed adequate staffing, balanced workload, interprofessional collaboration, and established policy and protocols to identify and manage delirium successfully. Research is needed to determine if implementing these changes increases recognition and decreases consequences of delirium. ©2016 American Association of Critical-Care Nurses.

The Research Agenda in ICU Telemedicine

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Hill, Nicholas S.; Lilly, Craig M.; Angus, Derek C.; Jacobi, Judith; Rubenfeld, Gordon D.; Rothschild, Jeffrey M.; Sales, Anne E.; Scales, Damon C.; Mathers, James A. L.

2011-01-01

ICU telemedicine uses audiovisual conferencing technology to provide critical care from a remote location. Research is needed to best define the optimal use of ICU telemedicine, but efforts are hindered by methodological challenges and the lack of an organized delivery approach. We convened an interdisciplinary working group to develop a research agenda in ICU telemedicine, addressing both methodological and knowledge gaps in the field. To best inform clinical decision-making and health policy, future research should be organized around a conceptual framework that enables consistent descriptions of both the study setting and the telemedicine intervention. The framework should include standardized methods for assessing the preimplementation ICU environment and describing the telemedicine program. This framework will facilitate comparisons across studies and improve generalizability by permitting context-specific interpretation. Research based on this framework should consider the multidisciplinary nature of ICU care and describe the specific program goals. Key topic areas to be addressed include the effect of ICU telemedicine on the structure, process, and outcome of critical care delivery. Ideally, future research should attempt to address causation instead of simply associations and elucidate the mechanism of action in order to determine exactly how ICU telemedicine achieves its effects. ICU telemedicine has significant potential to improve critical care delivery, but high-quality research is needed to best inform its use. We propose an agenda to advance the science of ICU telemedicine and generate research with the greatest potential to improve patient care. PMID:21729894

Vitamin D deficiency in elderly people in Swedish nursing homes is associated with increased mortality.

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Samefors, Maria; Östgren, Carl Johan; Mölstad, Sigvard; Lannering, Christina; Midlöv, Patrik; Tengblad, Anders

2014-05-01

Institutionalised elderly people at northern latitudes may be at elevated risk for vitamin D deficiency. In addition to osteoporosis-related disorders, vitamin D deficiency may influence several medical conditions conferring an increased mortality risk. The aim of this study was to explore the prevalence of vitamin D deficiency and its association with mortality. The Study of Health and Drugs in the Elderly (SHADES) is a prospective cohort study among elderly people (>65 years) in 11 nursing homes in Sweden. We analysed the levels of 25-hydroxyvitamin D₃ (25(OH)D₃) at baseline. Vital status of the subjects was ascertained and hazard ratios (HRs) for mortality according to 25(OH)D₃ quartiles were calculated. We examined 333 study participants with a mean follow-up of 3 years. A total of 147 (44%) patients died within this period. Compared with the subjects in Q4 (25(OH)D₃ >48  nmol/l), HR (with 95% CI) for mortality was 2.02 (1.31-3.12) in Q1 (25(OH)D₃ D₃ 30-37  nmol/l) (PD₃ 38-47  nmol/l) (PD₃ concentration was 40.2  nmol/l (S.D. 16.0) and 80% had 25(OH)D₃ below 50  nmol/l. The vitamin D levels decreased from baseline to the second and third measurements. Vitamin D deficiency was highly prevalent and associated with increased mortality among the elderly in Swedish nursing homes. Strategies are needed to prevent, and maybe treat, vitamin D deficiency in the elderly in nursing homes and the benefit of vitamin D supplementation should be evaluated in randomised clinical trials.

False Alarms and Overmonitoring: Major Factors in Alarm Fatigue Among Labor Nurses.

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Simpson, Kathleen Rice; Lyndon, Audrey

2018-06-08

Nurses can be exposed to hundreds of alarms during their shift, contributing to alarm fatigue. The purposes were to explore similarities and differences in perceptions of clinical alarms by labor nurses caring for generally healthy women compared with perceptions of adult intensive care unit (ICU) and neonatal ICU nurses caring for critically ill patients and to seek nurses' suggestions for potential improvements. Nurses were asked via focus groups about the utility of clinical alarms from medical devices. There was consensus that false alarms and too many devices generating alarms contributed to alarm fatigue, and most alarms lacked clinical relevance. Nurses identified certain types of alarms that they responded to immediately, but the vast majority of the alarms did not contribute to their clinical assessment or planned nursing care. Monitoring only those patients who need it and only those physiologic values that are warranted, based on patient condition, may decrease alarm burden.

Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study.

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Vahedian-Azimi, Amir; Hajiesmaeili, Mohammadreza; Kangasniemi, Mari; Fornés-Vives, Joana; Hunsucker, Rita L; Rahimibashar, Farshid; Pourhoseingholi, Mohammad A; Farrokhvar, Leily; Miller, Andrew C

2017-01-01

Health care is a demanding field, with a high level of responsibility and exposure to emotional and physical danger. High levels of stress may result in depression, anxiety, burnout syndrome, and in extreme cases, post-traumatic stress disorder. The aim of this study was to determine which personal, professional, and organizational variables are associated with greater perceived stress among critical care nurses for purposes of developing integrative solutions to decrease stress in the future. We conducted a correlation research survey using a cross-sectional design and an in-person survey method. The questionnaire consisted of 2 parts: (1) socioeconomic, professional, and institutional variables and (2) work stressors. Surveys were conducted between January 1, 2011, and December 1, 2015. Multistage cluster random sampling was utilized for data collection. Inclusion criteria were (1) age ≥18 years, (2) registered nurse, (3) works in the intensive care unit (ICU), and (4) willing and able to complete the survey. We surveyed 21 767 ICU nurses in Iran and found that male sex, lower levels of peer collaboration, working with a supervisor in the unit, nurse-patient ratios, and working in a surgical ICU were positively associated with greater stress levels. Increasing age and married status were negatively associated with stress. Intensive care unit type (semi-closed vs open), ICU bed number, shift time, working on holidays, education level, and demographic factors including body mass index, and number of children were not significantly associated with stress levels. As the largest study of its kind, these findings support those found in various European, North, and South American studies. Efforts to decrease workplace stress of ICU nurses by focusing on facilitating peer collaboration, improving resource availability, and staffing ratios are likely to show the greatest impact on stress levels.

NURSES’ PERCEPTIONS OF COMMUNICATION TRAINING IN THE ICU

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Radtke, Jill V.; Tate, Judith A.; Happ, Mary Beth

2011-01-01

Summary Objective To describe the experience and perceptions of nurse study participants regarding a communication intervention (training and communication tools) for use with nonspeaking, critically-ill patients. Research Methodology/Design Small focus groups and an individual interview were conducted with six critical care nurses. Transcripts were analysed using qualitative content analysis and constant comparison. Setting Two ICUs within a large, metropolitan medical centre in western Pennsylvania, United States of America. Main Outcome Measures Critical care nurses’ evaluations of (1) a basic communication skills training program (BCST) and (2) augmentative and alternative communication strategies (AAC) introduced during their study participation. Results Six main categories were identified in the data: 1) communication value/perceived competence; 2) communication intention; 3) benefits of training; 4) barriers to implementation; 5) preferences/utilization of strategies; and 6) leading-following. Perceived value of and individual competence in communication with nonspeaking patients varied. Nurses prioritized communication about physical needs, but recognized complexity of other intended patient messages. Nurses evaluated the BCST as helpful in reinforcing basic communication strategies and found several new strategies effective. Advanced strategies received mixed reviews. Primary barriers to practice integration included patients’ mental status, time constraints, and the small proportion of nurses trained or knowledgeable about best patient communication practices in the ICU. Conclusions The results suggest that the communication skills training program could be valuable in reinforcing basic/intuitive communication strategies, assisting in the acquisition of new skills, and ensuring communication supply availability. Practice integration will likely require unit-wide interdisciplinary dissemination, expert modelling and reinforcement. PMID:22172745

Exploring Communication Challenges Between Nurses and Mechanically Ventilated Patients in the Intensive Care Unit: A Structured Review.

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Dithole, Kefalotse; Sibanda, Sambulelwe; Moleki, Mary M; Thupayagale-Tshweneagae, Gloria

2016-06-01

Mechanical ventilation is a necessary procedure for patients with a range of illnesses and conditions. Mechanical ventilation affects voice production, leaving patients unable to communicate their needs with nurses and family. The communication difficulty causes distress, frustration, and anger if not attended to. This structured review sought to identify communication challenges which exist between nurses and mechanically ventilated patients in intensive care units (ICU) and hence explore possible solutions to improve these communication challenges. A electronic search of MEDLINE, CINAHL, and PsycINFO was conducted to identify relevant literature on nurse-patient communication challenges in the ICU published between January 2005 and December 2014. Studies meeting the inclusion criteria were retrieved in full, reviewed, and study quality assessed. Six studies were identified for inclusion in the review. Analysis identified five core influences on communication in the ICU: patient's consciousness level, nature of nurse-patient interactions, communication methods, staff skills and perceptions, and the intensive care physical environment. An evidence-based and multifactorial communication intervention encompassing staff skills development and training, development of relevant patient materials or devices and collaborations with relevant health professionals like speech and language therapists has the potential to improve nurse-patient communication in the ICU and hence improve patient outcomes. © 2016 Sigma Theta Tau International.

Frequency of nosocomial pneumonia in ICU Qazvin Razi hospital (2013

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S. Makhlogi

2016-12-01

Full Text Available Background: Nosocomial pneumonia is the most prevalent cause of hospital-acquired infection in intensive care units (ICU. The aim of this research was to detect the frequency and predisposing factors of nosocomial Ventilator Associated Pneumonia, by cross sectional study on 188 patients that were hospitalized in ICU Qazvin Razi Hospital. Using questionnaire based on the national nosocomial infection surveillance system (NNIS data collected and analyzed. The average age of patients was 51±24 years old, 37 hospitalized patients (19/6% in the fourth day of admission were affected Ventilator Associated Pneumonia. The most common pathogenesis of causing nosocomial pneumonia were klebsiella in 13 patients (35/1%, staph in 8 patients (21/6%, sodomona in 8 patients (21/6%, ecoli in 3 patients (8/1%, cetrobacter in 2 patients (5/4%, antrococus and Proteus each of them in 1 patient (each 2/7%. Considering (19/6% frequency of nosocomial pneumonia in this study, it’s necessary to act standard protocols in nursing care and medication process.

Swedish district nurses' attitudes to implement information and communication technology in home nursing.

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Nilsson, Carina; Skär, Lisa; Söderberg, Siv

2008-01-01

The use of information and communication technology has increased in the society, and can be useful in nursing care. The aim of this study was to describe district nurses' attitudes regarding the implementation of information and communication technology in home nursing. The first and third authors performed five focus group discussions with 19 district nurses' from five primary healthcare centres in northern Sweden. During the focus group discussions, the following topics were discussed: the current and future use of information and communication technology in home nursing; expectations, advantages, disadvantages and hindrances in the use of information and communication technology in home nursing; and the use of information and communication technology from an ethical perspective. The transcribed focus group discussions were analysed using qualitative content analysis. The results showed that district nurses' attitudes were positive regarding the use of information and communication technology in their work. They also asked for possibilities to influence the design and its introduction. However, the use of information and communication technology in home nursing can be described as a complement to communication that could not replace human physical encounters. Improvements and risks, as well as the importance of physical presence in home nursing were considered vital. The results revealed that the use of information and communication technology requires changes in the district nurses' work situation.

Design and implementation of a virtual world training simulation of ICU first hour handover processes.

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Brown, Ross; Rasmussen, Rune; Baldwin, Ian; Wyeth, Peta

2012-08-01

Nursing training for an Intensive Care Unit (ICU) is a resource intensive process. High demands are made on staff, students and physical resources. Interactive, 3D computer simulations, known as virtual worlds, are increasingly being used to supplement training regimes in the health sciences; especially in areas such as complex hospital ward processes. Such worlds have been found to be very useful in maximising the utilisation of training resources. Our aim is to design and develop a novel virtual world application for teaching and training Intensive Care nurses in the approach and method for shift handover, to provide an independent, but rigorous approach to teaching these important skills. In this paper we present a virtual world simulator for students to practice key steps in handing over the 24/7 care requirements of intensive care patients during the commencing first hour of a shift. We describe the modelling process to provide a convincing interactive simulation of the handover steps involved. The virtual world provides a practice tool for students to test their analytical skills with scenarios previously provided by simple physical simulations, and live on the job training. Additional educational benefits include facilitation of remote learning, high flexibility in study hours and the automatic recording of a reviewable log from the session. To the best of our knowledge, we believe this is a novel and original application of virtual worlds to an ICU handover process. The major outcome of the work was a virtual world environment for training nurses in the shift handover process, designed and developed for use by postgraduate nurses in training. Copyright © 2012 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Severity and workload of nursing with patients seeking admission to an intensive care unit

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Meire Cristina Novelli e Castro

2017-12-01

Full Text Available Abstract Objective: To identify the severity and workload of nursing with adult patients seeking admission to an Intensive Care Unit (ICU. Methods: A cross-sectional study with a quantitative, exploratory and prospective approach was performed, developed in a hospital in the state of São Paulo. Demographic data on patients were collected, the Simplified Acute Physiology Score III (SAPS III was applied to assess the severity of patients and the Nursing Activities Score (NAS was used to evaluate nursing workload, between July and August 2014. Results: The overall mean score of the SAPS III was 30.52 ± 18.39 and that of the NAS was 58.18 ± 22.29. The group of patients admitted to the ICU showed higher severity and higher workload of nursing compared to non-admitted patients. Non-admitted patients had an NAS of 53.85. Conclusion: The nursing workload in patients who were not admitted to the ICU was also high. The evaluation of workload in other contexts where patients are seriously ill is important. The workload assessment in other contexts where severely ill patients are found is evident.

Questionnaire survey on the use of a novel artificial pancreas by intensive care unit nurses.

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Mibu, Kiyo; Yatabe, Tomoaki; Yamasaki, Fumiyasu; Kitagawa, Hiroyuki; Munekage, Masaya; Namikawa, Tsutomu; Hanazaki, Kazuhiro

2015-06-01

The introduction of a color liquid-crystal display (LCD) on a novel artificial pancreas (STG-55, Nikkiso Co. Ltd. Tokyo, Japan) allowed nurses to more easily monitor changes in patients' blood glucose levels, compared to the previous model (STG-22). This study was conducted to examine the hypothesis that the STG-55 provided nurses with a feeling of security due to the introduction of the LCD screen. A questionnaire survey was conducted 6 months after the STG-55 was introduced (Survey 2012), among intensive care unit (ICU) nurses who had used both the STG-22 and the STG-55 for patient glycemic control. The results were then compared with the results from a questionnaire survey that was conducted after the STG-22 was introduced (Survey 2006). All ICU nurses (n = 19) responded to Survey 2012, and 95% of these nurses had responded to Survey 2006 (n = 19). After the introduction of the STG-22, 11 nurses (58%) reported becoming conscious of anxiety regarding hypoglycemia when they performed conventional glucose control with the sliding scale method. This anxiety awareness increased significantly (19 nurses, 100%; p survey indicate that all ICU nurses became conscious of anxiety regarding the risk of hypoglycemia when using the conventional sliding scale method after the introduction of the STG-55. However, the respondents were not satisfied with the STG-55, due to difficulties encountered during blood withdrawal.

[TYPE A BEHAVIOUR AS A PREDICTOR OF BURNOUT AND JOB SATISFACTION IN INTENSIVE CARE UNITS NURSES].

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Włodarczyk, Dorota; Pawliszewska, Anna

2015-01-01

Working at intensive care unit (ICU) is one ot the most difticult and taxing nursing speciaites. It demans not only extensive knowledge and professional skills but also specific personality temperamental dispositions. The aim of the study was to verify if typeA behavior (TAB) is a predictor ofburnout and job satisfaction in ICU nurses and if this effect still exists after controlling for selected demographic and job characteristics. The study group consisted of 99 nurses (77 women), aged 24-58 (mean (M) = 32.33; standard deviation (SD) = 8:81) working at ICU. The following tools were used: to measure TAB - Type A Behavior Survey BWZ by Wrzesniewski; job burnout - the Oldenburg Burnout Inventory OLBI by Demerouti et al.; and job satisfaction - the Job Satisfaction Scale by Zalewska. The results of hierarchical regression analyses showed that after controlling for selected demographic and job characteristics, tendency for aggressibn was a predictor of higher exhaustion, disengagement and lower job satisfaction. Achievement striving and tendency to dominate were related to higher job satisfaction and lower exhaustion, respectively. Significant predictors of professional functioning were also: duty work system, place of living and gender. The results of the study.confirmed that all 3 content features of TAB were significant predictors of job functioning of ICU nurses. They also indicate that considering TAB in the context of individual adjustment to the environment of the job at ICU would be a valuable direction forfuture research.

Inpatient Nursing and Parental Comfort in Managing Pediatric Tracheostomy Care and Emergencies.

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Pritchett, Cedric V; Foster Rietz, Melissa; Ray, Amrita; Brenner, Michael J; Brown, David

2016-02-01

Tracheostomy is a critical and often life-saving intervention, but associated risks are not negligible. The vulnerability of the pediatric population underlies the importance of caregiver comfort and competence in tracheostomy care. To assess inpatient nursing staff and parental perspectives in managing tracheostomy care. Cross-sectional analysis of survey data from (1) a volunteer sample of inpatient nurses in a tertiary care, freestanding pediatric hospital in the Midwest, assigned to clinical wards that provide care for children with tracheostomy tubes and (2) a consecutive sample of families whose child underwent tracheostomy tube placement at the same institution between March 1 and December 31, 2013. Nurse and parental comfort in managing acute and established tracheostomy tubes. Nursing data were analyzed with attention to years' experience and primary unit of practice. Respondents included 129 of 820 nurses (16% response rate) and family members of 19 of 38 children (50% response rate). When queried about changing established tracheostomies, 59 of 128 nurses (46%) reported being "totally comfortable," including 46 of 82 intensive care unit (ICU) nurses (56%) vs 13 of 46 floor nurses (28%) (P = .002) and 48 of 80 nurses with at least 5 years' experience (60%) vs 12 of 49 less experienced nurses (24%) (P tracheostomy, 61 nurses (47%) described being completely uncomfortable, including 27 of 83 ICU nurses (33%) vs 34 of 46 floor nurses (73%) (P = .006), and 33 of 80 nurses with at least 5 years' experience (41% ) vs 28 of 49 less experienced nurses (57%) (P = .03). Most families felt prepared for discharge (16 of 17 [94%]) and found the health care team accessible (16 of 17 [94%]), although only 5 of 18 families (28%) indicated that tracheostomy teaching was consistent. Nurses' comfort with tracheostomy was higher among nurses with at least 5 years' experience and primary ICU location. Whereas parental comfort with tracheostomy care was high

Dignity-conserving care actions in palliative care: an integrative review of Swedish research.

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Harstäde, Carina Werkander; Blomberg, Karin; Benzein, Eva; Östlund, Ulrika

2018-03-01

Previous research has proposed that persons in need of palliative care often have a loss of functions and roles that affects social and existential self-image. Moreover, these individuals also commonly suffer from complex multisymptoms. This, together with the situation of facing an impending death, can lead to a loss of dignity. Therefore, supporting these persons' dignity is a crucial challenge for professional nurses. The 'Dignity Care Intervention' addresses the multidimensionality of dignity by identifying patients' dignity-related concerns and suggests care actions to address them. At the present, the Dignity Care Intervention is adapted for implementation in Swedish care settings. Because expressions of dignity are influenced by culture, and an overview of care actions in a Swedish context is lacking, this integrative review aimed to find suggestions from Swedish research literature on what kind of care actions can preserve dignity. An integrative literature review was conducted using the databases SwePub and SweMed+. Articles published from 2006 to 2015 and theses published from 2000 to 2015 were searched for using the terms 'dignity' and 'palliative care'. Result sections of articles and theses were reviewed for dignity-conserving care actions synthesised by thematic analysis and categorised under themes and subthemes in Chochinov's model of dignity. Fifteen articles and 18 theses were included together providing suggestions of care actions in all themes and subthemes in the dignity model. Suggested care actions included listening, communication, information, symptom control, facilitating daily living and including patients in decision-making. Additionally, nurses' perceptiveness towards the patients was a core approach. The review offers culturally relevant suggestions on how to address specific dignity-related concerns. The adapted Dignity Care Intervention will be a way for Swedish nurses to provide person-centred palliative care that will conserve

Finding your way through EOL challenges in the ICU using Adaptive Leadership behaviours: A qualitative descriptive case study.

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Adams, Judith A; Bailey, Donald E; Anderson, Ruth A; Thygeson, Marcus

2013-12-01

Using the Adaptive Leadership framework, we describe behaviours that providers used while interacting with family members facing the challenges of recognising that their loved one was dying in the ICU. In this prospective pilot case study, we selected one ICU patient with end-stage illness who lacked decision-making capacity. Participants included four family members, one nurse and two physicians. The principle investigator observed and recorded three family conferences and conducted one in-depth interview with the family. Three members of the research team independently coded the transcripts using a priori codes to describe the Adaptive Leadership behaviours that providers used to facilitate the family's adaptive work, met to compare and discuss the codes and resolved all discrepancies. We identified behaviours used by nurses and physicians that facilitated the family's ability to adapt to the impending death of a loved one. Examples of these behaviours include defining the adaptive challenges for families and foreshadowing a poor prognosis. Nurse and physician Adaptive Leadership behaviours can facilitate the transition from curative to palliative care by helping family members do the adaptive work of letting go. Further research is warranted to create knowledge for providers to help family members adapt. Copyright © 2013 Elsevier Ltd. All rights reserved.

A Nationwide Census of ICU Capacity and Admissions in Mongolia.

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Naranpurev Mendsaikhan

Full Text Available In Mongolia, a Central Asian lower-middle income country, intensive care medicine is an under-resourced and-developed medical specialty. The burden of critical illness and capacity of intensive care unit (ICU services in the country is unknown. In this nationwide census, we collected data on adult and pediatric/neonatal ICU capacities and the number of ICU admissions in 2014. All hospitals registered to run an ICU service in Mongolia were surveyed. Data on the availability of an adult and/or pediatric/neonatal ICU service, the number of available ICU beds, the number of available functional mechanical ventilators, the number of patients admitted to the ICU, and the number of patients admitted to the study hospital were collected. In total, 70 ICUs with 349 ICU beds were counted in Mongolia (11.7 ICU beds/100,000 inhabitants; 1.7 ICU beds/100 hospital beds. Of these, 241 (69% were adult and 108 (31% pediatric/neonatal ICU beds. Functional mechanical ventilators were available for approximately half of the ICU beds (5.1 mechanical ventilators/100,000 inhabitants. While all provincial hospitals ran a pediatric/neonatal ICU, only dedicated pediatric hospitals in Ulaanbaatar did so. The number of adult and pediatric/neonatal ICU admissions varied between provinces. The number of adult ICU beds and adult ICU admissions per 100,000 inhabitants correlated (r = 0.5; p = 0.02, while the number of pediatric/neonatal ICU beds and pediatric/neonatal ICU admissions per 100,000 inhabitants did not (r = 0.25; p = 0.26. In conclusion, with 11.7 ICU beds per 100,000 inhabitants the ICU capacity in Mongolia is higher than in other low- and lower-middle-income countries. Substantial heterogeneities in the standardized ICU capacity and ICU admissions exist between Mongolian provinces. Functional mechanical ventilators are available for only half of the ICU beds. Pediatric/neonatal ICU beds make up one third of the national ICU capacity and appear to meet or even

Ergonomic relationship during work in nursing staff of intensive care unit with operating room

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Yousef Mahmoudifar

2017-01-01

Full Text Available Background and Objectives: High prevalence of work-related musculoskeletal disorders, especially in jobs such as nursing which covers tasks like patients' repositioning, has attracted great attentions from occupational healthcare experts to necessitate the knowledge of ergonomic science. Therefore, this study was performed aiming at ergonomic relationship during work in nursing staff of Intensive Care Unit (ICU with operating room. Materials and Methods: In this descriptive-analytical study (cohort, fifty personnel of ICU staff and fifty of operating room staff were selected through a census method and were assessed using tools such as Nordic questionnaire and Rapid Entire Body Assessment (REBA standards in terms of body posture ergonomics. The obtained data were analyzed by SPSS software and Chi-Square test after collection. Results: The most complaints were from the operating room group (68% and ICU staff (60% for the lumbar musculoskeletal system. There was a significant relationship between the total REBA scores of body, legs, neck, arm, force status, load fitting with hands and static or dynamic activities in the operating room and ICU staff groups (P < 0.05. In operating room and ICU groups, most subjects obtained score 11–15 and very high-risk level. Conclusion: Nurses working at operating room and ICU ward are subjected to high-risk levels and occupational injuries which is dramatically resulted from inappropriate body posture or particular conditions of their works. As a result, taking corrective actions along with planning and identifying ways will help prohibiting the prevalence of disorders in the future.

Scope of Nursing Care in Polish Intensive Care Units

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Mariusz Wysokiński

2013-01-01

Full Text Available Introduction. The TISS-28 scale, which may be used for nursing staff scheduling in ICU, does not reflect the complete scope of nursing resulting from varied cultural and organizational conditions of individual systems of health care. Aim. The objective of the study was an attempt to provide an answer to the question what scope of nursing care provided by Polish nurses in ICU does the TISS-28 scale reflect? Material and Methods. The methods of working time measurement were used in the study. For the needs of the study, 252 hours of continuous observation (day-long observation and 3.697 time-schedule measurements were carried out. Results. The total nursing time was 4125.79 min. (68.76 hours, that is, 60.15% of the total working time of Polish nurses during the period analyzed. Based on the median test, the difference was observed on the level of χ2=16945.8, P<0.001 between the nurses’ workload resulting from performance of activities qualified into the TISS-28 scale and load resulting from performance of interventions within the scopes of care not considered in this scale in Polish ICUs. Conclusions. The original version of the TISS-28 scale does not fully reflect the workload among Polish nurses employed in ICUs.

National survey focusing on the crucial information needs of intensive care charge nurses and intensivists: same goal, different demands.

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Lundgrén-Laine, Heljä; Kontio, Elina; Kauko, Tommi; Korvenranta, Heikki; Forsström, Jari; Salanterä, Sanna

2013-01-29

Although information technology adequately supports clinical care in many intensive care units (ICUs), it provides much poorer support for the managerial information needed to coordinate multi-professional care. To gain a general view of the most crucial multi-professional information needs of ICU shift leaders a national survey was conducted, focusing on the information needs of charge nurses and intensivists. Based on our previous observation study an online survey was developed, containing 122 information need statements related to the decision-making of ICU shift leaders. Information need statements were divided into six dimensions: patient admission, organisation and management of work, allocation of staff and material resources, special treatments, and patient discharge. This survey involved all ICU shift leaders (n = 738) who worked in any of the 17 highest level ICUs for adults in university hospitals in Finland during the autumn of 2009. Both charge nurses' and intensivists' crucial information needs for care coordination were evaluated. Two hundred and fifty-seven (50%) charge nurses and 96 (43%) intensivists responded to the survey. The consistency of the survey was found to be good (Cronbach's α scores between .87-.97, with a total explanatory power of 64.53%). Altogether, 57 crucial information needs for care coordination were found; 22 of which were shared between shift leaders. The most crucial of these information needs were related to organisation and management, patient admission, and allocation of staff resources. The associations between working experience, or shift leader acting frequencies, and crucial information needs were not statistically significant. However, a statistically significant difference was found between the number of ICU beds and the ICU experience of charge nurses with information needs, under the dimension of organisation and management of work. The information needs of charge nurses and intensivists differed. Charge nurses

The Facilitators and Barriers to Communication between Nurses and Family Member in Intensive Care Unit in Kerman, Iran

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Laleh loghmani

2014-02-01

Full Text Available Introduction: The communication between nurses and patients' families is commun- ication significantly impacts patient well-being as well as the quality and outcome of nursing care, this study aimed to demonstrated the facilitators and barriers which influence the role of communication among Iranian nurses and families member in ICU. Methods: This study was conducted by the grounded theory method. Participants comprised eight registered nurses and ten families. Patients were admitted to the ICU of two large university hospitals in Kerman, Iran. We used non-structured interviews for data collection. All interviews were transcribed verbatim with a simultaneous, constant comparative analysis of the audio tapes performed according to the Strauss and Corbin method (1998. Results: According to data analysis, Facilitative factors between nurses and families' communication consisted of two categories, i spiritual care, emotional support, Participation, notification and consultation and Barriers that were three categories: i misunderstandings regarding treatment ii job and iii patient difficulties.Conclusion: The findings led into the recognition of the important barriers and facilitators in communication between ICU team and the family of the patients. By identification of the barriers and facilitators of communication, establishing new rules and using creative methods in education and establishing the communication of ICU team and rules and using patient-based approach we can have effective communication.

Emotional Impact of End-of-Life Decisions on Professional Relationships in the ICU: An Obstacle to Collegiality?

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Laurent, Alexandra; Bonnet, Magalie; Capellier, Gilles; Aslanian, Pierre; Hebert, Paul

2017-12-01

End-of-life decisions are not only common in the ICU but also frequently elicit strong feelings among health professionals. Even though we seek to develop more collegial interprofessional approaches to care and health decision-making, there are many barriers to successfully managing complex decisions. The aim of this study is to better understand how emotions influence the end-of-life decision-making process among professionals working in ICU. Qualitative study with clinical interviews. All interviews were transcribed verbatim and analyzed thematically using interpretative phenomenological analysis. Two independent ICUs at the "Centre Hospitalier de l'Université de Montréal." Ten physicians and 10 nurses. None. During the end-of-life decision-making process, families and patients restructure the decision-making frame by introducing a strong emotional dimension. This results in the emergence of new challenges quite different from the immediacy often associated with intensive care. In response to changes in decision frames, physicians rely on their relationship with the patient's family to assist with advanced care decisions. Nurses, however, draw on their relationship and proximity to the patient to denounce therapeutic obstinacy. Our study suggests that during the end-of-life decision-making process, nurses' feelings toward their patients and physicians' feelings toward their patients' families influence the decisions they make. Although these emotional dimensions allow nurses and physicians to act in a manner that is consistent with their professional ethics, the professionals themselves seem to have a poor understanding of these dimensions and often overlook them, thus hindering collegial decisions.

A recovery program to improve quality of life, sense of coherence and psychological health in ICU survivors: a multicenter randomized controlled trial, the RAPIT study

DEFF Research Database (Denmark)

Jensen, Janet F.; Egerod, Ingrid; Bestle, Morten H.

2016-01-01

and December 2015, at ten intensive care units (ICUs) in Denmark. We randomly assigned 386 adult patients (≥18 years) after receiving mechanical ventilation (≥48 h) to standard care (SC) plus a nurse-led intensive care recovery program or standard care alone after ICU discharge (190 intervention, 196 SC......Purpose: The aim of this randomized controlled trial (RCT) was to test the effectiveness of a post-ICU recovery program compared to standard care during the first year after ICU discharge. Methods: A pragmatic, non-blinded, multicenter, parallel-group RCT was conducted between December 2012......). Primary outcome was health-related quality of life (HRQOL) at 12 months. Secondary outcomes were sense of coherence (SOC), anxiety, depression, and posttraumatic stress disorder (PTSD) assessed at 3 and 12 months after ICU discharge including utilization of healthcare services at 12 months. Results: At 12...

Type A behaviour as a predictor of burnout and job satisfaction in intensive care units nurses

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Dorota Włodarczyk

2015-06-01

Full Text Available Background: Working at intensive care unit (ICU is one of the most difficult and taxing nursing specialties. It demands not only extensive knowledge and professional skills but also specific personality-temperamental dispositions. The aim of the study was to verify if type A behavior (TAB is a predictor of burnout and job satisfaction in ICU nurses and if this effect still exists after controlling for selected demographic and job characteristics. Material and Methods: The study group consisted of 99 nurses (77 women, aged 24–58 (mean (M = 32.33; standard deviation (SD = 8.81 working at ICU. The following tools were used: to measure TAB – Type A Behavior Survey BWZ by Wrzesniewski; job burnout – the Oldenburg Burnout Inventory OLBI by Demerouti et al.; and job satisfaction – the Job Satisfaction Scale by Zalewska. Results: The results of hierarchical regression analyses showed that after controlling for selected demographic and job characteristics, tendency for aggression was a predictor of higher exhaustion, disengagement and lower job satisfaction. Achievement striving and tendency to dominate were related to higher job satisfaction and lower exhaustion, respectively. Significant predictors of professional functioning were also: duty work system, place of living and gender. Conclusions: The results of the study confirmed that all 3 content features of TAB were significant predictors of job functioning of ICU nurses. They also indicate that considering TAB in the context of individual adjustment to the environment of the job at ICU would be a valuable direction for future research. Med. Pr. 2015;66(2:213–224

The high cost of low-acuity ICU outliers.

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Dahl, Deborah; Wojtal, Greg G; Breslow, Michael J; Holl, Randy; Huguez, Debra; Stone, David; Korpi, Gloria

2012-01-01

Direct variable costs were determined on each hospital day for all patients with an intensive care unit (ICU) stay in four Phoenix-area hospital ICUs. Average daily direct variable cost in the four ICUs ranged from $1,436 to $1,759 and represented 69.4 percent and 45.7 percent of total hospital stay cost for medical and surgical patients, respectively. Daily ICU cost and length of stay (LOS) were higher in patients with higher ICU admission acuity of illness as measured by the APACHE risk prediction methodology; 16.2 percent of patients had an ICU stay in excess of six days, and these LOS outliers accounted for 56.7 percent of total ICU cost. While higher-acuity patients were more likely to be ICU LOS outliers, 11.1 percent of low-risk patients were outliers. The low-risk group included 69.4 percent of the ICU population and accounted for 47 percent of all LOS outliers. Low-risk LOS outliers accounted for 25.3 percent of ICU cost and incurred fivefold higher hospital stay costs and mortality rates. These data suggest that severity of illness is an important determinant of daily resource consumption and LOS, regardless of whether the patient arrives in the ICU with high acuity or develops complications that increase acuity. The finding that a substantial number of long-stay patients come into the ICU with low acuity and deteriorate after ICU admission is not widely recognized and represents an important opportunity to improve patient outcomes and lower costs. ICUs should consider adding low-risk LOS data to their quality and financial performance reports.

Needs and the Influencing Factors among Parents of Children in Pediatric ICU%儿科 ICU 患儿家长的需求及其影响因素

Institute of Scientific and Technical Information of China (English)

陈潇; 刘晓丹; 张洪; 尹丹丹; 朱凤

2016-01-01

Objective To investigate the current status of needs among parents of children in pediatric in-tensive care unit (ICU),and to explore its influencing factors.Methods By convenience sampling,100 par-ents were selected and investigated by general scale and Chinese Version of Critical Care Family Needs Scale.Results The total score of needs among parents of children in ICU was(138.34±1 6.96).The most important need of parents in pediatric intensive care unit (PICU)and neonatel intensive care unit (NICU) was the assurance to patient’s safety.Educational level,family monthly income and whether children with preterm birth were the main influencing factors and it can explain 29.0% of the variance.Conclusions The parents of children in ICU have high level of needs.It is necessary for nurses to provide specific health guid-ance according to the different influencing factors,as far as possible to meet the needs of the parents.%目的：分析儿科重症监护室(intensive care unit,ICU)患儿家长的需求现状,探讨其影响因素.方法便利抽样法选取2015年6－10月在长春市某三级甲等医院儿科 ICU 住院患儿的家长100名为研究对象,应用一般资料调查表、中文版重危患者家属需求量表对其进行问卷调查.结果儿科 ICU 患儿家长总体需求得分为(138．34±16．96)分,儿童重症监护室(pediatric intensive care unit,PICU)与新生儿重症监护室(neonatel intensive care unit,NICU)患儿家长一致认为保证患儿的病情是最重要的需求；文化程度、家庭月收入及患儿是否早产是儿科 ICU 患儿家长需求的影响因素,可解释患儿家长需求得分29．0％的变异量.结论儿科 ICU 患儿家长的需求总体处于较高水平,护理人员应根据不同影响因素给予针对性的健康指导,尽可能满足患儿家长的需求.

Quality of life before surgical ICU admission.

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Abelha, Fernando J; Santos, Cristina C; Barros, Henrique

2007-11-12

Examining the quality of life (QOL) of patients before ICU admission will allow outcome variables to be compared and analyzed in relation to it. The objective of this study was to analyze QOL of patients before admission to a surgical ICU and to study its relationship to outcome and to the baseline characteristics of the patients. All adult patients consecutively admitted to the surgical ICU between November 2004 and April 2005, who underwent non-cardiac surgery, were enrolled in this observational and prospective study. The following patient characteristics were recorded: age, gender, body mass index, ASA physical status, type and magnitude of surgical procedure, length of stay (LOS), in ICU and in hospital, mortality, Simplified Acute Physiology Score II (SAPS), history of co-morbidities and quality of life survey score (QOLSS). The relationships between QOLSS and ICU variables and outcome were evaluated. The relationship between the total QOLSS and each variable or outcome was assessed by multiple linear regression. One hundred eighty seven patients completed the study. The preadmission QOLSS of the patients studied was 4.43 +/- 4.90; 28% of patients had a normal quality of life (0 points), 38% had between 1 and 5 points (considered mild deterioration), 21% had between 6 and 10 points (moderate deterioration), 10% had between 11 and 15 points (considered major deterioration) and 3% had more than 15 points (severe limitation of quality of life). A worse preadmission QOLSS was associated with higher SAPS II scores, with older patients (age> 65 years) and with ASA physical status (ASA III/IV). Total QOLSS was significantly worse in elderly patients and in patients with co-morbidities and in patients more severely ill at ICU admission. Patients who died in the ICU and in hospital had worse QOLSS scores compared to those who survived. However, no statistical differences in QOLSS were found in relation to longer ICU stays (ICU LOS). Preadmission QOL correlates with

Communication skills intervention: promoting effective communication between nurses and mechanically ventilated patients.

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Dithole, K S; Thupayagale-Tshweneagae, Gloria; Akpor, Oluwaseyi A; Moleki, Mary M

2017-01-01

Patients in the Intensive Care Unit (ICU) often experience communication difficulties - usually associated with mechanical ventilation - resulting in psychological problems such as anxiety, fear, and depression. Good communication between nurses and patients is critical for success from personalised nursing care of each patient. The purpose of this study is to describe nurses' experience of a communication skills training intervention. A convenience sample of twenty intensive care nurses participated in the study. Data was collected by means of interviews with nurses. Data from the interviews were analysed using qualitative thematic content analysis. Six themes emerged: (1) acceptance of knowledge and skills developed during workshops; (2) management support; (3) appreciation of augmentative and alternative communication (AAC) devices; (4) change in attitudes; and (5) the need to share knowledge with others and (6) inclusion of communication skills workshop training as an integral part of an orientation programme for all nurses. The findings of this study indicated that the application of augmentative and alternative communication devices and strategies can improve nurse-patient communication in intensive care units. Therefore, the implementation of communication skills training for intensive care nurses should constantly be encouraged and, indeed, introduced as a key element of ICU care training.

Safety and Security Concerns of Nurses Working in the Intensive Care Unit: A Qualitative Study.

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Keys, Yolanda; Stichler, Jaynelle F

Intensive care units (ICUs) exist to serve as a safe place for critically ill patients to receive care from skilled practitioners. In this qualitative study, ICU nurses shared their perspectives on elements that promote safety and security on their units. After obtaining institutional review board approval, participants participated in telephone interviews with a nurse researcher who has experience as a bedside ICU nurse. Five categories and 14 themes were identified and then confirmed using member checking. Results indicate that participants prefer to provide care in ICUs with no more than 12 to 14 beds and provide the following: visibility of patients and coworkers; more than 1 way to exit; and can be locked in case of emergency or threat. Nearly all respondents mentioned adequate staffing as the most important attribute of a safe, secure care environment for patients and families. More research is needed to identify design features that make the most impact on providing a safe, secure ICU environment.

[Providing information to patient's families on the end of life process in the intensive care unit. Nursing evaluation].

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Pascual-Fernández, M Cristina

2014-01-01

Informing is a process that includes many aspects and when it involves a family member at the end of life it becomes a complicated matter, not only for giving the information, but also for the mood of family members. Thus, the information should be adapted to the language and education of the patient and family. That information must be proper and suitable to the moment. To describe the aspects of information offered to relatives of patients in the end of life process in Intensive Care Units (ICU), and to determine the nursing evaluation in this process. To evaluate the professionals' attitude on this subject. An observational study conducted on nurses in pediatric and adult ICU nurses of a large public health hospital complexes in the city of Madrid. The data was collected using a questionnaire on the evaluation of care of children who died in pediatric ICU. The majority of the nurses, 71% (159), said that the information was given in a place alone with the doctor. More than half (52.4%, 118) considered that the information was sufficient/insufficient depending on the day. Significant differences were found as regards the behavior of the staff at the time of a death in (P<.01), with pediatric ICU professionals being more empathetic. ICU nurses believe that the information is appropriate for the prognosis and adapted to the patient situation. They also consider the place where the information is given and the attitude of the professionals in the end of life process are adequate. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Estimating ICU bed capacity using discrete event simulation.

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Zhu, Zhecheng; Hen, Bee Hoon; Teow, Kiok Liang

2012-01-01

The intensive care unit (ICU) in a hospital caters for critically ill patients. The number of the ICU beds has a direct impact on many aspects of hospital performance. Lack of the ICU beds may cause ambulance diversion and surgery cancellation, while an excess of ICU beds may cause a waste of resources. This paper aims to develop a discrete event simulation (DES) model to help the healthcare service providers determine the proper ICU bed capacity which strikes the balance between service level and cost effectiveness. The DES model is developed to reflect the complex patient flow of the ICU system. Actual operational data, including emergency arrivals, elective arrivals and length of stay, are directly fed into the DES model to capture the variations in the system. The DES model is validated by open box test and black box test. The validated model is used to test two what-if scenarios which the healthcare service providers are interested in: the proper number of the ICU beds in service to meet the target rejection rate and the extra ICU beds in service needed to meet the demand growth. A 12-month period of actual operational data was collected from an ICU department with 13 ICU beds in service. Comparison between the simulation results and the actual situation shows that the DES model accurately captures the variations in the system, and the DES model is flexible to simulate various what-if scenarios. DES helps the healthcare service providers describe the current situation, and simulate the what-if scenarios for future planning.

Nursing students' perceptions of knowledge: an international perspective

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Majda Pahor

2015-03-01

Full Text Available Introduction: Nursing education in Europe is undergoing the development toward greater comparability under the Bologna process. Based on our mutual experiences from teaching in Slovenia and Sweden, the students' perspectives on knowledge and nursing practice became an issue. The aim was to explore Slovenian and Swedish undergraduate nursing students' perceptions of knowledge needed for future practice. Methods: A qualitative study design was applied. A questionnaire with open ended questions was used to collect opinions of 174 nursing students from the University of Ljubljana, Slovenia, and 109 nursing students from the University of Umea, Sweden. Textual data were analysed using qualitative content analysis. Results: Four subcategories were identified, related to the content of knowledge: knowledge about 'bodies and diseases', about 'people and communication'; and to its purpose: 'to do nursing' and 'to be a nurse'. The main theme, 'integration', indicated the students' awareness of the complexity of their future work and the need for a wide integrated knowledge. Discussion and conclusion: There were more similarities than differences between the Slovenian and Swedish students included in the study. The students were aware of the complex responsibilities and expressed the need for integrating various competences. Interprofessional education should become a constitutive part of nursing education programmes.

Impact of a standardized nurse observation protocol including MEWS after Intensive Care Unit discharge.

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De Meester, K; Das, T; Hellemans, K; Verbrugghe, W; Jorens, P G; Verpooten, G A; Van Bogaert, P

2013-02-01

Analysis of in-hospital mortality after serious adverse events (SAE's) in our hospital showed the need for more frequent observation in medical and surgical wards. We hypothesized that the incidence of SAE's could be decreased by introducing a standard nurse observation protocol. To investigate the effect of a standard nurse observation protocol implementing the Modified Early Warning Score (MEWS) and a color graphic observation chart. Pre- and post-intervention study by analysis of patients records for a 5-day period after Intensive Care Unit (ICU) discharge to 14 medical and surgical wards before (n=530) and after (n=509) the intervention. For the total study population the mean Patient Observation Frequency Per Nursing Shift (POFPNS) during the 5-day period after ICU discharge increased from .9993 (95% C.I. .9637-1.0350) in the pre-intervention period to 1.0732 (95% C.I. 1.0362-1.1101) (p=.005) in the post-intervention period. There was an increased risk of a SAE in patients with MEWS 4 or higher in the present nursing shift (HR 8.25; 95% C.I. 2.88-23.62) and the previous nursing shift (HR 12.83;95% C.I. 4.45-36.99). There was an absolute risk reduction for SAE's within 120h after ICU discharge of 2.2% (95% C.I. -0.4-4.67%) from 5.7% to 3.5%. The intervention had a positive impact on the observation frequency. MEWS had a predictive value for SAE's in patients after ICU discharge. The drop in SAE's was substantial but did not reach statistical significance. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Intensive care unit nurses' perceptions of safety after a highly specific safety intervention.

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Elder, N C; Brungs, S M; Nagy, M; Kudel, I; Render, M L

2008-02-01

It is unknown if successful changes in specific safety practices in the intensive care unit (ICU) generalize to broader concepts of patient safety by staff nurses. To explore perceptions of patient safety among nursing staff in ICUs following participation in a safety project that decreased hospital acquired infections. After implementation of practices that reduced catheter-related bloodstream infections in ICUs at four community hospitals, ICU nurses participated in focus groups to discuss patient safety. Audiotapes from the focus groups were transcribed, and two independent reviewers categorised the data which were triangulated with responses from selected questions of safety climate surveys and with the safety checklists used by management leadership on walk rounds. Thirty-three nurses attended eight focus groups; 92 nurses and managers completed safety climate surveys, and three separate leadership checklists were reviewed. In focus groups, nurses predominantly related patient safety to dangers in the physical environment (eg, bed rails, alarms, restraints, equipment, etc.) and to medication administration. These areas also represented 47% of checklist items from leadership walk rounds. Nurses most frequently mentioned self-initiated "double checking" as their main safety task. Focus-group participants and survey responses both noted inconsistency between management's verbal and written commitment compared with their day-to-day support of patient safety issues. ICU nurses who participated in a project to decrease hospital acquired infections did not generalize their experience to other aspects of patient safety or relate it to management's interest in patient safety. These findings are consistent with many adult learning theories, where self-initiated tasks, combined with immediate, but temporary problem-solving, are stronger learning forces than management-led activities with delayed feedback.

Mortality Associated With Emergency Department Boarding Exposure: Are There Differences Between Patients Admitted to ICU and Non-ICU Settings?

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Reznek, Martin A; Upatising, Benjavan; Kennedy, Samantha J; Durham, Natassia T; Forster, Richard M; Michael, Sean S

2018-05-01

Emergency Department (ED) boarding threatens patient safety. It is unclear whether boarding differentially affects patients admitted to intensive care units (ICUs) versus non-ICU settings. We performed a 2-hospital, 18-month, cross-sectional, observational, descriptive study of adult patients admitted from the ED. We used Kaplan-Meier estimation and Cox Proportional Hazards regression to describe differences in boarding time among patients who died during hospitalization versus those who survived, controlling for covariates that could affect mortality risk or boarding exposure, and separately evaluating patients admitted to ICUs versus non-ICU settings. We extracted age, race, sex, time variables, admission unit, hospital disposition, and Elixhauser comorbidity measures and calculated boarding time for each admitted patient. Among 39,781 admissions from the EDs (21.3% to ICUs), non-ICU patients who died in-hospital had a 1.2-fold risk (95% confidence interval, 1.03-1.36; P=0.016) of having experienced longer boarding times than survivors, accounting for covariates. We did not observe a difference among patients admitted to ICUs. Among non-ICU patients, those who died during hospitalization were more likely to have had incrementally longer boarding exposure than those who survived. This difference was not observed for ICU patients. Boarding risk mitigation strategies focused on ICU patients may have accounted for this difference, but we caution against interpreting that boarding can be safe. Segmentation by patients admitted to ICU versus non-ICU settings in boarding research may be valuable in ensuring that the safety of both groups is considered in hospital flow and boarding care improvements.

Report on visit from Prof. Kim Lutzen: Friday, 6 November 1998, Korolinska Institute (dept of nursing Stockholm, Sweden

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Kim Lutzen

1999-10-01

Full Text Available Prof. Kim Lutzen contacted the Department of Advanced Nursing Sciences, Unisa, via the Department's Web Page. Prof. Lutzen is the Chair of the Department of Nursing, which offers undergraduate, master and doctoral programmes. This Department of Nursing is situated within the Karolinska Institute, which comprises 29 Departments of Health Sciences, including a number of Medical Departments, Dentistry, Occupational Therapy, Physiotherapy, and Nursing. Prof. Lutzen emphasised that there is no Swedish phrase similar to "nursing science", consequently this t e n seems to be somewhat unfamiliar to the Swedish nurses. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

Improving Communication During Cardiac ICU Multidisciplinary Rounds Through Visual Display of Patient Daily Goals.

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Justice, Lindsey B; Cooper, David S; Henderson, Carla; Brown, James; Simon, Katherine; Clark, Lindsey; Fleckenstein, Elizabeth; Benscoter, Alexis; Nelson, David P

2016-07-01

To improve communication during daily cardiac ICU multidisciplinary rounds. Quality improvement methodology. Twenty-five-bed cardiac ICUs in an academic free-standing pediatric hospital. All patients admitted to the cardiac ICU. Implementation of visual display of patient daily goals through a write-down and read-back process. The Rounds Effectiveness Assessment and Communication Tool was developed based on the previously validated Patient Knowledge Assessment Tool to evaluate comprehension of patient daily goals. Rounds were assessed for each patient by the bedside nurse, nurse practitioner or fellow, and attending physician, and answers were compared to determine percent agreement per day. At baseline, percent agreement for patient goals was only 62%. After initial implementation of the daily goal write-down/read-back process, which was written on paper by the bedside nurse, the Rounds Effectiveness Assessment and Communication Tool survey revealed no improvement. With adaptation of the intervention so goals were written on whiteboards for visual display during rounds, the percent agreement improved to 85%. Families were also asked to complete a survey (1-6 Likert scale) of their satisfaction with rounds and understanding of daily goals before and after the intervention. Family survey results improved from a mean of 4.6-5.7. Parent selection of the best possible score for each question was 19% at baseline and 75% after the intervention. Visual display of patient daily goals via a write-down/read-back process improves comprehension of goals by all team members and improves parent satisfaction. The daily goal whiteboard facilitates consistent development of a comprehensive plan of care for each patient, fosters goal-directed care, and provides a checklist for providers and parents to review throughout the day.

Factors influencing when intensive care unit nurses go to the bedside to investigate patient related alarms: A descriptive qualitative study.

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Despins, Laurel A

2017-12-01

This study examines what prompts the intensive care unit (ICU) nurse to go to the patient's bedside to investigate an alarm and the influences on the nurse's determination regarding how quickly this needs to occur. A qualitative descriptive design guided data collection and analysis. Individual semi-structured interviews were conducted. Thematic analysis guided by the Patient Risk Detection Theoretical Framework was applied to the data. Four specialty intensive care units in an academic medical center. ICU nurses go the patient's bedside in response to an alarm to catch patient deterioration and avert harm. Their determination of the immediacy of patient risk and their desire to prioritize their bedside investigations to true alarms influences how quickly they proceed to the bedside. Ready visual access to physiological data and waveform configurations, experience, teamwork, and false alarms are important determinants in the timing of ICU nurses' bedside alarm investigations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Writing in and reading ICU diaries: qualitative study of families' experience in the ICU.

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Maité Garrouste-Orgeas

Full Text Available PURPOSE: Keeping an ICU patient diary has been reported to benefit the patient's recovery. Here, we investigated the families' experience with reading and writing in patient ICU diaries kept by both the family and the staff. METHODS: We conducted a qualitative study involving 32 semi-structured in-depth interviews of relatives of 26 patients (34% of all family members who visited patients who met our ICU-diary criterion, i.e., ventilation for longer than 48 hours. Grounded theory was used to conceptualise the interview data via a three-step coding process (open coding, axial coding, and selective coding. RESULTS: Communicative, emotional, and humanising experiences emerged from our data. First, family members used the diaries to access, understand, and assimilate the medical information written in the diaries by staff members, and then to share this information with other family members. Second, the diaries enabled family members to maintain a connection with the patient by documenting their presence and expressing their love and affection. Additionally, families confided in the diaries to maintain hope. Finally, family members felt the diaries humanized the medical staff and patient. CONCLUSIONS: Our findings indicate positive effects of diaries on family members. The diaries served as a powerful tool to deliver holistic patient- and family-centered care despite the potentially dehumanising ICU environment. The diaries made the family members aware of their valuable role in caring for the patient and enhanced their access to and comprehension of medical information. Diaries may play a major role in improving the well-being of ICU-patient families.

[End-of-Life Care in Intensive Care Units: Nursing strategies of family involvement at the end of life].

Science.gov (United States)

Cyrol, Katharina; Fröhlich, Martin R; Piatti, Francesca; Imhof, Lorenz

2018-06-01

Background: Family members of people dying in the intensive care unit (ICU) are exposed to many stress factors and they often do not experience involvement in End-of-Life (EoL) situations. For example, they criticize a low degree of participation in patients care, delayed or incomplete information and lack of privacy. Even nursing staff is facing various obstacles in EoL situations in ICUs. Aim: This study investigates strategies used by ICU nursing staff in German-speaking Switzerland to increase family members participation in situations at the end of life. Method: Data was collected by conducting 12 semi-structured interviews using an approach based on Grounded Theory. A model was developed to explain nursing strategies for family involvement in EoL situations in the ICU. Conclusions: Nurses provide personal space and tranquillity for family members and allow them to be present at any time. Against this background, they support family members and enable them to say goodbye consciously to a loved one. Subsequent work should examine the effectiveness of the strategies described, particularly in terms of stress reactions displayed by family members in the aftermath of EoL situations. In practice, family members should be provided space for privacy. The entire healthcare team is recommended to identify and pursue common values and objectives. Moreover, intradisciplinary exchange and mentoring need to be encouraged. In order to prepare future nursing staff for EoL situations in the ICU, recognizing and promoting their educational skills is mandatory.

Quality of life before surgical ICU admission

Directory of Open Access Journals (Sweden)

Barros Henrique

2007-11-01

Full Text Available Abstract Background: Examining the quality of life (QOL of patients before ICU admission will allow outcome variables to be compared and analyzed in relation to it. The objective of this study was to analyze QOL of patients before admission to a surgical ICU and to study its relationship to outcome and to the baseline characteristics of the patients. Methods: All adult patients consecutively admitted to the surgical ICU between November 2004 and April 2005, who underwent non-cardiac surgery, were enrolled in this observational and prospective study. The following patient characteristics were recorded: age, gender, body mass index, ASA physical status, type and magnitude of surgical procedure, length of stay (LOS, in ICU and in hospital, mortality, Simplified Acute Physiology Score II (SAPS, history of co-morbidities and quality of life survey score (QOLSS. The relationships between QOLSS and ICU variables and outcome were evaluated. The relationship between the total QOLSS and each variable or outcome was assessed by multiple linear regression. Results: One hundred eighty seven patients completed the study. The preadmission QOLSS of the patients studied was 4.43 ± 4.90; 28% of patients had a normal quality of life (0 points, 38% had between 1 and 5 points (considered mild deterioration, 21% had between 6 and 10 points (moderate deterioration, 10% had between 11 and 15 points (considered major deterioration and 3% had more than 15 points (severe limitation of quality of life. A worse preadmission QOLSS was associated with higher SAPS II scores, with older patients (age> 65 years and with ASA physical status (ASA III/IV. Total QOLSS was significantly worse in elderly patients and in patients with co-morbidities and in patients more severely ill at ICU admission. Patients who died in the ICU and in hospital had worse QOLSS scores compared to those who survived. However, no statistical differences in QOLSS were found in relation to longer ICU stays

Correlation between workplace and occupational burnout syndrome in nurses

OpenAIRE

Ahmadi, Omid; Azizkhani, Reza; Basravi, Monem

2014-01-01

Background: This study was conducted to determine the effect of nurses′ workplace on burnout syndrome among nurses working in Isfahan′s Alzahra Hospital as a reference and typical university affiliated hospital, in 2010. Materials and Methods: In this cross-sectional study, 100 nurses were randomly selected among those working in emergency, orthopedic, dialysis wards and intensive care unit (ICU). Required data on determination of occupational burnout rate among the nurses of these wards ...

Knowledge and attitudes of nurses regarding pain in the intensive ...

African Journals Online (AJOL)

The tool was used in the three referral hospitals in Rwanda to assess knowledge and attitudes from 69 nurses practicing in ICU. We compared the pain management performance in regard to the age, level of education, experience and history of training in pain management between nurses. The researcher used one way ...

Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness.

Science.gov (United States)

Koch, Sven H; Weir, Charlene; Haar, Maral; Staggers, Nancy; Agutter, Jim; Görges, Matthias; Westenskow, Dwayne

2012-01-01

Fatal errors can occur in intensive care units (ICUs). Researchers claim that information integration at the bedside may improve nurses' situation awareness (SA) of patients and decrease errors. However, it is unclear which information should be integrated and in what form. Our research uses the theory of SA to analyze the type of tasks, and their associated information gaps. We aimed to provide recommendations for integrated, consolidated information displays to improve nurses' SA. Systematic observations methods were used to follow 19 ICU nurses for 38 hours in 3 clinical practice settings. Storyboard methods and concept mapping helped to categorize the observed tasks, the associated information needs, and the information gaps of the most frequent tasks by SA level. Consensus and discussion of the research team was used to propose recommendations to improve information displays at the bedside based on information deficits. Nurses performed 46 different tasks at a rate of 23.4 tasks per hour. The information needed to perform the most common tasks was often inaccessible, difficult to see at a distance or located on multiple monitoring devices. Current devices at the ICU bedside do not adequately support a nurse's information-gathering activities. Medication management was the most frequent category of tasks. Information gaps were present at all levels of SA and across most of the tasks. Using a theoretical model to understand information gaps can aid in designing functional requirements. Integrated information that enhances nurses' Situation Awareness may decrease errors and improve patient safety in the future.

Intensive Care Unit (ICU) - Managed Elderly Hospitalizations with Dementia in Texas, 2001-2010: A Population-Level Analysis.

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Oud, Lavi

2016-10-20

BACKGROUND The demand for critical care services among elderly with dementia outpaces that of their non-dementia elderly counterparts. However, there are scarce data on the corresponding attributes among ICU-managed patients with dementia. MATERIAL AND METHODS We used the Texas Inpatient Public Use Data File to examine temporal trends of the demographics, burden of comorbidities, measures of severity of illness, use of healthcare resources, and short-term outcomes among hospitalizations aged 65 years or older with a reported diagnosis of dementia, who were admitted to ICU (D-ICU hospitalizations) between 2001 and 2010. Average annual percent changes (AAPC) were derived. RESULTS D-ICU hospitalizations (n=276,056) had increasing mean (SD) Charlson comorbidity index [1.7 (1.5) vs. 2.6 (1.9)], with reported organ failure (OF) nearly doubling from 25% to 48.5%, between 2001–2001 and 2009–2010, respectively. Use of life support interventions was infrequent, but rose in parallel with corresponding changes in respiratory and renal failure. Median total hospital charges increased from $26,442 to $36,380 between 2001–2002 and 2009–2010. Routine home discharge declined (–5.2%/year [–6.2%– –4.1%]) with corresponding rising use of home health services (+7.2%/year [4.4–10%]). Rates of discharge to another hospital or a nursing facility remained unchanged, together accounting for 60.4% of discharges of hospital survivors in 2010. Transfers to a long-term acute care hospital increased 9.2%/year (6.9–11.5%). Hospital mortality (7.5%) remained unchanged. CONCLUSIONS Elderly D-ICU hospitalizations have increasing comorbidity burden, with rising severity of illness, and increasing use of health care resources. Though the majority survived hospitalization, most D-ICU hospitalizations were discharged to another facility.

A research regarding the relationship among intensive care nurses' self-esteem, job satisfaction and subjective well-being

Directory of Open Access Journals (Sweden)

Huihui Liu

2017-07-01

Conclusion: The study shows that the prevalence of subjective well-being and self-esteem with ICU nurses are at a low level, and job satisfaction is at the median level. Associations among self-esteem, job satisfaction, and subjective well-being in ICUs have been confirmed. Self-esteem and job satisfaction positively correlated with nurse subjective well-being. The higher the self-esteem and job satisfaction levels are, the stronger the subjective well-being is. The working pressure in ICUs cannot be alleviated temporarily; hence, to promote a high subjective well-being, managers and ICU nurses increase their self-esteem and job satisfaction through taking strategies that strengthen psychological construction.

Mindfulness predicts student nurses' communication self-efficacy: A cross-national comparative study.

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Sundling, Vibeke; Sundler, Annelie J; Holmström, Inger K; Kristensen, Dorte Vesterager; Eide, Hilde

2017-08-01

The aim of this study was to compare student nurses' communication self-efficacy, empathy, and mindfulness across two countries, and to analyse the relationship between these qualities. The study had a cross-sectional design. Data was collected from final year student nurses in Norway and Sweden. Communication self-efficacy, empathy, and mindfulness were reported by questionnaires; Clear-cut communication with patients, Jefferson Scale of Empathy, and Langer 14 items mindfulness scale. The study included 156 student nurses, 94 (60%) were Swedish. The mean communication self-efficacy score was 119 (95% CI 116-122), empathy score 115 (95% CI 113-117) and mindfulness score 79 (95% CI 78-81). A Mann-Whitney test showed that Swedish students scored significantly higher on communication self-efficacy, empathy, and mindfulness than Norwegian students did. When adjusted for age, gender, and country in a multiple linear regression, mindfulness was the only independent predictor of communication self-efficacy. The Swedish student nurses in this study scored higher on communication self-efficacy, empathy, and mindfulness than Norwegian students did. Student nurses scoring high on mindfulness rated their communication self-efficacy higher. A mindful learning approach may improve communication self-efficacy and possibly the effect of communication skills training. Copyright © 2017 Elsevier B.V. All rights reserved.

Post-ICU psychological morbidity in very long ICU stay patients with ARDS and delirium.

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Bashar, Farshid R; Vahedian-Azimi, Amir; Hajiesmaeili, Mohammadreza; Salesi, Mahmood; Farzanegan, Behrooz; Shojaei, Seyedpouzhia; Goharani, Reza; Madani, Seyed J; Moghaddam, Kivan G; Hatamian, Sevak; Moghaddam, Hosseinali J; Mosavinasab, Seyed M M; Elamin, Elamin M; Miller, Andrew C

2018-02-01

We investigated the impact of delirium on illness severity, psychological state, and memory in acute respiratory distress syndrome patients with very long ICU stay. Prospective cohort study in the medical-surgical ICUs of 2 teaching hospitals. Very long ICU stay (>75days) and prolonged delirium (≥40days) thresholds were determined by ROC analysis. Subjects were ≥18years, full-code, and provided informed consent. Illness severity was assessed using Acute Physiology and Chronic Health Evaluation IV, Simplified Acute Physiology Score-3, and Sequential Organ Failure Assessment scores. Psychological impact was assessed using the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, and the 14-question Post-Traumatic Stress Syndrome (PTSS-14). Memory was assessed using the ICU Memory Tool survey. 181 subjects were included. Illness severity did not correlate with delirium duration. On logistic regression, only PTSS-14<49 correlated with delirium (p=0.001; 95% CI 1.011, 1.041). 49% remembered their ICU stay clearly. 47% had delusional memories, 50% reported intrusive memories, and 44% reported unexplained feelings of panic or apprehension. Delirium was associated with memory impairment and PTSS-14 scores suggestive of PTSD, but not illness severity. Copyright © 2017. Published by Elsevier Inc.

Struggling for Independence: A Grounded Theory Study on Convalescence of ICU-survivors 12 Months Post ICU Discharge

DEFF Research Database (Denmark)

Ågård, Anne Sophie; Egerod, Ingrid; Tønnesen, Else Kirstine

2012-01-01

Objectives: To explore and explain the challenges, concerns and coping modalities in ICU-survivors living with a partner or spouse during the first 12 months post ICU discharge. Design: Qualitative, longitudinal grounded theory study. Settings: Five ICUs in Denmark, four general, one neurosurgical...

Doing one's utmost: nurses' descriptions of caring for dying patients in an intensive care environment.

Science.gov (United States)

Fridh, Isabell; Forsberg, Anna; Bergbom, Ingegerd

2009-10-01

The aim of this study was to explore nurses' experiences and perceptions of caring for dying patients in an intensive care unit (ICU) with focus on unaccompanied patients, the proximity of family members and environmental aspects. Interviews were conducted with nine experienced ICU nurses. A qualitative descriptive approach was employed. The analysis was performed by means of conventional content analysis [Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277-88] following the steps described by e.g. Elo and Kyngas [Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs 2008;62:107-15]. The analysis resulted in a main category; Doing one's utmost, described by four generic categories and 15 sub-categories, comprising a common vision of the patients' last hours and dying process. This description was dominated by the nurses' endeavour to provide dignified end-of-life care (EOLC) and, when relatives were present, to give them an enduring memory of their loved one's death as a calm and dignified event despite his/her previous suffering and death in a high-technological environment. This study contributes new knowledge about what ICU nurses focus on when providing EOLC to unaccompanied patients but also to those whose relatives were present. Nurses' EOLC was mainly described as their relationship and interaction with the dying patient's relatives, while patients who died alone were considered tragic but left a lesser impression in the nurses' memory.

Knowledge of the nursing team on pressure ulcer prevention.

Science.gov (United States)

Galvão, Nariani Souza; Serique, Maria Alice Barbosa; Santos, Vera Lúcia Conceição de Gouveia; Nogueira, Paula Cristina

2017-04-01

describe and analyze the nursing team's knowledge about classification, evaluation and measures to prevent pressure ulcers (PU) in patients hospitalized in the ICU of a teaching hospital in the city of Manaus. a descriptive and exploratory study was conducted after approval by a research ethics committee. Data were collected using a validated instrument. The study sample was made up of 40 nursing staff members, of whom 14 were nurses and 26 were nursing technicians/aides. Data were analyzed through descriptive statistics and Student's t-test, with value of pprevention category (pprevention was found among nurses and nursing technicians/aides, demanding the training of these professionals.

Epidemiology of Pregnancy-Associated ICU Utilization in Texas: 2001 - 2010.

Science.gov (United States)

Oud, Lavi

2017-02-01

ICU admission is uncommon among obstetric patients. Nevertheless, the epidemiology of ICU utilization is considered to be a useful proxy for study of severe maternal morbidity and near-miss events. However, there is paucity of population-level studies in obstetric patients in the United States. The Texas Inpatient Public Use Data File and state-based reports were used to identify pregnancy-associated hospitalizations and those involving admission to ICU (n = 158,410) for the years 2001 - 2010. The clinical characteristics, outcomes, and the overall incidence and temporal trends of ICU admission were examined and stratified analyses of pregnancy outcomes were performed in specific categories of pregnancy-associated hospitalizations. In addition, ICU utilization among hospitalizations with maternal complications and organ dysfunction was evaluated. Chronic comorbidities (9.7%) and presence of organ dysfunction (6.2%) were uncommon among ICU admissions, with 26.5% having high severity of illness. The incidence of ICU admission was 39.0 per 1,000 pregnancy-associated hospitalizations-years. Marked variability was found in ICU admission both across pregnancy outcomes (ranging from 0.6 per 1,000 abortions-years to 85.9 per 1,000 stillbirths-years) and categories of pregnancy-associated hospitalizations (ranging from 32.1 per 1,000 delivery hospitalizations-years to 144.8 per 1,000 postpartum hospitalizations-years). The incidence of ICU admission rose 68% among pregnancy-associated hospitalizations and for all examined subgroups, except abortion. Preeclampsia/eclampsia (23.3%) and obstetric hemorrhage (6.9%) were the most common maternal complications among ICU admissions. Four hundred fourteen women (0.3%) died, while 97.6% were discharged home. This study documents the highest incidence of ICU utilization in obstetric patients in the US to date. The findings suggest low threshold for obstetric ICU admissions in the state and do not support comparative use of ICU

A software communication tool for the tele-ICU.

Science.gov (United States)

Pimintel, Denise M; Wei, Shang Heng; Odor, Alberto

2013-01-01

The Tele Intensive Care Unit (tele-ICU) supports a high volume, high acuity population of patients. There is a high-volume of incoming and outgoing calls, especially during the evening and night hours, through the tele-ICU hubs. The tele-ICU clinicians must be able to communicate effectively to team members in order to support the care of complex and critically ill patients while supporting and maintaining a standard to improve time to intervention. This study describes a software communication tool that will improve the time to intervention, over the paper-driven communication format presently used in the tele-ICU. The software provides a multi-relational database of message instances to mine information for evaluation and quality improvement for all entities that touch the tele-ICU. The software design incorporates years of critical care and software design experience combined with new skills acquired in an applied Health Informatics program. This software tool will function in the tele-ICU environment and perform as a front-end application that gathers, routes, and displays internal communication messages for intervention by priority and provider.

Transforming a conservative clinical setting: ICU nurses' strategies to improve care for patients' relatives through a participatory action research.

Science.gov (United States)

Zaforteza, Concha; Gastaldo, Denise; Moreno, Cristina; Bover, Andreu; Miró, Rosa; Miró, Margalida

2015-12-01

This study focuses on change strategies generated through a dialogical-reflexive-participatory process designed to improve the care of families of critically ill patients in an intensive care unit (ICU) using a participatory action research in a tertiary hospital in the Balearic Islands (Spain). Eleven professionals (representatives) participated in 11 discussion groups and five in-depth interviews. They represented the opinions of 49 colleagues (participants). Four main change strategies were created: (i) Institutionally supported practices were confronted to make a shift from professional-centered work to a more inclusive, patient-centered approach; (ii) traditional power relations were challenged to decrease the hierarchical power differences between physicians and nurses; (iii) consensus was built about the need to move from an individual to a collective position in relation to change; and (iv) consensus was built about the need to develop a critical attitude toward the conservative nature of the unit. The strategies proposed were both transgressive and conservative; however, when compared with the initial situation, they enhanced the care offered to patients' relatives and patient safety. Transforming conservative settings requires capacity to negotiate positions and potential outcomes. However, when individual critical capacities are articulated with a new approach to micropolitics, transformative proposals can be implemented and sustained. © 2015 John Wiley & Sons Ltd.

Swedish nurses encounter barriers when promoting healthy habits in children.

Science.gov (United States)

Ljungkrona-Falk, Lena; Brekke, Hilde; Nyholm, Maria

2014-12-01

To increase the understanding of difficulties in promoting healthy habits to parents, we explore barriers in health-care provision. The aim of this study is to describe nurses' perceived barriers when discussing with parents regarding healthy food habits, physical activity and their child's body weight. A mixed method approach was chosen. Nurses (n = 76) working at 29 different Child Health Care Centers' in an area in west Sweden were included in the study. Three focus group interviews were conducted and 17 nurses were selected according to maximum variation. Data were categorized and qualitative content analysis was the chosen analysis method. In the second method, data were obtained from a questionnaire distributed to all 76 nurses. The latent content was formulated into a theme: even with encouragement and support, the nurses perceive barriers of both an external and internal nature. The results identified four main barriers: experienced barriers in the workplace-internal and external; the nurse's own fear and uncertainty; perceived obstacles in nurse-parent interactions and modern society impedes parents' ability to promote healthy habits. The nurses' perceived barriers were confirmed by the results from 62 of the nurses who completed the questionnaire. Despite education and professional support, the health professionals perceived both external and internal barriers in promoting healthy habits to parents when implementing a new method of health promotion in primary care. Further qualitative studies are needed to gain deeper understanding of the perceived barriers when promoting healthy habits to parents. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Structural, Nursing, and Physician Characteristics and 30-Day Mortality for Patients Undergoing Cardiac Surgery in Pennsylvania.

Science.gov (United States)

Lane-Fall, Meghan B; Ramaswamy, Tara S; Brown, Sydney E S; He, Xu; Gutsche, Jacob T; Fleisher, Lee A; Neuman, Mark D

2017-09-01

Cardiac surgery ICU characteristics and clinician staffing patterns have not been well characterized. We sought to describe Pennsylvania cardiac ICUs and to determine whether ICU characteristics are associated with mortality in the 30 days after cardiac surgery. From 2012 to 2013, we conducted a survey of cardiac surgery ICUs in Pennsylvania to assess ICU structure, care practices, and clinician staffing patterns. ICU data were linked to an administrative database of cardiac surgery patient discharges. We used logistic regression to measure the association between ICU variables and death in 30 days. Cardiac surgery ICUs in Pennsylvania. Patients having coronary artery bypass grafting and/or cardiac valve repair or replacement from 2009 to 2011. None. Of the 57 cardiac surgical ICUs in Pennsylvania, 43 (75.4%) responded to the facility survey. Rounds included respiratory therapists in 26 of 43 (60.5%) and pharmacists in 23 of 43 (53.5%). Eleven of 41 (26.8%) reported that at least 2/3 of their nurses had a bachelor's degree in nursing. Advanced practice providers were present in most of the ICUs (37/43; 86.0%) but residents (8/42; 18.6%) and fellows (7/43; 16.3%) were not. Daytime intensivists were present in 21 of 43 (48.8%) responding ICUs; eight of 43 (18.6%) had nighttime intensivists. Among 29,449 patients, there was no relationship between mortality and nurse ICU experience, presence of any intensivist, or absence of residents after risk adjustment. To exclude patients who may have undergone transcatheter aortic valve replacement, we conducted a subgroup analysis of patients undergoing only coronary artery bypass grafting, and results were similar. Pennsylvania cardiac surgery ICUs have variable structures, care practices, and clinician staffing, although none of these are statistically significantly associated with mortality in the 30 days following surgery after adjustment.

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

Directory of Open Access Journals (Sweden)

Babita Gupta

2012-01-01

Full Text Available 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 and Methods: Sixty questionnaires were distributed and the results analyzed. A database was prepared and the audit was done. Results: Forty-two (70% questionnaires were filled and returned. A majority (38 of staff nurses expressed awareness of nutrition guidelines. A large number (32 of staff nurses knew about nutrition protocols of the ICU. Almost all (40 opined enteral nutrition to be the preferred route of nutrition unless contraindicated. All staff nurses were of opinion that enteral nutrition is to be started at the earliest (within 24-48 h of the ICU stay. Everyone opined that the absence of bowel sounds is an absolute contraindication to initiate enteral feeding. Passage of flatus was considered mandatory before starting enteral nutrition by 86% of the respondents. Everyone knew that the method of Ryle′s tube feeding in their ICU is intermittent boluses. Only 4 staff nurses were unaware of any method to confirm Ryle′s tube position. The backrest elevation rate was 100%. Gastric residual volumes were always checked, but the amount of the gastric residual volume for the next feed to be withheld varied. The majority said that the unused Ryle′s tube feed is to be discarded after 6 h. The most preferred (48% method to upgrade their knowledge of enteral nutrition was from the ICU protocol manual. Conclusion: Information generated from this study can be helpful in identifying nutrition practices that are lacking and may be used to review and revise enteral feeding

Characteristics and Outcomes of Elderly Patients Refused to ICU

Directory of Open Access Journals (Sweden)

María-Consuelo Pintado

2013-01-01

Full Text Available Background. There are few data regarding the process of deciding which elderly patients are refused to ICU admission, their characteristics, and outcome. Methods. Prospective longitudinal observational cohort study. We included all consecutive patients older than 75 years, who were evaluated for admission to but were refused to treatment in ICU, during 18 months, with 12-month followup. We collected demographic data, ICU admission/refusal reasons, previous functional and cognitive status, comorbidity, severity of illness, and hospital and 12-month mortality. Results. 338 elderly patients were evaluated for ICU admission and 88 were refused to ICU (26%. Patients refused because they were “too ill to benefit” had more comorbidity and worse functional and mental situation than those admitted to ICU; there were no differences in illness severity. Hospital mortality rate of the whole study cohort was 36.3%, higher in patients “too ill to benefit” (55.6% versus 35.8%, P<0.01, which also have higher 1-year mortality (73.7% versus 42.5%, P<0.01. High comorbidity, low functional status, unavailable ICU beds, and age were associated with refusal decision on multivariate analysis. Conclusions. Prior functional status and comorbidity, not only the age or severity of illness, can help us more to make the right decision of admitting or refusing to ICU patients older than 75 years.

An elicitation study of critical care nurses' salient hand hygiene beliefs.

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Piras, Susan E; Lauderdale, Jana; Minnick, Ann

2017-10-01

To describe critical care nurses' hand hygiene attitudinal, normative referent, and control beliefs. Hand hygiene is the primary strategy to prevent healthcare-associated infections. Social influence is an underdeveloped hand hygiene strategy. This qualitative descriptive study was conducted with 25 ICU nurses in the southeastern United States. Data were collected using the Nurses' Salient Belief Instrument. Thematic analysis generated four themes: Hand Hygiene is Protective; Nurses look to Nurses; Time-related Concerns; and Convenience is Essential. Nurses look to nurses as hand hygiene referents and believe hand hygiene is a protective behaviour that requires time and functional equipment. Copyright © 2017 Elsevier Ltd. All rights reserved.

The caring moment and the green-thumb phenomenon among Swedish nurses

DEFF Research Database (Denmark)

Jensen, Kirsten Pryds; Bäck-Pettersson, Siv; Segesten, K

1993-01-01

People who have a special gift for gardening are sometimes described as having a green thumb. Likewise, some nurses have a green thumb for nursing. The aims of this study were to identify and describe the characteristics of green-thumb nurses and of caring situations. A descriptive......-exploratory design was used, and 16 nurses, recruited by their superiors, participated in semi-structured interviews. The findings revealed that the green-thumb nurse is competent, compassionate, and courageous. The essence of the caring moment was identified as the green-thumb nurse's ability to act on the spur...

Prominent attractive qualities of nurses' work in operating room departments: A questionnaire study.

Science.gov (United States)

Björn, Catrine; Josephson, Malin; Wadensten, Barbro; Rissén, Dag

2015-01-01

The shortage of nurses in operating room departments (ORs) in Sweden and other countries can lead to reduced capacity and quality in healthcare, as well as more intense work for those on the job. Little is known about what nurses in ORs perceive as crucial for their workplace to be attractive. To capture attractive qualities of nurses' work in Swedish ORs and take a first step in the process of adapting the Attractive Work Questionnaire for use in a health care context. The Attractive Work Questionnaire was completed by 147 (67% ) nurses in four Swedish ORs. Principal Component Analyses (PCA) were performed to determine the underlying structure of the data. Factors contributing to job attractiveness identified in the area "work conditions" were: relations, leadership, equipment, salary, organisation, physical work environment, location, and working hours; in the area "work content": mental work, autonomy and work rate; and in the area "job satisfaction": status and acknowledgement. The PCA showed consistency with the original Attractive Work Questionnaire, Cronbach's alpha varied between 0.57-0.90. Prominent attractive qualities for nurses' work in Swedish ORs were possible to identify through the Attractive Work Questionnaire and the results suggest that the questionnaire can be useful in a health care context.

Intensive Care Unit (ICU) – Managed Elderly Hospitalizations with Dementia in Texas, 2001–2010: A Population-Level Analysis

Science.gov (United States)

Oud, Lavi

2016-01-01

Background The demand for critical care services among elderly with dementia outpaces that of their non-dementia elderly counterparts. However, there are scarce data on the corresponding attributes among ICU-managed patients with dementia. Material/Methods We used the Texas Inpatient Public Use Data File to examine temporal trends of the demographics, burden of comorbidities, measures of severity of illness, use of healthcare resources, and short-term outcomes among hospitalizations aged 65 years or older with a reported diagnosis of dementia, who were admitted to ICU (D-ICU hospitalizations) between 2001 and 2010. Average annual percent changes (AAPC) were derived. Results D-ICU hospitalizations (n=276,056) had increasing mean (SD) Charlson comorbidity index [1.7 (1.5) vs. 2.6 (1.9)], with reported organ failure (OF) nearly doubling from 25% to 48.5%, between 2001–2001 and 2009–2010, respectively. Use of life support interventions was infrequent, but rose in parallel with corresponding changes in respiratory and renal failure. Median total hospital charges increased from $26,442 to $36,380 between 2001–2002 and 2009–2010. Routine home discharge declined (−5.2%/year [−6.2%– −4.1%]) with corresponding rising use of home health services (+7.2%/year [4.4–10%]). Rates of discharge to another hospital or a nursing facility remained unchanged, together accounting for 60.4% of discharges of hospital survivors in 2010. Transfers to a long-term acute care hospital increased 9.2%/year (6.9–11.5%). Hospital mortality (7.5%) remained unchanged. Conclusions Elderly D-ICU hospitalizations have increasing comorbidity burden, with rising severity of illness, and increasing use of health care resources. Though the majority survived hospitalization, most D-ICU hospitalizations were discharged to another facility. PMID:27764074

Conflicts in the ICU: perspectives of administrators and clinicians.

Science.gov (United States)

Danjoux Meth, Nathalie; Lawless, Bernard; Hawryluck, Laura

2009-12-01

The purpose of this study is to understand conflicts in the ICU setting as experienced by clinicians and administrators and explore methods currently used to resolve such conflicts when there may be discordance between clinicians and families, caregivers or administration. Qualitative case study methodology using semi-structured interviews was used. The sample included community and academic health science centres in 16 hospitals from across the province of Ontario, Canada. A total of 42 participants including hospital administrators and ICU clinicians were interviewed. Participants were sampled purposively to ensure representation. The most common source of conflict in the ICU is a result of disagreement about the goals of treatment. Such conflicts arise between the ICU and referring teams (inter-team), among members of the ICU team (intra-team), and between the ICU team and patients' family/substitute decision-maker (SDM). Inter- and intra-team conflicts often contribute to conflicts between the ICU team and families. Various themes were identified as contributing factors that may influence conflict resolution practices as well as the various consequences and challenges of conflict situations. Limitations of current conflict resolution policies were revealed as well as suggested strategies to improve practice. There is considerable variability in dealing with conflicts in the ICU. Greater attention is needed at a systems level to support a culture aimed at prevention and resolution of conflicts to avoid increased sources of anxiety, stress and burnout.

Escalation of Commitment in the Surgical ICU.

Science.gov (United States)

Braxton, Carla C; Robinson, Celia N; Awad, Samir S

2017-04-01

Escalation of commitment is a business term that describes the continued investment of resources into a project even after there is objective evidence of the project's impending failure. Escalation of commitment may be a contributor to high healthcare costs associated with critically ill patients as it has been shown that, despite almost certain futility, most ICU costs are incurred in the last week of life. Our objective was to determine if escalation of commitment occurs in healthcare settings, specifically in the surgical ICU. We hypothesize that factors previously identified in business and organizational psychology literature including self-justification, accountability, sunk costs, and cognitive dissonance result in escalation of commitment behavior in the surgical ICU setting resulting in increased utilization of resources and cost. A descriptive case study that illustrates common ICU narratives in which escalation of commitment can occur. In addition, we describe factors that are thought to contribute to escalation of commitment behaviors. Escalation of commitment behavior was observed with self-justification, accountability, and cognitive dissonance accounting for the majority of the behavior. Unlike in business decisions, sunk costs was not as evident. In addition, modulating factors such as personality, individual experience, culture, and gender were identified as contributors to escalation of commitment. Escalation of commitment occurs in the surgical ICU, resulting in significant expenditure of resources despite a predicted and often known poor outcome. Recognition of this phenomenon may lead to actions aimed at more rational decision making and may contribute to lowering healthcare costs. Investigation of objective measures that can help aid decision making in the surgical ICU is warranted.

Knowledge Sharing, Control of Care Quality, and Innovation in Intensive Care Nursing

DEFF Research Database (Denmark)

Paunova, Minna; Li-Ying, Jason; Egerod, Ingrid Eugenie

This study investigates the influence of nurse knowledge sharing behavior on nurse innovation, given different conditions of control of care quality within the intensive care unit (ICU). After conducting a number of interviews and a pilot study, we carried out a multi-source survey study of more...... control of care quality and innovate may be conflicting, unless handled properly....

National survey focusing on the crucial information needs of intensive care charge nurses and intensivists: same goal, different demands

Directory of Open Access Journals (Sweden)

Lundgrén-Laine Heljä

2013-01-01

Full Text Available Abstract Background Although information technology adequately supports clinical care in many intensive care units (ICUs, it provides much poorer support for the managerial information needed to coordinate multi-professional care. To gain a general view of the most crucial multi-professional information needs of ICU shift leaders a national survey was conducted, focusing on the information needs of charge nurses and intensivists. Methods Based on our previous observation study an online survey was developed, containing 122 information need statements related to the decision-making of ICU shift leaders. Information need statements were divided into six dimensions: patient admission, organisation and management of work, allocation of staff and material resources, special treatments, and patient discharge. This survey involved all ICU shift leaders (n = 738 who worked in any of the 17 highest level ICUs for adults in university hospitals in Finland during the autumn of 2009. Both charge nurses’ and intensivists’ crucial information needs for care coordination were evaluated. Results Two hundred and fifty-seven (50% charge nurses and 96 (43% intensivists responded to the survey. The consistency of the survey was found to be good (Cronbach’s α scores between .87–.97, with a total explanatory power of 64.53%. Altogether, 57 crucial information needs for care coordination were found; 22 of which were shared between shift leaders. The most crucial of these information needs were related to organisation and management, patient admission, and allocation of staff resources. The associations between working experience, or shift leader acting frequencies, and crucial information needs were not statistically significant. However, a statistically significant difference was found between the number of ICU beds and the ICU experience of charge nurses with information needs, under the dimension of organisation and management of work. The information

The role of nurses' clinical impression in the first assessment of children at the emergency department.

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Zachariasse, Joany M; van der Lee, Dominique; Seiger, Nienke; de Vos-Kerkhof, Evelien; Oostenbrink, Rianne; Moll, Henriëtte A

2017-11-01

To assess the diagnostic value and determinants of nurses' clinical impression for the recognition of children with a serious illness on presentation to the emergency department (ED). Secondary analysis of a prospective cohort. 6390 consecutive children nurses' clinical impression for the prediction of serious illness, defined by intensive care unit (ICU) and hospital admission. Determinants of nurses' impression that a child appeared ill. Nurses considered a total of 1279 (20.0%) children appearing ill. Sensitivity of nurses' clinical impression for the recognition of patients requiring ICU admission was 0.70 (95% CI 0.62 to 0.76) and specificity was 0.81 (95% CI 0.80 to 0.82). Sensitivity for hospital admission was 0.48 (95% CI 0.45 to 0.51) and specificity was 0.88 (95% CI 0.87 to 0.88). When adjusted for age, gender, triage urgency and abnormal vital signs, nurses' impression remained significantly associated with ICU (OR 4.54; 95% CI 3.09 to 6.66) and hospital admission (OR 4.00; 95% CI 3.40 to 4.69). Ill appearance was positively associated with triage urgency, fever and abnormal vital signs and negatively with self-referral and presentation outside of office hours. The overall clinical impression of experienced nurses at the ED is on its own, not an accurate predictor of serious illness in children, but provides additional information above some well-established and objective predictors of illness severity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Swedish Government Minister at CERN

CERN Document Server

2008-01-01

The Swedish Minister for Higher Education and Research recently visited CERN. The Swedish Minister was greeted by Swedish scientists working at CERN. Signing of the Swedish Computing Memorandum of Understanding. Pär Omling, Director-General of the Swedish Research Council (left), and Jos Engelen, CERN’s Chief Scientific Officer. Lars Leijonborg, the Swedish Minister for Higher Education and Research, was welcomed to CERN by Director-General Robert Aymar on 10 March. After an introduction to the Laboratory’s activities, the Minister was given guided tours of the control room, the ATLAS surface hall and experiment cavern and the adjoining LHC tunnel. Mr Leijonborg was then greeted by Swedish scientists and given an overview of the Swedish research programme at CERN. Five Swedish university groups are taking part in LHC research. Swedish universities are notably involved in the manufacture of parts for the sub-detectors of AT...

Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods.

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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.

Health among Schoolchildren from the School Nurse's Perspective

Science.gov (United States)

Ellertsson, Ann-Sofi; Garmy, Pernilla; Clausson, Eva K.

2017-01-01

The aim of the study was to investigate Swedish school nurses' perceptions of schoolchildren's health. The study is based on two national surveys in which school nurses responded to questions about schoolchildren's health in 2015 (n = 181) and 2005 (n = 129). A statistical comparison showed that physical and mental health of schoolchildren in…

The Iatroref study: medical errors are associated with symptoms of depression in ICU staff but not burnout or safety culture.

Science.gov (United States)

Garrouste-Orgeas, Maité; Perrin, Marion; Soufir, Lilia; Vesin, Aurélien; Blot, François; Maxime, Virginie; Beuret, Pascal; Troché, Gilles; Klouche, Kada; Argaud, Laurent; Azoulay, Elie; Timsit, Jean-François

2015-02-01

Staff behaviours to optimise patient safety may be influenced by burnout, depression and strength of the safety culture. We evaluated whether burnout, symptoms of depression and safety culture affected the frequency of medical errors and adverse events (selected using Delphi techniques) in ICUs. Prospective, observational, multicentre (31 ICUs) study from August 2009 to December 2011. Burnout, depression symptoms and safety culture were evaluated using the Maslach Burnout Inventory (MBI), CES-Depression scale and Safety Attitudes Questionnaire, respectively. Of 1,988 staff members, 1,534 (77.2 %) participated. Frequencies of medical errors and adverse events were 804.5/1,000 and 167.4/1,000 patient-days, respectively. Burnout prevalence was 3 or 40 % depending on the definition (severe emotional exhaustion, depersonalisation and low personal accomplishment; or MBI score greater than -9). Depression symptoms were identified in 62/330 (18.8 %) physicians and 188/1,204 (15.6 %) nurses/nursing assistants. Median safety culture score was 60.7/100 [56.8-64.7] in physicians and 57.5/100 [52.4-61.9] in nurses/nursing assistants. Depression symptoms were an independent risk factor for medical errors. Burnout was not associated with medical errors. The safety culture score had a limited influence on medical errors. Other independent risk factors for medical errors or adverse events were related to ICU organisation (40 % of ICU staff off work on the previous day), staff (specific safety training) and patients (workload). One-on-one training of junior physicians during duties and existence of a hospital risk-management unit were associated with lower risks. The frequency of selected medical errors in ICUs was high and was increased when staff members had symptoms of depression.

Nurses' Knowledge and Responsibility toward Nutritional Assessment for Patients in Intensive Care Units

Directory of Open Access Journals (Sweden)

Mahmoud Al Kalaldeh

2014-09-01

Full Text Available Introduction: Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures.Methods: This cross sectional study recruited nurses from different health sectors in Jordan. ICU nurses from the governmental sector (two hospitals and private sectors (two hospitals were surveyed using a self-administered questionnaire. Nurses' knowledge and responsibility towards nutritional assessment were examined.Results: A total of 220 nurses from both sectors have completed the questionnaire. Nurses were consistent in regard to knowledge, responsibility, and documentation of nutritional assessment. Nurses in the governmental hospitals inappropriately perceived the application of aspiration reduction measures. However, they scored higher in applying physical examination and anthropometric assessment.  Although both nurses claimed higher use of biochemical measurements, biophysical measurements were less frequently used. Older nurses with longer clinical experience exhibited better adherence to biophysical measurement than younger nurses.Conclusion: Nursing nutritional assessment is still suboptimal to attain nutritional goals. Assessment of body weight, history of nutrition intake, severity of illness, and function of gastrointestinal tract should be considered over measuring albumin and pre-albumin levels.  A well-defined evidence-based protocol as well as a multidisciplinary nutritional team for nutritional assessment is the best to minimize episodes of under-nutrition.

Reducing unnecessary culturing: a systems approach to evaluating urine culture ordering and collection practices among nurses in two acute care settings

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Robert Redwood

2018-01-01

Full Text Available Abstract Background Inappropriate ordering and acquisition of urine cultures leads to unnecessary treatment of asymptomatic bacteriuria (ASB. Treatment of ASB contributes to antimicrobial resistance particularly among hospital-acquired organisms. Our objective was to investigate urine culture ordering and collection practices among nurses to identify key system-level and human factor barriers and facilitators that affect optimal ordering and collection practices. Methods We conducted two focus groups, one with ED nurses and the other with ICU nurses. Questions were developed using the Systems Engineering Initiative for Patient Safety (SEIPS framework. We used iterative categorization (directed content analysis followed by summative content analysis to code and analyze the data both deductively (using SEIPS domains and inductively (emerging themes. Results Factors affecting optimal urine ordering and collection included barriers at the person, process, and task levels. For ED nurses, barriers included patient factors, physician communication, reflex culture protocols, the electronic health record, urinary symptoms, and ED throughput. For ICU nurses, barriers included physician notification of urinalysis results, personal protective equipment, collection technique, patient body habitus, and Foley catheter issues. Conclusions We identified multiple potential process barriers to nurse adherence with evidence-based recommendations for ordering and collecting urine cultures in the ICU and ED. A systems approach to identifying barriers and facilitators can be useful to design interventions for improving urine ordering and collection practices.

A Coordinated Patient Transport System for ICU Patients Requiring Surgery: Impact on Operating Room Efficiency and ICU Workflow.

Science.gov (United States)

Brown, Michael J; Kor, Daryl J; Curry, Timothy B; Marmor, Yariv; Rohleder, Thomas R

2015-01-01

Transfer of intensive care unit (ICU) patients to the operating room (OR) is a resource-intensive, time-consuming process that often results in patient throughput inefficiencies, deficiencies in information transfer, and suboptimal nurse to patient ratios. This study evaluates the implementation of a coordinated patient transport system (CPTS) designed to address these issues. Using data from 1,557 patient transfers covering the 2006-2010 period, interrupted time series and before and after designs were used to analyze the effect of implementing a CPTS at Mayo Clinic, Rochester. Using a segmented regression for the interrupted time series, on-time OR start time deviations were found to be significantly lower after the implementation of CPTS (p < .0001). The implementation resulted in a fourfold improvement in on-time OR starts (p < .01) while significantly reducing idle OR time (p < .01). A coordinated patient transfer process for moving patient from ICUs to ORs can significantly improve OR efficiency, reduce nonvalue added time, and ensure quality of care by preserving appropriate care provider to patient ratios.

Nurse and patient interaction behaviors' effects on nursing care quality for mechanically ventilated older adults in the ICU.

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Nilsen, Marci L; Sereika, Susan M; Hoffman, Leslie A; Barnato, Amber; Donovan, Heidi; Happ, Mary Beth

2014-01-01

The study purposes were to (a) describe interaction behaviors and factors that may effect communication and (b) explore associations between interaction behaviors and nursing care quality indicators among 38 mechanically ventilated patients (age ≥60 years) and their intensive care unit nurses (n = 24). Behaviors were measured by rating videorecorded observations from the Study of Patient-Nurse Effectiveness with Communication Strategies (SPEACS). Characteristics and quality indicators were obtained from the SPEACS dataset and medical chart abstraction. All positive behaviors occurred at least once. Significant (p quality. Copyright 2014, SLACK Incorporated.

Determining the economic cost of ICU treatment: a prospective "micro-costing" study.

LENUS (Irish Health Repository)

McLaughlin, Anne Marie

2012-02-01

OBJECTIVE: To prospectively assess the cost of patients in an adult intensive care unit (ICU) using bottom-up costing methodology and evaluate the usefulness of "severity of illness" scores in estimating ICU cost. METHODS AND DESIGN: A prospective study costing 64 consecutive admissions over a 2-month period in a mixed medical\\/surgical ICU. RESULTS: The median daily ICU cost (interquartile range, IQR) was 2,205 euro (1,932 euro-3,073 euro), and the median total ICU cost (IQR) was 10,916 euro (4,294 euro-24,091 euro). ICU survivors had a lower median daily ICU cost at 2,164 per day, compared with 3,496 euro per day for ICU non-survivors (P = 0.08). The requirements for continuous haemodiafiltration, blood products and anti-fungal agents were associated with higher daily and overall ICU costs (P = 0.002). Each point increase in SAPS3 was associated with a 305 euro (95% CI 31 euro-579 euro) increase in total ICU cost (P = 0.029). However, SAPS3 accounted for a small proportion of the variance in this model (R (2) = 0.08), limiting its usefulness as a stand-alone predictor of cost in clinical practice. A model including haemodiafiltration, blood products and anti-fungal agents explained 54% of the variance in total ICU cost. CONCLUSION: This bottom-up costing study highlighted the considerable individual variation in costs between ICU patients and identified the major factors contributing to cost. As the requirement for expensive interventions was the main driver for ICU cost, "severity of illness" scores may not be useful as stand-alone predictors of cost in the ICU.

Caritas, spirituality and religiosity in nurses' coping.

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Ekedahl, M A; Wengström, Y

2010-07-01

The purpose of this qualitative study was to investigate registered nurses' coping processes when working with terminally ill and dying cancer patients, with special focus on religious aspects of coping resources. What religious components can be identified as coping resources in oncology nurses' orienting system and what function has religiosity in the nurse's work? The theoretical reference is care philosophy and the psychology of religion and coping. The material consists of interviews with 15 Swedish registered oncology nurses. The results highlight different dynamic aspects of the nurses' life orientation such as caritas, religiosity, spirituality and atheism and demonstrate that religiosity can have a protective function that facilitates coping, as the nurse has something to turn to. Religious coping dominated by basic trust where prayer is used as a coping strategy may support the nurse.

The role of the nurse at the end of the life of a critically ill patient.

Science.gov (United States)

González-Rincón, M; Díaz de Herrera-Marchal, P; Martínez-Martín, M L

2018-06-11

Analyze the role of the nurse at the end of the life of a critically ill patient. Bibliographic review from a search of the health science databases such as PubMed, CINAHL, Cuiden, Scopus, Cochrane, as well as specialized platforms, general and thematic browsers. The limits were language (English or Spanish) and publication date (2005-2015). 180 articles met the inclusion criteria, and 16 of them were selected for analysis. The main results were grouped into three categories of analysis: direct patient care, family-focussed care and the nurse's role within the team. the described roles place the nurse as a key element in humanising death in the ICU and so nurses can and must lead change, playing an active role in creating strategies that really promote the integration of a palliative care approach in ICU. Copyright © 2018 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

Nurses Empathy and Family Needs in the Intensive Care Units

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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.

Acute Kidney Injury Classification in Neuro-ICU Patient Group

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Canan Akıncı

2012-12-01

Full Text Available Objective: To investigate the role of acute kidney injury (AKI classification system for kidney injury outcome in neuro-Intensive care unit (ICU patients. Material and Method: Total 432 patients who admitted to ICU between 2005 and 2009 evaluated in this study. All patients’ AKI stage, Acute Physiology and Chronic Health Evaluation (APACHE-II, Sequential Organ Failure Assessment Score (SOFA, Glasgow Coma Score (GCS, Glasgow Outcome Score (GOS, mortality rate, length of ICU stay, need for intubation, and mechanical ventilation were recorded. Results: AKI was found in 24 of all 432 patents’ (5.5%. We found that, patients with AKI had higher APHACE-II score, SOFA score and mortality rates; longer ICU stay, duration of mechanical ventilation and intubation and lower GCS and GOS than without AKI group. Conclusion: Length of ICU stay and mortality rate were higher in AKI positive group.

[The work of the intensive care nurse: a study on the social representations structure].

Science.gov (United States)

Silva, Iranete Almeida Sousa; da Cruz, Enêde Andrade

2008-09-01

This study aims at characterizing the social representations of the nurse in the intensive care unit (ICU) by identifying the central core and the peripheral system. It was carried out in five ICUs from both public and philanthropic teaching, research and assistance hospitals in Salvador (Bahia, Brazil). Data were gathered from ninety nurses by means of free evocation from the phrase: nurse's work in an ICU and then processed with the EVOC software. Analysis was performed by building a four-digit chart based on the structural approach to the theory of social representations. Results point out stress, responsibility, integral care and gratification as the core elements. The peripheral system comprised personal and professional attitudes deemed necessary to perform the work. Therefore, it could be concluded that stress and responsible work are relieved by the gratifying feeling of providing integral care, which demands a range of personal and professional attitudes.

Delayed Recognition of Deterioration of Patients in General Wards Is Mostly Caused by Human Related Monitoring Failures: A Root Cause Analysis of Unplanned ICU Admissions.

Directory of Open Access Journals (Sweden)

Louise S van Galen

Full Text Available An unplanned ICU admission of an inpatient is a serious adverse event (SAE. So far, no in depth-study has been performed to systematically analyse the root causes of unplanned ICU-admissions. The primary aim of this study was to identify the healthcare worker-, organisational-, technical,- disease- and patient- related causes that contribute to acute unplanned ICU admissions from general wards using a Root-Cause Analysis Tool called PRISMA-medical. Although a Track and Trigger System (MEWS was introduced in our hospital a few years ago, it was implemented without a clear protocol. Therefore, the secondary aim was to assess the adherence to a Track and Trigger system to identify deterioration on general hospital wards in patients eventually transferred to the ICU.Retrospective observational study in 49 consecutive adult patients acutely admitted to the Intensive Care Unit from a general nursing ward. 1. PRISMA-analysis on root causes of unplanned ICU admissions 2. Assessment of protocol adherence to the early warning score system.Out of 49 cases, 156 root causes were identified. The most frequent root causes were healthcare worker related (46%, which were mainly failures in monitoring the patient. They were followed by disease-related (45%, patient-related causes (7, 5%, and organisational root causes (3%. In only 40% of the patients vital parameters were monitored as was instructed by the doctor. 477 vital parameter sets were found in the 48 hours before ICU admission, in only 1% a correct MEWS was explicitly documented in the record.This in-depth analysis demonstrates that almost half of the unplanned ICU admissions from the general ward had healthcare worker related root causes, mostly due to monitoring failures in clinically deteriorating patients. In order to reduce unplanned ICU admissions, improving the monitoring of patients is therefore warranted.

Preoperative information for ICU patients to reduce anxiety during and after the ICU-stay: protocol of a randomized controlled trial [NCT00151554

Directory of Open Access Journals (Sweden)

Koller Michael

2006-03-01

Full Text Available Abstract Background According to current evidence and psychological theorizing proper information giving seems to be a promising way to reduce patient anxiety. In the case of surgical patients, admission to the intensive care unit (ICU is strongly associated with uncertainty, unpredictability and anxiety for the patient. Thus, ICU specific information could have a high clinical impact. This study investigates the potential benefits of a specifically designed ICU-related information program for patients who undergo elective cardiac, abdominal or thoracic surgery and are scheduled for ICU stay. Methods/Design The trial is designed as a prospective randomized controlled trial including an intervention and a control group. The control group receives the standard preparation currently conducted by surgeons and anesthetists. The intervention group additionally receives a standardized information program with specific procedural, sensory and coping information about the ICU. A measurable clinical relevant difference regarding anxiety will be expected after discharge from ICU. Power calculation (α = 0.05; β = 0.20; Δ = 8.50 score points resulted in a required sample size of N = 120 cardiac surgical patients (n = 60 vs. n = 60. Furthermore, N = 20 abdominal or thoracic surgical patients will be recruited (n = 10 vs. n = 10 to gain insight to a possible generalization to other patient groups. Additionally the moderating effect of specific patient attributes (need for cognition, high trait anxiety will be investigated to identify certain patient groups which benefit most. Discussion The proposed study promises to strengthen evidence on effects of a specific, concise information program that addresses the information needs of patients scheduled for ICU stay.

Simplified Mortality Score for the Intensive Care Unit (SMS-ICU)

DEFF Research Database (Denmark)

Granholm, Anders; Perner, Anders; Krag, Mette

2017-01-01

validate a clinical prediction rule that predicts 90-day mortality on ICU admission. The development sample will comprise 4247 adult critically ill patients acutely admitted to the ICU, enrolled in 5 contemporary high-quality ICU studies/trials. The score will be developed using binary logistic regression...

Occupational stress and mental health among nurses in a medical intensive care unit of a general hospital in Bandar Abbas in 2013.

Science.gov (United States)

Tajvar, Abdolhamid; Saraji, Gebraeil Nasl; Ghanbarnejad, Amin; Omidi, Leila; Hosseini, Seyed Sodabeh Seyed; Abadi, Ali Salehi Sahl

2015-07-01

Many nurses have reported experiencing high levels of occupational stress in their work environment. Stress, as an outcome of stressful workplaces and tasks, affects nursing behavior in hospital wards. The objectives of this research were to determine the prevalence of occupational stress and mental health problems in nurses in the intensive care unit (ICU) at Shahid Mohammadi Hospital in Bandar Abbas in 2013 and to determine the relationship between occupational stress and mental health. This cross-sectional study was conducted in 2013 on all of the nurses working in ICU at Shahid Mohammadi Hospital located in Bandar Abbas, Iran. Seventy-two nurses were selected as the population for this study, and all of them were female. Two questionnaires were used in this study, i.e., General Health Questionnaire-28 (GHQ-28) for assessing mental health and an occupational stress test for assessing job stress. Furthermore, the relationship between occupational stress and mental health was examined. One-way analysis of variance (ANOVA), independent samples t-test, and Pearson's product-moment correlation test were used to analyze the data. High and moderate levels of occupational stress were experienced by 83.9% and 10.7% of ICU nurses, respectively. The prevalence of mental disorders, somatic symptoms, anxiety, social dysfunction, and depression were 58.9, 60.7, 62.5, 71.4, and 10.7%, respectively. The findings of the independent samples t-test showed that somatic symptoms had significant relationships with age and working experience (p = 0.01). According to the independent samples t-test, there were no significant differences between somatic symptoms and working different shifts (p > 0.05). There was a high prevalence of occupational stress among ICU nurses. There was a significant relationship between occupational stress and mental health. Future interventions are needed to codify a comprehensive health program in this field to reduce occupational stress and enhance nurses

Impact of prior ICU experience on ICU patient family members' psychological distress: A descriptive study.

Science.gov (United States)

Lewis, Chrystal L; Taylor, Jessica Z

2017-12-01

To determine if current levels of anxiety, depression and acute stress disorder symptoms differ significantly among family members of intensive-care-unit patients depending upon previous intensive-care experience. This study used a prospective, descriptive study design. Family members (N=127) from patients admitted within a 72-hour timeframe to the medical, surgical, cardiac and neurological intensive care units were recruited from waiting rooms at a medium-sized community hospital in the Southeastern United States. Participants completed the Hospital Anxiety and Depression Scale, the Impact of Events Scale-Revised, the Acute Stress Disorder Scale and a demographic questionnaire. A multivariate analysis revealed that family members of intensive-care-unit patients with a prior intensive-care experience within the past two years (n=56) were significantly more likely to report anxiety, depression and acute stress symptoms, Λ=0.92, F [4122]=2.70, p=0.034, partial η 2 =0.08, observed power=0.74. Results of this study show that family members' psychological distress is higher with previous familial or personal intensive-care experience. Nurses need to assess for psychological distress in ICU family members and identify those who could benefit from additional support services provided in collaboration with multidisciplinary support professionals. Copyright © 2017 Elsevier Ltd. All rights reserved.

Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden.

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Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas

2017-07-14

Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier

ICU versus Non-ICU Hospital Death: Family Member Complicated Grief, Posttraumatic Stress, and Depressive Symptoms.

Science.gov (United States)

Probst, Danielle R; Gustin, Jillian L; Goodman, Lauren F; Lorenz, Amanda; Wells-Di Gregorio, Sharla M

2016-04-01

Family members of patients who die in an ICU are at increased risk of psychological sequelae compared to those who experience a death in hospice. This study explored differences in rates and levels of complicated grief (CG), posttraumatic stress disorder (PTSD), and depression between family members of patients who died in an ICU versus a non-ICU hospital setting. Differences in family members' most distressing experiences at the patient's end of life were also explored. The study was an observational cohort. Subjects were next of kin of 121 patients who died at a large, Midwestern academic hospital; 77 died in the ICU. Family members completed measures of CG, PTSD, depression, and end-of-life experiences. Participants were primarily Caucasian (93%, N = 111), female (81%, N = 98), spouses (60%, N = 73) of the decedent, and were an average of nine months post-bereavement. Forty percent of family members met the Inventory of Complicated Grief CG cut-off, 31% met the Impact of Events Scale-Revised PTSD cut-off, and 51% met the Center for Epidemiologic Studies Depression Scale depression cut-off. There were no significant differences in rates or levels of CG, PTSD, or depressive symptoms reported by family members between hospital settings. Several distressing experiences were ranked highly by both groups, but each setting presented unique distressing experiences for family members. Psychological distress of family members did not differ by hospital setting, but the most distressing experiences encountered at end of life in each setting highlight potentially unique interventions to reduce distress post-bereavement for family members.

Palliative Care Needs Assessment in the Neuro-ICU: Effect on Family.

Science.gov (United States)

Creutzfeldt, Claire J; Hanna, Marina G; Cheever, C Sherry; Lele, Abhijit V; Spiekerman, Charles; Engelberg, Ruth A; Curtis, J Randall

2017-10-01

Examine the association of a daily palliative care needs checklist on outcomes for family members of patients discharged from the neurosciences intensive care unit (neuro-ICU). We conducted a prospective, longitudinal cohort study in a single, thirty-bed neuro-ICU in a regional comprehensive stroke and level 1 trauma center. One of two neuro-ICU services that admit patients to the same ICU on alternating days used a palliative care needs checklist during morning work rounds. Between March and October, 2015, surveys were mailed to family members of patients discharged from the neuro-ICU. Nearly half of surveys (n = 91, 48.1%) were returned at a median of 4.7 months. At the time of survey completion, mean Modified rankin scale score (mRS) of neuro-ICU patients was 3.1 (SD 2). Overall ratings of quality of care were relatively high (82.2 on a 0-100 scale) with 32% of family members meeting screening criteria for depressive syndrome. The primary outcome measuring family satisfaction, consisting of eight items from the Family Satisfaction in the ICU questionnaire, did not differ significantly between families of patients from either ICU service nor did family ratings of depression (PHQ-8) and post-traumatic stress (PCL-17). Among families of patients discharged from the neuro-ICU, the daily use of a palliative care needs checklist had no measurable effect on family satisfaction scores or long-term psychological outcomes. Further research is needed to identify optimal interventions to meet the palliative care needs specific to family members of patients treated in the neuro-ICU.

In-hospital outcome of patients discharged from the ICU with ...

African Journals Online (AJOL)

Objective. To document the outcome of patients discharged from the intensive care unit (ICU) with tracheostomies. Design and setting. This was a retrospective study conducted in the ICU of Dr George Mukhari Hospital, Pretoria. Patients. All patients discharged from the ICU with tracheostomies over a period of 1 year from 1 ...

Swedish Disarmament Policy

OpenAIRE

2012-01-01

NPIHP Partners Host Conference on Swedish Disarmament Policy Dec 05, 2012 The Nuclear Proliferation International History Project is pleased to announce a conference on Swedish nuclear disarmament policy, organized and hosted by Stockholm University on 26 november 2012. Organized by Stockholm University Professor Thomas Jonter, Emma Rosengren, Goran Rydeberg, and Stellan Andersson under the aegis of the Swedish Disarmament Resaerch Project, the conference featured keynote addresses by Hans Bl...

Enabling ICU patients to die at home.

Science.gov (United States)

Battle, Emma; Bates, Lucy; Liderth, Emma; Jones, Samantha; Sheen, Sheryl; Ginty, Andrew; Northmore, Melanie

2014-10-07

There is often an overlap between intensive care medicine and palliative medicine. When all curative treatment options have been explored, keeping the patient comfortable and free from pain is the main concern for healthcare practitioners. Patient autonomy in end of life decisions has not been encouraged in the intensive care unit (ICU), until now, because of its specialised and technical nature. Staff at the Royal Bolton Hospital have broken down the barriers to enabling ICU patients to die in their own homes, and have developed a system of collaborative working that can help to fulfil a patient's final wish to go home. This article describes how ICU staff developed a process that enabled two ventilated patients to be transferred home for end of life care.

Nursing staff turnover at a Swedish university hospital: an exploratory study.

Science.gov (United States)

Sellgren, Stina F; Kajermo, Kerstin N; Ekvall, Göran; Tomson, Göran

2009-11-01

The aim was to explore opinions on individual needs and other factors that may influence nursing staff turnover. High staff turnover is a great problem for many hospitals. It is shown to have a negative effect on the quality of nursing care and to increase hospital costs. In 2004 in a large university hospital in Sweden five focus group discussions (FGDs) including department heads (1), nursing managers (2) and members of nursing staff (2) were carried out. The questions to be addressed were 'Why do nurses leave?' and 'Why do nurses stay?' In addition, register data of staff turnover for 2002-2003 were analysed in relation to different facts about the units, such as number of employees, type of care and medical specialty. Categories of opinions identified in the FGDs were compared with results of the statistical analyses on the relationship between staff turnover and unit parameters to identify overall factors that may influence on nurse staff turnover. Four major factors were identified as having a possible influence on staff turnover: 'intrinsic values of motivation', 'work load', 'unit size 'and 'leadership'. Smaller units had lower staff turnover as well as outpatient units and day care. It was not possible to compare statements from participants from smaller units with those from participants from larger units. Two factors had diverging data, 'salary' and 'spirit of the time'. A surprising finding was the little mention of patient care in relation to staff turnover. It is important for managers to ensure that intrinsic values of nurses are met to minimise the risk for high turnover rates. Inpatient care must receive adequate staffing and nursing care could be organised into smaller units or work teams to avoid dissatisfaction and high turnover.

Mapping VIPS concepts for nursing interventions to the ISO reference terminology model for nursing actions: A collaborative Scandinavian analysis

DEFF Research Database (Denmark)

Ehnfors, Margareta; Angermo, Lilly Marit; Berring, Lene

2006-01-01

analyzed the VIPS model's concepts for nursing interventions using prototypical examples of nursing actions, involving 233 units of analyses, and collaborated in mapping the two models. All nursing interventions in the VIPS model comprise actions and targets, but a few lack explicit expressions of means......The aims of this study were to analyze the coherence between the concepts for nursing interventions in the Swedish VIPS model for nursing recording and the ISO Reference Terminology Model for Nursing Actions and to identify areas in the two models for further development. Seven Scandinavian experts....... In most cases, the recipient of care is implicit. Expressions for the aim of an action are absent from the ISO model. By this mapping we identified areas for future development of the VIPS model and the experience from nursing terminology work in Scandinavia can contribute to the international...

Simulator-based crew resource management training for interhospital transfer of critically ill patients by a mobile ICU.

Science.gov (United States)

Droogh, Joep M; Kruger, Hanneke L; Ligtenberg, Jack J M; Zijlstra, Jan G

2012-12-01

Transporting critically ill ICU patients by standard ambulances, with or without an accompanying physician, imposes safety risks. In 2007 the Dutch Ministry of Public Health required that all critically ill patients transferred between ICUs in different hospitals be transported by a mobile ICU (MICU). Since March 2009 a specially designed MICU and a retrieval team have served the region near University Medical Center Groningen, in the northeastern region of the Netherlands. The MICU transport program includes simulator-based crew resource management (CRM) training for the intensivists and ICU nurses, who, with the drivers, constitute the MICU crews. Training entails five pivotal aspects: (1) preparation, (2) teamwork, (3) new equipment, (4) mobility, and (5) safety. For example, the training accustoms participants to working in the narrow, moving ambulance and without benefit of additional manpower. The scenario-based team training, which takes about four hours, occurs in a training facility, with its reconstructed ICU, and then in the MICU itself. A "wireless" patient simulator that is able to mimic hemodynamic and respiratory patterns and to simulate lung and heart sounds is used. All scenarios can be adjusted to simulate medical, logistic, or technical problems. Since the start of MICU training in 2009, more than 70 training sessions, involving 100 team members, have been conducted. Quality issues identified include failure to anticipate possible problems (such as failing to ask for intubation of a respiratory-compromised patient at intake); late responses to alarms of the ventilator, perfusor pump, or monitor; and not anticipating a possible shortage of medication. Setting up and implementing simulator-based CRM training provides feasible and helpful preparation for an MICU team.

Plan to Have No Unplanned: A Collaborative, Hospital-Based Quality-Improvement Project to Reduce the Rate of Unplanned Extubations in the Pediatric ICU.

Science.gov (United States)

Tripathi, Sandeep; Nunez, Denise J; Katyal, Chaavi; Ushay, H Michael

2015-08-01

Although under-reported and understudied, unplanned extubations carry a significant risk of patient harm and even death. They are an important yardstick of quality control of care of intubated patients in the ICU. A unit-based risk assessment and multidisciplinary approach is required to decrease the incidence of unplanned extubations. As part of a quality-improvement initiative of Children's Hospital at Montefiore, all planned and unplanned extubations in a multidisciplinary 20-bed pediatric ICU were evaluated over a 12-month period (January to December 2010). At the end of 6 months, an interim analysis was performed, and high-risk patient groups and patient care factors were identified. These factors were targeted in the second phase of the project. Over this period, there were a total of 267 extubations, of which 231 (87%) were planned extubations and 36 (13%) were unplanned. A patient care policy targeting the risk factors was instituted, along with extensive nursing and other personnel education in the second phase. As a result of this intervention, the unplanned extubation rate in the pediatric ICU decreased from 3.55 to 2.59/100 intubation days. All subjects who had an unplanned extubation during nursing procedures or transport required re-intubation, whereas none of the unplanned extubations during ventilator weaning required re-intubation. A targeted approach based on unit-specific risk factors is most effective in quality-improvement projects. A specific policy for sedation and weaning can be very helpful in managing intubated patients and preventing unintended harm. Copyright © 2015 by Daedalus Enterprises.

A Systematic Review of Early Warning Systems' Effects on Nurses' Clinical Performance and Adverse Events Among Deteriorating Ward Patients.

Science.gov (United States)

Lee, Ju-Ry; Kim, Eun-Mi; Kim, Sun-Aee; Oh, Eui Geum

2018-04-25

Early warning systems (EWSs) are an integral part of processes that aim to improve the early identification and management of deteriorating patients in general wards. However, the widespread implementation of these systems has not generated robust data regarding nurses' clinical performance and patients' adverse events. This review aimed to determine the ability of EWSs to improve nurses' clinical performance and prevent adverse events among deteriorating ward patients. The PubMed, CINAHL, EMBASE, and Cochrane Library databases were searched for relevant publications (January 1, 1997, to April 12, 2017). In addition, a grey literature search evaluated several guideline Web sites. The main outcome measures were nurses' clinical performance (vital sign monitoring and rapid response team notification) and patients' adverse events (in-hospital mortality, cardiac arrest, and unplanned intensive care unit [ICU] admission). The search identified 888 reports, although only five studies fulfilled the inclusion criteria. The findings of these studies revealed that EWSs implementation had a positive effect on nurses' clinical performance, based on their frequency of documenting vital signs that were related to the patient's clinical deterioration. In addition, postimplementation reductions were identified for cardiac arrest, unplanned ICU admission, and unexpected death. It seems that EWSs can improve nurses' clinical performance and prevent adverse events (e.g., in-hospital mortality, unplanned ICU admission, and cardiac arrest) among deteriorating ward patients. However, additional high-quality evidence is needed to more comprehensively evaluate the effects of EWSs on these outcomes.

Awareness of bispectral index monitoring system among the critical care nursing personnel in a tertiary care hospital of India

Directory of Open Access Journals (Sweden)

Shikha Thakur

2011-01-01

Full Text Available Background: Bispectral index monitoring system (BIS is one of the several systems used to measure the effects of anaesthetic and sedative drugs on the brain and to track changes in the patient′s level of sedation and hypnosis. BIS monitoring provides information clinically relevant to the adjustment of dosages of sedating medication. It can help the nursing personnel in preventing under- and over sedation among intensive care unit (ICU patients. Objective: The present study was conducted to assess the knowledge of nursing personnel working in the ICU regarding BIS. Methods: Fifty-four subjects participated in the study. A structured questionnaire was developed to assess the knowledge of the nursing personnel regarding BIS. Focus group discussions were held among the nursing personnel to know their views regarding BIS. Results: Mean age (years of the subjects was 30.7΁7.19 (21-47 years, with a female preponderance. Although the use of BIS in ICU is not common, majority (94.44% were aware of BIS and its purpose. 79.62% of the subjects knew about its implication in patient care. The mean knowledge score of the subjects was 11.87΁2.43 (maximum score being 15. Conclusion: There exists an awareness among the critical care nursing staff in our institution regarding BIS and its clinical implications. Its use in the critical care setting may benefit the patients in terms of providing optimal sedation.

The perceived perceptions of head school nurses in developing school nursing roles within schools.

Science.gov (United States)

Morberg, Siv; Lagerström, Monica; Dellve, Lotta

2009-11-01

To gain a deeper understanding of how Swedish head school nurses perceive their leadership in developing school health care. A well-functioning school health care is important for promoting the health of children and young people. Constructivist-grounded theory was used to analyse 11 individual interviews with nine head school nurses. Head school nurses strive to find a balance between what they experience as vague formal goals and strong informal goals which leads to creating local goals in order to develop school health care. The head school nurse's job is experienced as a divided and pioneering job in which there is uncertainty about the leadership role. They provide individual support to school nurses, are the link between school nurses and decision makers and highlight the importance of school nurses' work to organizational leaders. This study shows that school health care needs to be founded on evidence-based methods. Therefore, a structured plan for education and training in school health care management, based on research and in cooperation with the academic world, would develop the head school nurses' profession, strengthen the position of school health care and advance the school nurses' work.

Beyond profession: nursing leadership in contemporary healthcare.

Science.gov (United States)

Sorensen, Roslyn; Iedema, Rick; Severinsson, Elisabeth

2008-07-01

To examine nursing leadership in contemporary health care and its potential contribution to health service organization and management. As the nursing profession repositions itself as an equal partner in health care beside medicine and management, its enhanced nursing standards and clinical knowledge are not leading to a commensurate extension of nursing's power and authority in the organization. An ethnographic study of an ICU in Sydney, Australia, comprising: interviews with unit nursing managers (4); focus groups (3) with less experienced, intermediate and experienced nurses (29 in total); and interviews with senior nurse manager (1). Inter- and intra-professional barriers in the workplace, fragmentation of multidisciplinary clinical systems that collectively deliver care, and clinical and administrative disconnection in resolving organizational problems, prevented nurses articulating a model of intensive and end-of-life care. Professional advocacy skills are needed to overcome barriers and to articulate and operationalize new nursing knowledge and standards if nurses are to enact and embed a leadership role. The profession will need to move beyond a reliance on professional clinical models to become skilled multidisciplinary team members and professional advocates for nurses to take their place as equal partners in health care.

Impact of telephone nursing education program for equity in healthcare

OpenAIRE

H?glund, Anna T.; Carlsson, Marianne; Holmstr?m, Inger K.; Kaminsky, Elenor

2016-01-01

Background The Swedish Healthcare Act prescribes that healthcare should be provided according to needs and with respect for each person?s human dignity. The goal is equity in health for the whole population. In spite of this, studies have revealed that Swedish healthcare is not always provided equally. This has also been observed in telephone nursing. Therefore, the aim of the present study was to investigate if and how an educational intervention can improve awareness of equity in healthcare...

Risk factors for post-ICU red blood cell transfusion: a prospective study

Science.gov (United States)

Marque, Sophie; Cariou, Alain; Chiche, Jean-Daniel; Mallet, Vincent Olivier; Pene, Frédéric; Mira, Jean-Paul; Dhainaut, Jean-François; Claessens, Yann-Erick

2006-01-01

Introduction Factors predictive of the need for red blood cell (RBC) transfusion in the intensive care unit (ICU) have been identified, but risk factors for transfusion after ICU discharge are unknown. This study aims identifies risk factors for RBC transfusion after discharge from the ICU. Methods A prospective, monocentric observational study was conducted over a 6-month period in a 24-bed medical ICU in a French university hospital. Between June and December 2003, 550 critically ill patients were consecutively enrolled in the study. Results A total of 428 patients survived after treatment in the ICU; 47 (11% of the survivors, 8.5% of the whole population) required RBC transfusion within 7 days after ICU discharge. Admission for sepsis (odds ratio [OR] 341.60, 95% confidence interval [CI] 20.35–5734.51), presence of an underlying malignancy (OR 32.6, 95%CI 3.8–280.1), female sex (OR 5.4, 95% CI 1.2–24.9), Logistic Organ Dysfunction score at ICU discharge (OR 1.45, 95% CI 1.1–1.9) and age (OR 1.06, 95% CI 1.02–1.12) were independently associated with RBC transfusion after ICU stay. Haemoglobin level at discharge predicted the need for delayed RBC transfusion. Use of vasopressors (OR 0.01, 95%CI 0.001–0.17) and haemoglobin level at discharge from the ICU (OR 0.02, 95% CI 0.007–0.09; P < 0.001) were strong independent predictors of transfusion of RBC 1 week after ICU discharge. Conclusion Sepsis, underlying conditions, unresolved organ failures and haemoglobin level at discharge were related to an increased risk for RBC transfusion after ICU stay. We suggest that strategies to prevent transfusion should focus on homogeneous subgroups of patients and take into account post-ICU needs for RBC transfusion. PMID:16965637

The contents of a patient diary and its significance for persons cared for in an ICU: A qualitative study.

Science.gov (United States)

Strandberg, Sandra; Vesterlund, Lisa; Engström, Åsa

2018-04-01

The aim of this study was to describe the contents of a patient diary and its significance for persons cared for in an ICU. An empirical study with a qualitative design. Eight telephone interviews and one face-to-face interview were conducted with nine persons previously been treated in an ICU and been given a patient diary. In addition, the person would have read his/her diary. The data have been analysed with qualitative content analysis. The study identified one overarching theme; Gaining understanding, and four categories; The diary is written for me, Creating memories from the time of care, Who writes in the diary and, The ability to return to the diary. The diary meant that participants gained an understanding of their time in the ICU while they were critically ill and the diary was important to be able to return to. What formerly critically ill patients appreciate most about the diary is that the diary is personally written, which makes them feel confirmed and valuable as a person. Guidelines for how and when a diary should be written and used would likely encourage critical care nurses and relatives to write in it. Copyright © 2017 Elsevier Ltd. All rights reserved.

Severity and workload related to adverse events in the ICU.

Science.gov (United States)

Serafim, Clarita Terra Rodrigues; Dell'Acqua, Magda Cristina Queiroz; Castro, Meire Cristina Novelli E; Spiri, Wilza Carla; Nunes, Hélio Rubens de Carvalho

2017-01-01

To analyze whether an increase in patient severity and nursing workload are correlated to a greater incidence of adverse events (AEs) in critical patients. A prospective single cohort study was performed on a sample of 138 patients hospitalized in an intensive care unit (ICU). A total of 166 AEs, occurred, affecting 50.7% of the patients. Increased patient severity presented a direct relationship to the probability of AEs occurring. However, nursing workload did not present a statistically significant relationship with the occurrence of AEs. The results cast light on the importance of using evaluation tools by the nursing personnel in order to optimize their daily activities and focus on patient safety. Analisar se o aumento da gravidade do paciente e a carga de trabalho de enfermagem está relacionado à maior incidência de Eventos Adversos (EAs) em pacientes críticos. Estudo de coorte única, prospectivo, com amostra de 138 pacientes internados em uma Unidade de Terapia Intensiva (UTI). Ao todo, foram evidenciados 166 EAs, que acometeram 50,7% dos pacientes. O aumento da gravidade do paciente apresentou relação direta com a chance de ocorrência de EAs. Entretanto, a carga de trabalho de enfermagem não apresentou relação estatisticamente significativa, na ocorrência de EAs. Os resultados permitem refletir acerca da importância da equipe de enfermagem, em utilizar instrumentos de avaliação, com o objetivo de melhorar e planejar suas ações diárias, com foco na segurança do paciente.

The Facilitators and Barriers to Communication between Nurses and Family Member in Intensive Care Unit in Kerman, Iran

OpenAIRE

Laleh loghmani; Fariba borhani; Abbas Abbaszadeh

2014-01-01

Introduction: The communication between nurses and patients' families is commun- ication significantly impacts patient well-being as well as the quality and outcome of nursing care, this study aimed to demonstrated the facilitators and barriers which influence the role of communication among Iranian nurses and families member in ICU. Methods: This study was conducted by the grounded theory method. Participants comprised eight registered nurses and ten families. Patients were admitted to the ...

Fluctuations in sedation levels may contribute to delirium in ICU patients

DEFF Research Database (Denmark)

Svenningsen, Helle; Egerod, I; Videbech, Poul

2013-01-01

Delirium in patients admitted to the intensive care unit (ICU) is a serious complication potentially increasing morbidity and mortality. The aim of this study was to investigate the impact of fluctuating sedation levels on the incidence of delirium in ICU.......Delirium in patients admitted to the intensive care unit (ICU) is a serious complication potentially increasing morbidity and mortality. The aim of this study was to investigate the impact of fluctuating sedation levels on the incidence of delirium in ICU....

The nursing role during end-of-life care in the intensive care unit related to the interaction between patient, family and professional: an integrative review

NARCIS (Netherlands)

Noome, M.; Beneken genaamd Kolmer, D.M.; Leeuwen, E. van; Dijkstra, B.M.; Vloet, L.C.M.

2016-01-01

AIM: The aim of this study was to explore how intensive care unit (ICU) nurses describe their role during End-of-Life Care (EOLC) in the ICU, related to the interaction between patient, family and professionals (care triad). METHOD: Three electronic databases, PubMed, CINAHL and EMBASE, and

The nursing role during end-of-life care in the intensive care unit related to the interaction between patient, family and professional : An integrative review

NARCIS (Netherlands)

Noome, M.; Beneken genaamd Kolmer, D.M.; van Leeuwen, E.; Dijkstra, B.M.; Vloet, L.

2016-01-01

Aim The aim of this study was to explore how intensive care unit (ICU) nurses describe their role during End-of-Life Care (EOLC) in the ICU, related to the interaction between patient, family and professionals (care triad). Method Three electronic databases, PubMed, CINAHL and EMBASE, and reference

Nursing workload as a risk factor for healthcare associated infections in ICU: a prospective study.

Directory of Open Access Journals (Sweden)

Renata M Daud-Gallotti

Full Text Available INTRODUCTION: Nurse understaffing is frequently hypothesized as a potential risk factor for healthcare-associated infections (HAI. This study aimed to evaluate the role of nursing workload in the occurrence of HAI, using Nursing Activities Score (NAS. METHODS: This prospective cohort study enrolled all patients admitted to 3 Medical ICUs and one step-down unit during 3 months (2009. Patients were followed-up until HAI, discharge or death. Information was obtained from direct daily observation of medical and nursing rounds, chart review and monitoring of laboratory system. Nursing workload was determined using NAS. Non-compliance to the nurses' patient care plans (NPC was identified. Demographic data, clinical severity, invasive procedures, hospital interventions, and the occurrence of other adverse events were also recorded. Patients who developed HAI were compared with those who did not. RESULTS: 195 patients were included and 43 (22% developed HAI: 16 pneumonia, 12 urinary-tract, 8 bloodstream, 2 surgical site, 2 other respiratory infections and 3 other. Average NAS and average proportion of non compliance with NPC were significantly higher in HAI patients. They were also more likely to suffer other adverse events. Only excessive nursing workload (OR: 11.41; p: 0.019 and severity of patient's clinical condition (OR: 1.13; p: 0.015 remained as risk factors to HAI. CONCLUSIONS: Excessive nursing workload was the main risk factor for HAI, when evaluated together with other invasive devices except mechanical ventilation. To our knowledge, this study is the first to evaluate prospectively the nursing workload as a potential risk factor for HAI, using NAS.

Association Between ICU Admission During Morning Rounds and Mortality

Science.gov (United States)

Gajic, Ognjen; Morales, Ian J.; Keegan, Mark T.; Peters, Steve G.; Hubmayr, Rolf D.

2009-01-01

Background: No previous study has evaluated the association between admission to ICUs during round time and patient outcome. The objective of this study was to determine the association between round-time ICU admission and patient outcome. Methods: This retrospective study included 49,844 patients admitted from October 1994 to December 2007 to four ICUs (two surgical, one medical, and one multispecialty) of an academic medical center. Of these patients, 3,580 were admitted to the ICU during round time (8:00 am to 10:59 am) and 46,264 were admitted during nonround time (from 1:00 pm to 6:00 am). The medical ICU had 24-h/7-day per week intensivist coverage during the last 2 years of the study. We compared the baseline characteristics and outcome of patients admitted to the ICU between the two groups. Data were abstracted from the acute physiology and chronic health evaluation (APACHE) III database. Results: The round-time and non-round-groups were similar in gender, ethnicity, and age. The predicted hospital mortality rate of the round time group was higher (17.4% vs 12.3% predicted, respectively; p < 0.001). The hospital length of stay was similar between the two groups. The round-time group had a higher hospital mortality rate (16.2% vs 8.8%, respectively; p < 0.001). Most of the round-time ICU admissions and deaths occurred in the medical ICU. Round-time admission was an independent risk factor for hospital death (odds ratio, 1.321; 95% CI, 1.178 to 1.481). This independent association was present for the whole study period except for the last 2 years. Conclusions: Patients admitted to the ICU during morning rounds have higher severity of illness and mortality rates. PMID:19505985

Improved communication in post-ICU care by improving writing of ICU discharge letters: a longitudinal before-after study.

Science.gov (United States)

Medlock, Stephanie; Eslami, Saeid; Askari, Marjan; van Lieshout, Erik Jan; Dongelmans, Dave A; Abu-Hanna, Ameen

2011-11-01

The discharge letter is the primary means of communication at patient discharge, yet discharge letters are often not completed on time. A multifaceted intervention was performed to improve communication in patient hand-off from the intensive care unit (ICU) to the wards by improving the timeliness of discharge letters. A management directive was operationalised by a working group of ICU staff in a longitudinal before-after study. The intervention consisted of (a) changing policy to require a letter for use as a transfer note at the time of ICU discharge, (b) changing the assignment of responsibility to an automatic process, (c) leveraging positive peer pressure by making the list of patients in need of letters visible to colleagues and (d) provision of decision support, through automatic copying of important content from the patient record to the letter and email reminders if letters were not written on time. Statistical process control charts were used to monitor the longitudinal effect of the intervention. The intervention resulted in a 77.9% absolute improvement in the proportion of patients with a complete transfer note at the time of discharge, and an 85.2% absolute improvement in the number of discharge letters written. Statistical process control shows that the effect was sustained over time. A multifaceted intervention can be highly effective for improving discharge communication from the ICU.

Nursing care in a high-technological environment: Experiences of critical care nurses.

Science.gov (United States)

Tunlind, Adam; Granström, John; Engström, Åsa

2015-04-01

Management of technical equipment, such as ventilators, infusion pumps, monitors and dialysis, makes health care in an intensive care setting more complex. Technology can be defined as items, machinery and equipment that are connected to knowledge and management to maximise efficiency. Technology is not only the equipment itself, but also the knowledge of how to use it and the ability to convert it into nursing care. The aim of this study is to describe critical care nurses' experience of performing nursing care in a high technology healthcare environment. Qualitative, personal interviews were conducted during 2012 with eight critical care nurses in the northern part of Sweden. Interview transcripts were analysed using qualitative content analysis. Three themes with six categories emerged. The technology was described as a security that could facilitate nursing care, but also one that could sometimes present obstacles. The importance of using the clinical gaze was highlighted. Nursing care in a high technological environment must be seen as multi-faceted when it comes to how it affects CCNs' experience. The advanced care conducted in an ICU could not function without high-tech equipment, nor could care operate without skilled interpersonal interaction and maintenance of basal nursing. That technology is seen as a major tool and simultaneously as a barrier to patient-centred care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Boarding ICU patients: Are our rounding practices subpar?

Science.gov (United States)

Nunn, Andrew M; Hatchimonji, Justin S; Holena, Daniel N; Seamon, Mark J; Smith, Brian P; Kaplan, Lewis J; Martin, Niels D; Reilly, Patrick M; Schwab, C William; Pascual, Jose L

2018-04-01

Surgical Intensive Care Unit (SICU) patients "boarding" in ICUs other than the designated home unit have been shown to suffer increased rates of complications. We hypothesized that ICU rounding practices are different when SICU patients are housed in home vs. boarding ICUs. SICU rounds were observed at an academic quaternary medical center. Individual patient rounding time and order seen on rounds along with patient data and demographics were recorded. Multivariable regression analysis was used for comparison between patients. Non-boarders were older, observed on a later post ICU admission day and were more likely to be mechanically ventilated. Boarded patients were often seen at the end of rounds and for less time. Not being a boarder, age, APACHE II score on admission, vasopressor use, and positive pressure ventilation all predicted increased rounding time. Surgical ICU patients boarding in non-preferred units are often seen at the end of rounds, result in a greater reliance upon telephone communication, and receive less bedside attention from ICU provider teams. Copyright © 2017 Elsevier Inc. All rights reserved.

ICU early physical rehabilitation programs: financial modeling of cost savings.

Science.gov (United States)

Lord, Robert K; Mayhew, Christopher R; Korupolu, Radha; Mantheiy, Earl C; Friedman, Michael A; Palmer, Jeffrey B; Needham, Dale M

2013-03-01

To evaluate the potential annual net cost savings of implementing an ICU early rehabilitation program. Using data from existing publications and actual experience with an early rehabilitation program in the Johns Hopkins Hospital Medical ICU, we developed a model of net financial savings/costs and presented results for ICUs with 200, 600, 900, and 2,000 annual admissions, accounting for both conservative- and best-case scenarios. Our example scenario provided a projected financial analysis of the Johns Hopkins Medical ICU early rehabilitation program, with 900 admissions per year, using actual reductions in length of stay achieved by this program. U.S.-based adult ICUs. Financial modeling of the introduction of an ICU early rehabilitation program. Net cost savings generated in our example scenario, with 900 annual admissions and actual length of stay reductions of 22% and 19% for the ICU and floor, respectively, were $817,836. Sensitivity analyses, which used conservative- and best-case scenarios for length of stay reductions and varied the per-day ICU and floor costs, across ICUs with 200-2,000 annual admissions, yielded financial projections ranging from -$87,611 (net cost) to $3,763,149 (net savings). Of the 24 scenarios included in these sensitivity analyses, 20 (83%) demonstrated net savings, with a relatively small net cost occurring in the remaining four scenarios, mostly when simultaneously combining the most conservative assumptions. A financial model, based on actual experience and published data, projects that investment in an ICU early rehabilitation program can generate net financial savings for U.S. hospitals. Even under the most conservative assumptions, the projected net cost of implementing such a program is modest relative to the substantial improvements in patient outcomes demonstrated by ICU early rehabilitation programs.

Development of the 3-SET 4P questionnaire for evaluating former ICU patients' physical and psychosocial problems over time: a pilot study.

Science.gov (United States)

Akerman, Eva; Fridlund, Bengt; Ersson, Anders; Granberg-Axéll, Anetth

2009-04-01

Current studies reveal a lack of consensus for the evaluation of physical and psychosocial problems after ICU stay and their changes over time. The aim was to develop and evaluate the validity and reliability of a questionnaire for assessing physical and psychosocial problems over time for patients following ICU recovery. Thirty-nine patients completed the questionnaire, 17 were retested. The questionnaire was constructed in three sets: physical problems, psychosocial problems and follow-up care. Face and content validity were tested by nurses, researchers and patients. The questionnaire showed good construct validity in all three sets and had strong factor loadings (explained variance >70%, factor loadings >0.5) for all three sets. There was good concurrent validity compared with the SF 12 (r(s)>0.5). Internal consistency was shown to be reliable (Cronbach's alpha 0.70-0.85). Stability reliability on retesting was good for the physical and psychosocial sets (r(s)>0.5). The 3-set 4P questionnaire was a first step in developing an instrument for assessment of former ICU patients' problems over time. The sample size was small and thus, further studies are needed to confirm these findings.

Interprofessional Care and Teamwork in the ICU.

Science.gov (United States)

Donovan, Anne L; Aldrich, J Matthew; Gross, A Kendall; Barchas, Denise M; Thornton, Kevin C; Schell-Chaple, Hildy M; Gropper, Michael A; Lipshutz, Angela K M

2018-03-07

We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles. Original articles, review articles, and systematic reviews were considered. Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. "Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils

Knowledge of the nursing team on pressure ulcer prevention

Directory of Open Access Journals (Sweden)

Nariani Souza Galvão

Full Text Available ABSTRACT Objective: describe and analyze the nursing team's knowledge about classification, evaluation and measures to prevent pressure ulcers (PU in patients hospitalized in the ICU of a teaching hospital in the city of Manaus. Method: a descriptive and exploratory study was conducted after approval by a research ethics committee. Data were collected using a validated instrument. The study sample was made up of 40 nursing staff members, of whom 14 were nurses and 26 were nursing technicians/aides. Data were analyzed through descriptive statistics and Student's t-test, with value of p<0.05. Results: the overall mean of hits was 63.4% for technicians/aides and 51.4% for nurses, with statistically significant differences between the groups only for the PU prevention category (p<0.001. Conclusion: a deficit of knowledge on PU prevention was found among nurses and nursing technicians/aides, demanding the training of these professionals.

Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units.

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Xu, Jie; Reale, Carrie; Slagle, Jason M; Anders, Shilo; Shotwell, Matthew S; Dresselhaus, Timothy; Weinger, Matthew B

Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.

Well-being of intensive care nurses (WEBIC) : a job analytic approach

NARCIS (Netherlands)

Blanc, Le P.M.; Jonge, de J.; Rijk, de A.E.; Schaufeli, W.B.

2001-01-01

This paper presents the results of a validation study of the so-called well-being of intensive care nurses (WEBIC)-questionnaire that is designed to perform a detailed job analysis of intensive care unit (ICU) nurses’ jobs. The WEBIC-questionnaire is based on modern sociotechnical systems theory,

Perceptions of complementary therapies among Swedish registered professions in surgical care.

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Bjerså, Kristofer; Forsberg, Anna; Fagevik Olsén, Monika

2011-02-01

There is increasing interest in complementary and alternative medicine (CAM) among healthcare professions. However, no studies have been conducted in Sweden or in a surgical context. The aim of this study is to describe different perceptions of complementary therapies among registered healthcare professions in Swedish surgical care. Sixteen interviews were conducted with registered physicians, nurses, physiotherapists and clinical dieticians at a Swedish university hospital. Analysis was made with a phenomenographic research approach. The findings showed variations in perceptions of the definition of complementary therapies. A constructive approach toward use was observed, but there was a conflict in matters of indications and contraindications, and also criticism over a lack of knowledge. There was seen to be a need for education to be able to act professionally. Scepticism over high costs of treatment was highlighted. In conclusion, a need for policies on management, education and research in the field of CAM should be addressed. Copyright © 2010 Elsevier Ltd. All rights reserved.

Emotional reactions and needs of family members of ICU patients.

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Płaszewska-Żywko, Lucyna; Gazda, Dorota

2012-01-01

The aim of the study was to determine emotional reactions and needs of families of ICU patients. The study group included 60 relatives of ICU patients, aged 18-80 years. The diagnostic questionnaire-based survey was conducted. The questionnaire contained questions regarding demographic data, emotions and needs as well as the Courtauld Emotional Control Scale (CECS). The major emotions of patients' families on ICU admission were anxiety, uncertainty, fear, depression, and nervousness (particularly among parents and adult offsprings). On second-third day of hospitalisation, the emotions became less severe (P emotional reactions were better controlled by men (P emotions (P emotions of ICU patients' relatives were highly intense, especially amongst parents and adult children. Women were characterised by higher levels of emotions and needs compared to men.

Lived experiences of Rwandan ICU nurses caring for patients with a ...

African Journals Online (AJOL)

family involvement in this decision making process is low, with the doctor as the major .... 'Yeah … there is a change … patients without a DNR will be treated differently. ... with a DNR order receive less attention from the nurses. This was.

Consideration of pain felt by patients in the ICU.

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Hasegawa, Ryuichi

2017-01-01

Patients in the ICU are often treated under extreme conditions, with the patient often fearful of losing his life or experiencing severe pain. As a result, high-quality pain management is required. However, response to pain is often inadequate due to continuous administration of sedatives, difficulties in communicating with intubated patients, and/or poor awareness of pain in patients not receiving surgery. Reports on difficulties in pain management in the ICU are many, but few consider the correlation between pain management and patient prognosis. Consequently, consideration on how to implement pain control activities in the ICU to improve patient prognosis is needed.

Fall prevention in nursing homes

DEFF Research Database (Denmark)

Andresen, Mette; Hauge, Johnny

2014-01-01

that the number of hospitalization after a fall injury will become an even greater task for the Danish hospitals, The aim of the study was to show if there is a relationship between physically frail elderly nursing home resident’s subjective evaluation of fall-risk and an objective evaluation of their balance....... Further, to suggest tools for fall prevention in nursing home settings on the basis of the results of this study and the literature. A quantitative method inspired by the survey method was used to give an overview of fall patterns, subjective and objective evaluations of fallrisk. Participants were 16...... physically frail elderly nursing home residents from three different nursing homes. Measures: a small staff-questionnaire about incidences and places where the participants had falling-episodes during a 12 month period, The Falls Effi cacy Scale Swedish version (FES(S)) and Berg Balance Scale (BBS) Results...

Acute Physiologic Stress and Subsequent Anxiety Among Family Members of ICU Patients.

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Beesley, Sarah J; Hopkins, Ramona O; Holt-Lunstad, Julianne; Wilson, Emily L; Butler, Jorie; Kuttler, Kathryn G; Orme, James; Brown, Samuel M; Hirshberg, Eliotte L

2018-02-01

The ICU is a complex and stressful environment and is associated with significant psychologic morbidity for patients and their families. We sought to determine whether salivary cortisol, a physiologic measure of acute stress, was associated with subsequent psychologic distress among family members of ICU patients. This is a prospective, observational study of family members of adult ICU patients. Adult medical and surgical ICU in a tertiary care center. Family members of ICU patients. Participants provided five salivary cortisol samples over 24 hours at the time of the patient ICU admission. The primary measure of cortisol was the area under the curve from ground; the secondary measure was the cortisol awakening response. Outcomes were obtained during a 3-month follow-up telephone call. The primary outcome was anxiety, measured by the Hospital Anxiety and Depression Scale-Anxiety. Secondary outcomes included depression and posttraumatic stress disorder. Among 100 participants, 92 completed follow-up. Twenty-nine participants (32%) reported symptoms of anxiety at 3 months, 15 participants (16%) reported depression symptoms, and 14 participants (15%) reported posttraumatic stress symptoms. In our primary analysis, cortisol level as measured by area under the curve from ground was not significantly associated with anxiety (odds ratio, 0.94; p = 0.70). In our secondary analysis, however, cortisol awakening response was significantly associated with anxiety (odds ratio, 1.08; p = 0.02). Roughly one third of family members experience anxiety after an ICU admission for their loved one, and many family members also experience depression and posttraumatic stress. Cortisol awakening response is associated with anxiety in family members of ICU patients 3 months following the ICU admission. Physiologic measurements of stress among ICU family members may help identify individuals at particular risk of adverse psychologic outcomes.

Workplace distress and ethical dilemmas in neuroscience nursing.

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Silén, Marit; Tang, Ping Fen; Wadensten, Barbro; Ahlström, Gerd

2008-08-01

This study concerns Swedish nurses' experiences of workplace stress and the occurrence of ethical dilemmas in a neurological setting. Qualitative interviews were conducted with 21 nurses. The interview results were subjected to qualitative latent content analysis and sorted into 4 content areas: workplace distress, ethical dilemmas, managing distress and ethical dilemmas, and quality of nursing. Common workplace stressors were high workload and lack of influence. These were perceived to have negative consequences for the quality of nursing. Ethical dilemmas mainly concerned decision making on initiation or withdrawal of treatment, which was experienced as a troublesome situation where conflicts could arise. The nurses managed the distress and ethical dilemmas by accepting and adjusting to the situation and seeking support from colleagues. They also endeavored to gain new strength in their private lives.

Prevalence and Impact of Unknown Diabetes in the ICU.

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Carpenter, David L; Gregg, Sara R; Xu, Kejun; Buchman, Timothy G; Coopersmith, Craig M

2015-12-01

Many patients with diabetes and their care providers are unaware of the presence of the disease. Dysglycemia encompassing hyperglycemia, hypoglycemia, and glucose variability is common in the ICU in patients with and without diabetes. The purpose of this study was to determine the impact of unknown diabetes on glycemic control in the ICU. Prospective observational study. Nine ICUs in an academic, tertiary hospital and a hybrid academic/community hospital. Hemoglobin A1c levels were ordered at all ICU admissions from March 1, 2011 to September 30, 2013. Electronic medical records were examined for a history of antihyperglycemic medications or International Classification of Diseases, 9th Edition diagnosis of diabetes. Patients were categorized as having unknown diabetes (hemoglobin A1c > 6.5%, without history of diabetes), no diabetes (hemoglobin A1c 6.5%, with documented history of diabetes). None. A total of 15,737 patients had an hemoglobin A1c and medical record evaluable for the history of diabetes, and 5,635 patients had diabetes diagnosed by either medical history or an elevated hemoglobin A1c in the ICU. Of these, 1,460 patients had unknown diabetes, accounting for 26.0% of all patients with diabetes. This represented 41.0% of patients with an hemoglobin A1c > 6.5% and 9.3% of all ICU patients. Compared with patients without diabetes, patients with unknown diabetes had a higher likelihood of requiring an insulin infusion (44.3% vs 29.3%; p 180 mg/dL; p < 0.0001) and hypoglycemia (8.9% vs 2.5%; blood glucose < 70 mg/dL; p < 0.0001), higher glycemic variability (55.6 vs 28.8, average of patient SD of glucose; p < 0.0001), and increased mortality (13.8% vs 11.4%; p = 0.01). Patients with unknown diabetes represent a significant percentage of ICU admissions. Measurement of hemoglobin A1c at admission can prospectively identify a population that are not known to have diabetes but have significant challenges in glycemic control in the ICU.

Association between education in EOL care and variability in EOL practice: a survey of ICU physicians.

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Forte, Daniel Neves; Vincent, Jean Louis; Velasco, Irineu Tadeu; Park, Marcelo

2012-03-01

This study investigated the association between physician education in EOL and variability in EOL practice, as well as the differences between beliefs and practices regarding EOL in the ICU. Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, as well physicians' personal, professional and EOL educational characteristics. The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 ± 8 years, with a mean of 14 ± 7 years since graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356-0.848), P = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs. 46/83, OR = 4.1959 (1.271-13.845), P = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians who would apply "full code" had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012-0.710), P = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122-0.361), P EOL is associated with variability in EOL decisions in the ICU. Moreover, actual practice may differ from what physicians believe is best for the patient.

Long-Term Mental Health Problems After Delirium in the ICU.

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Wolters, Annemiek E; Peelen, Linda M; Welling, Maartje C; Kok, Lotte; de Lange, Dylan W; Cremer, Olaf L; van Dijk, Diederik; Slooter, Arjen J C; Veldhuijzen, Dieuwke S

2016-10-01

To determine whether delirium during ICU stay is associated with long-term mental health problems defined as symptoms of anxiety, depression, and posttraumatic stress disorder. Prospective cohort study. Survey study, 1 year after discharge from a medical-surgical ICU in the Netherlands. One-year ICU survivors of an ICU admission lasting more than 48 hours, without a neurologic disorder or other condition that would impede delirium assessment during ICU stay. None. One year after discharge, ICU survivors received a survey containing the Hospital Anxiety and Depression Scale with a subscale for symptoms of depression and a subscale for symptoms of anxiety, and the Impact of Event Scale 15 item measuring symptoms of posttraumatic stress disorder. Participants were classified as having experienced no delirium (n = 270; 48%), a single day of delirium (n = 86; 15%), or multiple days of delirium (n = 211; 37%) during ICU stay. Log-binomial regression was used to assess the association between delirium and symptoms of anxiety, depression, and posttraumatic stress disorder. The study population consisted of 567 subjects; of whom 246 subjects (43%) reported symptoms of anxiety (Hospital Anxiety and Depression Scale with a subscale for anxiety, ≥ 8), and 254 (45%) symptoms of depression (Hospital Anxiety and Depression Scale with a subscale for depression, ≥ 8). In 220 patients (39%), the Impact of Event Scale 15 item was greater than or equal to 35, indicating a high probability of posttraumatic stress disorder. There was substantial overlap between these mental health problems-63% of the subjects who scored positive for the presence of any three of the mental health problems, scored positive for all three. No association was observed between either a single day or multiple days of delirium and symptoms of anxiety, depression, or posttraumatic stress disorder. Although symptoms of anxiety, depression, and posttraumatic stress disorder were found to be common 1 year after

Abstracting ICU Nursing Care Quality Data From the Electronic Health Record.

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Seaman, Jennifer B; Evans, Anna C; Sciulli, Andrea M; Barnato, Amber E; Sereika, Susan M; Happ, Mary Beth

2017-09-01

The electronic health record is a potentially rich source of data for clinical research in the intensive care unit setting. We describe the iterative, multi-step process used to develop and test a data abstraction tool, used for collection of nursing care quality indicators from the electronic health record, for a pragmatic trial. We computed Cohen's kappa coefficient (κ) to assess interrater agreement or reliability of data abstracted using preliminary and finalized tools. In assessing the reliability of study data ( n = 1,440 cases) using the finalized tool, 108 randomly selected cases (10% of first half sample; 5% of last half sample) were independently abstracted by a second rater. We demonstrated mean κ values ranging from 0.61 to 0.99 for all indicators. Nursing care quality data can be accurately and reliably abstracted from the electronic health records of intensive care unit patients using a well-developed data collection tool and detailed training.

Trigger performance of mid-level ICU mechanical ventilators during assisted ventilation: a bench study.

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Ferreira, Juliana C; Chipman, Daniel W; Kacmarek, Robert M

2008-09-01

To compare the triggering performance of mid-level ICU mechanical ventilators with a standard ICU mechanical ventilator. Experimental bench study. The respiratory care laboratory of a university-affiliated teaching hospital. A computerized mechanical lung model, the IngMar ASL5000. Ten mid-level ICU ventilators were compared to an ICU ventilator at two levels of lung model effort, three combinations of respiratory mechanics (normal, COPD and ARDS) and two modes of ventilation, volume and pressure assist/control. A total of 12 conditions were compared. Performance varied widely among ventilators. Mean inspiratory trigger time was ventilators. The mean inspiratory delay time (time from initiation of the breath to return of airway pressure to baseline) was longer than that for the ICU ventilator for all tested ventilators except one. The pressure drop during triggering (Ptrig) was comparable with that of the ICU ventilator for only two ventilators. Expiratory Settling Time (time for pressure to return to baseline) had the greatest variability among ventilators. Triggering differences among these mid-level ICU ventilators and with the ICU ventilator were identified. Some of these ventilators had a much poorer triggering response with high inspiratory effort than the ICU ventilator. These ventilators do not perform as well as ICU ventilators in patients with high ventilatory demand.

An Alternative Consent Process for Minimal Risk Research in the ICU.

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Terry, Melissa A; Freedberg, Daniel E; Morris, Marilyn C

2017-09-01

Seeking consent for minimal risk research in the ICU poses challenges, especially when the research is time-sensitive. Our aim was to determine the extent to which ICU patients or surrogates support a deferred consent process for a minimal risk study without the potential for direct benefit. Prospective cohort study. Five ICUs within a tertiary care hospital. Newly admitted ICU patients 18 years old or older. We administered an eight-item verbal survey to patients or surrogates approached for consent to participate in a minimal risk, ICU-based study. The parent study involved noninvasive collection of biosamples and clinical data at the time of ICU admission and again 3 days later. If patients had capacity at the time of ICU admission, or if a surrogate was readily available, consent was sought prior to initial sample collection; otherwise, a waiver of consent was granted, and deferred consent was sought 3 days later. Quantitative and qualitative data were analyzed. One hundred fifty-seven individuals were approached for consent to participate in the parent study; none objected to the consent process. One hundred thirty-five of 157 (86%) competed the survey, including 94 who consented to the parent study and 41 who declined. Forty-four of 60 individuals (73%) approached for deferred consent responded positively to the question "Did we make the right choice in waiting until now to ask your consent?" three of 60 (5%) responded negatively, and 13 of 60 (22%) made a neutral or unrelated response. The most common reason given for endorsing the deferred consent process was the stress of the early ICU experience 25 of 44 (61%). Most patients and surrogates accept a deferred consent process for minimal risk research in the ICU. For appropriate ICU-based research, investigators and Institutional Review Boards should consider a deferred consent process if the subject lacks capacity and an appropriate surrogate is not readily available.

Readmissions and death after ICU discharge: development and validation of two predictive models.

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Omar Badawi

Full Text Available INTRODUCTION: Early discharge from the ICU is desirable because it shortens time in the ICU and reduces care costs, but can also increase the likelihood of ICU readmission and post-discharge unanticipated death if patients are discharged before they are stable. We postulated that, using eICU® Research Institute (eRI data from >400 ICUs, we could develop robust models predictive of post-discharge death and readmission that may be incorporated into future clinical information systems (CIS to assist ICU discharge planning. METHODS: Retrospective, multi-center, exploratory cohort study of ICU survivors within the eRI database between 1/1/2007 and 3/31/2011. EXCLUSION CRITERIA: DNR or care limitations at ICU discharge and discharge to location external to hospital. Patients were randomized (2∶1 to development and validation cohorts. Multivariable logistic regression was performed on a broad range of variables including: patient demographics, ICU admission diagnosis, admission severity of illness, laboratory values and physiologic variables present during the last 24 hours of the ICU stay. Multiple imputation was used to address missing data. The primary outcomes were the area under the receiver operator characteristic curves (auROC in the validation cohorts for the models predicting readmission and death within 48 hours of ICU discharge. RESULTS: 469,976 and 234,987 patients representing 219 hospitals were in the development and validation cohorts. Early ICU readmission and death was experienced by 2.54% and 0.92% of all patients, respectively. The relationship between predictors and outcomes (death vs readmission differed, justifying the need for separate models. The models for early readmission and death produced auROCs of 0.71 and 0.92, respectively. Both models calibrated well across risk groups. CONCLUSIONS: Our models for death and readmission after ICU discharge showed good to excellent discrimination and good calibration. Although

A psychometric evaluation of the Swedish version of the Research Utilization Questionnaire using a Rasch measurement model.

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Lundberg, Veronica; Boström, Anne-Marie; Malinowsky, Camilla

2017-07-30

Evidence-based practice and research utilisation has become a commonly used concept in health care. The Research Utilization Questionnaire (RUQ) has been recognised to be a widely used instrument measuring the perception of research utilisation among nursing staff in clinical practice. Few studies have however analysed the psychometric properties of the RUQ. The aim of this study was to examine the psychometric properties of the Swedish version of the three subscales in RUQ using a Rasch measurement model. This study has a cross-sectional design using a sample of 163 staff (response rate 81%) working in one nursing home in Sweden. Data were collected using the Swedish version of RUQ in 2012. The three subscales Attitudes towards research, Availability of and support for research use and Use of research findings in clinical practice were investigated. Data were analysed using a Rasch measurement model. The results indicate presence of multidimensionality in all subscales. Moreover, internal scale validity and person response validity also provide some less satisfactory results, especially for the subscale Use of research findings. Overall, there seems to be a problem with the negatively worded statements. The findings suggest that clarification and refining of items, including additional psychometric evaluation of the RUQ, are needed before using the instrument in clinical practice and research studies among staff in nursing homes. © 2017 Nordic College of Caring Science.

Modeling Serum Creatinine in Septic ICU Patients

DEFF Research Database (Denmark)

De Gaetano, Andrea; Cortese, Giuliana; Pedersen, Morten Gram

2004-01-01

Serum creatinine is a metabolite assumed to be constantly produced by the normally functioning muscle mass and is a good measure for monitoring daily renal function in the intensive care unit (ICU). High serum creatinine levels or an abnormal departure from normal pre-disease basal levels....... The present work details the structure of a model describing observed creatinine serum concentration (CSC) variations, depending on the time-varying septic insult to renal function in ICU patients, as well as the estimation of its parameters. CSC determinations were routinely obtained from 12 patients...

Who Needs to Be Allocated in ICU after Thoracic Surgery? An Observational Study

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Liana Pinheiro

2016-01-01

Full Text Available Background. The effective use of ICU care after lung resections has not been completely studied. The aims of this study were to identify predictive factors for effective use of ICU admission after lung resection and to develop a risk composite measure to predict its effective use. Methods. 120 adult patients undergoing elective lung resection were enrolled in an observational prospective cohort study. Preoperative evaluation and intraoperative assessment were recorded. In the postoperative period, patients were stratified into two groups according to the effective and ineffective use of ICU. The use of ICU care was considered effective if a patient experienced one or more of the following: maintenance of controlled ventilation or reintubation; acute respiratory failure; hemodynamic instability or shock; and presence of intraoperative or postanesthesia complications. Results. Thirty patients met the criteria for effective use of ICU care. Logistic regression analysis identified three independent predictors of effective use of ICU care: surgery for bronchiectasis, pneumonectomy, and age ≥ 57 years. In the absence of any predictors the risk of effective need of ICU care was 6%. Risk increased to 25–30%, 66–71%, and 93% with the presence of one, two, or three predictors, respectively. Conclusion. ICU care is not routinely necessary for all patients undergoing lung resection.

Nurses Use of Critical Care Pain Observational Tool in Patients with Low Consciousness

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Ahmad-Ali Asadi-Noghabi

2015-07-01

Full Text Available Objectives: The diagnosis of pain in patients with low consciousness is a major challenge in the intensive care unit (ICU. Therefore, the use of behavioral tools for pain assessment could be an effective tool to manage pain in this group of patients. The aim of this study was to determine the effects on pain management by nurses using a critical care pain observational tool in patients with a decreased level of consciousness. Methods: Our research used a before and after design to evaluate the ability of nurses to manage pain in patients with low consciousness. A total of 106 ICU nurses were included in the study. The study was divided into three phases: pre-implementation, implementation, and post-implementation. The researchers first observed the nurses management of pain in their patients; this was done three times using a checklist following tracheal suctioning and position change procedures. The nurses were then taught how to apply the critical-care pain observational tool (CPOT. Post-implementation of the tool, the researchers re-evaluated trained the nurses’ pain management. Results: Performance scores after training improved with relation to the nurses diagnosis of pain, pharmacological and nonpharmacological actions, reassessment of pain, and re-relieving of any pain. However, use of the tool did not improve the recording of the patient’s pain and the relief measures used. Conclusion: Use of the CPOT can increase nurse’s sensitivity to pain in non-conscious patients and drive them to track and perform pain management.

School Nurses Avoid Addressing Child Sexual Abuse

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Engh Kraft, Lisbet; Rahm, GullBritt; Eriksson, Ulla-Britt

2017-01-01

Child sexual abuse (CSA) is a global public health problem with major consequences for the individual child and society. An earlier Swedish study showed that the school nurses did not initially talk about nor mention CSA as one form of child abuse. For the child to receive adequate support, the disclosure is a precondition and is dependent on an…

[Innovations in continuing/permanent education methods for the intensive care nurses].

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Vázquez Guillamet, B; Guillamet Lloveras, A; Martínez Estalella, G; Pérez Ramírez, F

2014-01-01

Intensive care nursing is carried out in a dynamic environment characterized by the continuous incorporation of new technologies, approaches to care and a request for safety, participation and transparency by the public. Continuing/permanent intensive care nursing training in the acquisition of new competencies is key in this setting. In order to achieve this goal, simulation and problem based learning should be incorporated as essential methodologies to teach these skills. At the same time research should be done on which attitudes, competences, and knowledge are necessary to increase their intellectual knowledge. The core characteristics of ICU and its nursing should allow a deep change in their approach to continuing/permanent nursing education. Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.

Effect of nursing care hours on the outcomes of Intensive Care assistance.

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Tatiana do Altíssimo Nogueira

Full Text Available To correlate the average number of nursing care hours dedicated to Intensive Care Unit (ICU patients with nursing care indicators.Transverse, descriptive study conducted between 2011 and 2013. Data were obtained from the electronic records system and from the nursing staff daily schedule. Generalized Linear Models were used for analysis.A total of 1,717 patients were included in the study. The average NAS (Nursing Activities Score value was 54.87. The average ratio between the number of nursing care hours provided to the patient and the number of nursing care hours required by the patient (hours ratio was 0.87. Analysis of the correlation between nursing care indicators and the hours ratio showed that the indicators phlebitis and ventilator-associated pneumonia significantly correlated with hours ratio; that is, the higher the hours ratio, the lower the incidence of phlebitis and ventilator-associated pneumonia.The number of nursing care hours directly impacts patient outcomes, which makes adjustment of nurse staffing levels essential.

Exploring family experiences of nursing aspects of end-of-life care in the ICU: A qualitative study.

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Noome, Marijke; Dijkstra, Boukje M; van Leeuwen, Evert; Vloet, Lilian C M

2016-04-01

The aim of this study was to examine the experience(s) of family with the nursing aspects of End-of-life care in the intensive care unit after a decision to end life-sustaining treatment, and to describe what nursing care was most appreciated and what was lacking. A phenomenological approach including inductive thematic analysis was used. Twenty-six family members of deceased critically ill-patients were interviewed within two months after the patient's death about their experiences with nursing aspects of end-of-life care in the intensive care unit. Most family members experienced nursing contribution to end-of-life care of the patient and themselves, especially supportive care. Families mentioned the following topics: Communication between intensive care nurses, critically ill patients and family; Nursing care for critically ill patients; Nursing care for families of critically ill patients; Pre-conditions. Families appreciated that intensive care nurses were available at any time and willing to answer questions. But care was lacking because families had for example, a sense of responsibility for obtaining information, they had problems to understand their role in the decision-making process, and were not invited by nurses to participate in the care. Most family appreciated the nursing EOLC they received, specifically the nursing care given to the patient and themselves. Some topics needed more attention, like information and support for the family. Copyright © 2016 Elsevier Ltd. All rights reserved.

Sustaining critical care: using evidence-based simulation to evaluate ICU management policies.

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Mahmoudian-Dehkordi, Amin; Sadat, Somayeh

2017-12-01

Intensive Care Units (ICU) are costly yet critical hospital departments that should be available to care for patients needing highly specialized critical care. Shortage of ICU beds in many regions of the world and the constant fire-fighting to make these beds available through various ICU management policies motivated this study. The paper discusses the application of a generic system dynamics model of emergency patient flow in a typical hospital, populated with empirical evidence found in the medical and hospital administration literature, to explore the dynamics of intended and unintended consequences of such ICU management policies under a natural disaster crisis scenario. ICU management policies that can be implemented by a single hospital on short notice, namely premature transfer from ICU, boarding in ward, and general ward admission control, along with their possible combinations, are modeled and their impact on managerial and health outcome measures are investigated. The main insight out of the study is that the general ward admission control policy outperforms the rest of ICU management policies under such crisis scenarios with regards to reducing total mortality, which is counter intuitive for hospital administrators as this policy is not very effective at alleviating the symptoms of the problem, namely high ED and ICU occupancy rates that are closely monitored by hospital management particularly in times of crisis. A multivariate sensitivity analysis on parameters with diverse range of values in the literature found the superiority of the general ward admission control to hold true in every scenario.

Corporate Governance in the Swedish Banking Sector

OpenAIRE

Palmberg, Johanna

2010-01-01

This paper studies the corporate governance structure among Swedish banks. Who controls the Swedish banks and what characteristics does the Swedish banking sector have? Issues related to corporate governance such as ownership structure, board of directors and control-enhancing mechanisms will be studied. The Swedish banking law, how Swedish banks handled the financial crises and government measures to deal with the financial crisis is also analyzed.

Utility of the PRE-DELIRIC delirium prediction model in a Scottish ICU cohort.

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Paton, Lia; Elliott, Sara; Chohan, Sanjiv

2016-08-01

The PREdiction of DELIRium for Intensive Care (PRE-DELIRIC) model reliably predicts at 24 h the development of delirium during intensive care admission. However, the model does not take account of alcohol misuse, which has a high prevalence in Scottish intensive care patients. We used the PRE-DELIRIC model to calculate the risk of delirium for patients in our ICU from May to July 2013. These patients were screened for delirium on each day of their ICU stay using the Confusion Assessment Method for ICU (CAM-ICU). Outcomes were ascertained from the national ICU database. In the 39 patients screened daily, the risk of delirium given by the PRE-DELIRIC model was positively associated with prevalence of delirium, length of ICU stay and mortality. The PRE-DELIRIC model can therefore be usefully applied to a Scottish cohort with a high prevalence of substance misuse, allowing preventive measures to be targeted.

Nursing workload in a trauma intensive care unit

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Luana Loppi Goulart

2014-06-01

Full Text Available 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 patients, of which most were male, young adults, presenting polytrauma, coming from the Reference Emergency Unit, in surgical treatment, and discharged from the ICU. The average obtained on the Nursing Activities Score instrument was 72% during hospitalization periods. The data displayed moderate correlation between workload and patient severity. In other words, the higher the score, the higher the patient’s mortality risk. doi: 10.5216/ree.v16i2.22922.

Experiences of ICU survivors in a low middle income country- a multicenter study.

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Pieris, Lalitha; Sigera, Ponsuge Chathurani; De Silva, Ambepitiyawaduge Pubudu; Munasinghe, Sithum; Rashan, Aasiyah; Athapattu, Priyantha Lakmini; Jayasinghe, Kosala Saroj Amarasiri; Samarasinghe, Kerstein; Beane, Abi; Dondorp, Arjen M; Haniffa, Rashan

2018-03-21

Stressful patient experiences during the intensive care unit (ICU) stay is associated with reduced satisfaction in High Income Countries (HICs) but has not been explored in Lower and Middle Income Countries (LMICs). This study describes the recalled experiences, stress and satisfaction as perceived by survivors of ICUs in a LMIC. This follow-up study was carried out in 32 state ICUs in Sri Lanka between July and December 2015.ICU survivors' experiences, stress factors encountered and level of satisfaction were collected 30 days after ICU discharge by a telephone questionnaire adapted from Granja and Wright. Of 1665 eligible ICU survivors, 23.3% died after ICU discharge, 49.1% were uncontactable and 438 (26.3%) patients were included in the study. Whilst 78.1% (n = 349) of patients remembered their admission to the hospital, only 42.3% (n = 189) could recall their admission to the ICU. The most frequently reported stressful experiences were: being bedridden (34.2%), pain (34.0%), general discomfort (31.7%), daily needle punctures (32.9%), family worries (33.6%), fear of dying and uncertainty in the future (25.8%). The majority of patients (376, 84.12%) found the atmosphere of the ICU to be friendly and calm. Overall, the patients found the level of health care received in the ICU to be "very satisfactory" (93.8%, n = 411) with none of the survivors stating they were either "dissatisfied" or "very dissatisfied". In common with HIC, survivors were very satisfied with their ICU care. In contrast to HIC settings, specific ICU experiences were frequently not recalled, but those remembered were reported as relatively stress-free. Stressful experiences, in common with HIC, were most frequently related to uncertainty about the future, dependency, family, and economic concerns.

Long-Term Mental Health Problems after Delirium in the ICU

NARCIS (Netherlands)

Wolters, Annemiek E.; Peelen, Linda M.; Welling, Maartje C.; Kok, Lotte; De Lange, Dylan W.; Cremer, Olaf L.; Van Dijk, Diederik; Slooter, Arjen J C; Veldhuijzen, Dieuwke S.

2016-01-01

Objectives: To determine whether delirium during ICU stay is associated with long-term mental health problems defined as symptoms of anxiety, depression, and posttraumatic stress disorder.  Design: Prospective cohort study.  Setting: Survey study, 1 year after discharge from a medical-surgical ICU

Tracheal intubation in the ICU: Life saving or life threatening?

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Jigeeshu V Divatia

2011-01-01

Full Text Available Tracheal intubation (TI is a routine procedure in the intensive care unit (ICU, and is often life saving. However, life-threatening complications occur in a significant proportion of procedures, making TI perhaps one the most common but underappreciated airway emergencies in the ICU. In contrast to the controlled conditions in the operating room (OR, the unstable physiologic state of critically ill patients along with underevaluation of the airways and suboptimal response to pre-oxygenation are the major factors for the high incidence of life-threatening complications like severe hypoxaemia and cardiovascular collapse in the ICU. Studies have shown that strategies planned for TI in the OR can be adapted and extrapolated for use in the ICU. Non-invasive positive-pressure ventilation for pre-oxygenation provides adequate oxygen stores during TI for patients with precarious respiratory pathology. The intubation procedure should include not only airway management but also haemodynamic, gas exchange and neurologic care, which are often crucial in critically ill patients. Hence, there is a necessity for the implementation of an Intubation Bundle during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

The Effects of Social Influence on Nurses' Hand Hygiene Behaviors.

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Piras, Susan E; Minnick, Ann; Lauderdale, Jana; Dietrich, Mary S; Vogus, Timothy J

2018-04-01

The aim of this article is to describe the associations of nurses' hand hygiene (HH) attitudes, subjective norms, and perceived behavioral control with observed and self-reported HH behavior. Hand hygiene is an essential strategy to prevent healthcare-associated infections. Despite tremendous efforts, nurses' HH adherence rates remain suboptimal. This quantitative descriptive study of ICU nurses in the southeastern United States was guided by the theory of planned behavior. The self-administered Patient Safety Opinion Survey and iScrub application, which facilitates observation, comprised the data set. Nurses' observed HH median was 55%; tendency to self-report was a much higher 90%. Subjective norm and perceived control scores were associated with observed and self-reported HH (P < .05) but not attitude scores or reports of intention. Nurses' subjective norm and perceived control are associated with observed and self-reported HH performance. Healthcare workers overestimate their HH performance. Findings suggest future research to explore manipulators of these variables to change nurses' HH behavior.

Aspergillosis in Intensive Care Unit (ICU patients: epidemiology and economic outcomes

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Baddley John W

2013-01-01

Full Text Available Abstract Background Few data are available regarding the epidemiology of invasive aspergillosis (IA in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs among ICU patients with IA who lack traditional risk factors for IA, such as cancer, transplants, neutropenia or HIV infection. Methods Retrospective cohort study using Premier Inc. Perspective™ US administrative hospital database (2005–2008. Adults with ICU stays and aspergillosis (ICD-9 117.3 plus 484.6 who received initial antifungal therapy (AF in the ICU were included. Patients with traditional risk factors (cancer, transplant, neutropenia, HIV/AIDS were excluded. The relationship of antifungal therapy and co-morbidities to economic outcomes were examined using Generalized linear models. Results From 6,424 aspergillosis patients in the database, 412 (6.4% ICU patients with IA were identified. Mean age was 63.9 years and 53% were male. Frequent co-morbidities included steroid use (77%, acute respiratory failure (76% and acute renal failure (41%. In-hospital mortality was 46%. The most frequently used AF was voriconazole (71% received at least once. Mean length of stay (LOS was 26.9 days and mean total hospital cost was $76,235. Each 1 day lag before initiating AF therapy was associated with 1.28 days longer hospital stay and 3.5% increase in costs (p  Conclusions Invasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of Aspergillus as a potential etiology in ICU patients.

The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation.

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Lecuyer, Lucien; Chevret, Sylvie; Thiery, Guillaume; Darmon, Michael; Schlemmer, Benoît; Azoulay, Elie

2007-03-01

Cancer patients requiring mechanical ventilation are widely viewed as poor candidates for intensive care unit (ICU) admission. We designed a prospective study evaluating a new admission policy titled The ICU Trial. Prospective study. Intensive care unit. One hundred eighty-eight patients requiring mechanical ventilation and having at least one other organ failure. Over a 3-yr period, all patients with hematologic malignancies or solid tumors proposed for ICU admission underwent a triage procedure. Bedridden patients and patients in whom palliative care was the only cancer treatment option were not admitted to the ICU. Patients at earliest phase of the malignancy (diagnosis ventilation, vasopressors, or dialysis after 3 days in the ICU died. Survival was 40% in mechanically ventilated cancer patients who survived to day 5 and 21.8% overall. If these results are confirmed in future interventional studies, we recommend ICU admission with full-code management followed by reappraisal on day 6 in all nonbedridden cancer patients for whom lifespan-extending cancer treatment is available.

Nursing workload and adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia. A pilot study.

Science.gov (United States)

Jam, R; Hernández, O; Mesquida, J; Turégano, C; Carrillo, E; Pedragosa, R; Gómez, V; Martí, L; Vallés, J; Delgado-Hito, P

To analyse whether adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia (VAP) is associated with nursing workload. A prospective observational study performed in a single medical-surgical ICU. Nurses in charge of patients under ventilator support were assessed. knowledge questionnaire, application of non-pharmacological VAP prevention measures, and workload (Nine Equivalents of Nursing Manpower Use Score). Phases: 1) the nurses carried out a educational programme, consisting of 60-minute lectures on non-pharmacological measures for VAP prevention, and at the end completed a questionnaire knowledge; 2) observation period; 3) knowledge questionnaire. Among 67 ICU-staff nurses, 54 completed the educational programme and were observed. A total of 160 observations of 49 nurses were made. Adequate knowledge was confirmed in both the initial and final questionnaires. Application of preventive measures ranged from 11% for hand washing pre-aspiration to 97% for the use of a sterile aspiration probe. The Nine Equivalents of Nursing Manpower Use Score was 50±13. No significant differences were observed between the association of the nurses' knowledge and the application of preventive measures or between workload and the application of preventive measures. Nurses' knowledge of VAP prevention measures is not necessarily applied in daily practice. Failure to follow these measures is not subject to lack of knowledge or to increased workload, but presumably to contextual factors. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

A literature review of organisational, individual and teamwork factors contributing to the ICU discharge process.

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Lin, Frances; Chaboyer, Wendy; Wallis, Marianne

2009-02-01

It is everyday news that we need more intensive care unit (ICU) beds, thus effective use of existing resources is imperative. The aim of this literature review was to critically analyse current literature on how organizational factors, individual factors and teamwork factors influence the ICU discharge process. A better understanding of discharge practices has the potential to ultimately influence ICU resource availability. Databases including CINAHL, MEDLINE, PROQUEST, SCIENCE DIRECT were searched using key terms such as ICU discharge, discharge process, ICU guidelines and policies, discharge decision-making, ICU organisational factors, ICU and human factors, and ICU patient transfer. Articles' reference lists were also used to locate relevant literature. A total of 21 articles were included in the review. Only a small number of ICUs used written patient discharge guidelines. Consensus, rather than empirical evidence, dictates the importance of guidelines and policies. Premature discharge, discharge after hours and discharge by triage still exist due to resources constraints, even though the literature suggests these are associated with increased mortality. Teamwork and team training appear to be effective in improving efficiency and communication between professions or between clinical areas. However, this aspect has rarely been researched in relation to ICU patient discharge. Intensive care patient discharge is influenced by organisational factors, individual factors and teamwork factors. Organisational interventions are effective in reducing ICU discharge delay and shortening patient hospital stay. More rigorous research is needed to discover how these factors influence the ICU discharge process.

Present-Day Influence of English on Swedish as Found in Swedish Job Advertisements.

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Larson, Ben E.

1990-01-01

A brief analysis of job advertisements in Swedish newspapers notes the increasing trend toward the use of English rather than Swedish words for certain terms, attributing such use to the wish to show an international labor perspective. (five references) (CB)

Protocolised approach to end-of-life care in the ICU--the ICU PALCare Pilot Project.

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Rajamani, A; Barrett, E; Weisbrodt, L; Bourne, J; Palejs, P; Gresham, R; Huang, S

2015-05-01

International literature on end-of-life care in intensive care units (ICUs) supports the use of 'protocol bundles', which is not common practice in our 18-bed adult general ICU in Sydney, New South Wales. We conducted a prospective observational study to identify problems related to end-of-life care practices and to determine whether there was a need to develop protocol bundles. Any ICU patient who had 'withdrawal' of life-sustaining treatment to facilitate a comfortable death was eligible. Exclusion criteria included organ donors, unsuitable family dynamics and lack of availability of research staff to obtain family consent. Process-of-care measures were collected using a standardised form. Satisfaction ratings were obtained using de-identified questionnaire surveys given to the healthcare staff shortly after the withdrawal of therapy and to the families 30 days later. Twenty-three patients were enrolled between June 2011 and July 2012. Survey questionnaires were given to 25 family members and 30 healthcare staff, with a high completion rate (24 family members [96%] and 28 staff [93.3%]). Problems identified included poor documentation of family meetings (39%) and symptom management. Emotional/spiritual support was not offered to families (39.1%) or ICU staff (0%). The overall level of end-of-life care was good. The overwhelming majority of families and healthcare staff were highly satisfied with the care provided. Problems identified related to communication documentation and lack of spiritual/emotional support. To address these problems, targeted measures would be more useful than the adoption of protocol bundles. Alternate models of satisfaction surveys may be needed.

Between violation and competent care--lived experiences of dependency on care in the ICU.

Science.gov (United States)

Lykkegaard, Kristina; Delmar, Charlotte

2015-01-01

This study explores the perceived meaning of dependency on care as experienced by intensive care patients. Research from non-intensive settings shows that dependency is often experienced negatively, but literature on the subject experienced by patients in the ICU is sparse. The study is based on in-depth qualitative semi-structured interviews of lived experience with three former patients admitted to an intensive care unit at a Danish university hospital. The in-depth interviews have been characterized as narratives. The main inspiration for the analysis method is Ricoeur's phenomenological hermeneutical interpretation theory. The study has found that dependency is experienced as difficult, and the relationship with the nurses seems to be ambivalent. The good relationship is experienced to make dependency easier, whereas negative experiences make it harder to cope with dependency. The participants deal with dependency by accepting negative experiences in gratitude for having recovered from critical illness. The findings might be influenced by studies being conducted in a western country setting where independence is valued. They can be used as means of reflection on nursing practice and matters such as communication and patient participation.

Between violation and competent care—Lived experiences of dependency on care in the ICU

Science.gov (United States)

Lykkegaard, Kristina; Delmar, Charlotte

2015-01-01

This study explores the perceived meaning of dependency on care as experienced by intensive care patients. Research from non-intensive settings shows that dependency is often experienced negatively, but literature on the subject experienced by patients in the ICU is sparse. The study is based on in-depth qualitative semi-structured interviews of lived experience with three former patients admitted to an intensive care unit at a Danish university hospital. The in-depth interviews have been characterized as narratives. The main inspiration for the analysis method is Ricoeur's phenomenological hermeneutical interpretation theory. The study has found that dependency is experienced as difficult, and the relationship with the nurses seems to be ambivalent. The good relationship is experienced to make dependency easier, whereas negative experiences make it harder to cope with dependency. The participants deal with dependency by accepting negative experiences in gratitude for having recovered from critical illness. The findings might be influenced by studies being conducted in a western country setting where independence is valued. They can be used as means of reflection on nursing practice and matters such as communication and patient participation. PMID:25765881

Timing of onset of gastrointestinal bleeding in the ICU

DEFF Research Database (Denmark)

Granholm, A; Lange, T; Anthon, C T

2018-01-01

BACKGROUND: Critically ill patients are at risk of gastrointestinal bleeding, but clinically important gastrointestinal bleeding is rare. The majority of intensive care unit (ICU) patients receive stress ulcer prophylaxis (SUP), despite uncertainty concerning the balance between benefit and harm....... For approximately half of ICU patients with gastrointestinal bleeding, onset is early, ie within the first two days of the ICU stay. The aetiology of gastrointestinal bleeding and consequently the balance between benefit and harm of SUP may differ between patients with early vs late gastrointestinal bleeding...... will describe baseline characteristics and assess the time to onset of the first clinically important episode of GI bleeding accounting for survival status and allocation to SUP or placebo. In addition, we will describe differences in therapeutic and diagnostic procedures used in patients with clinically...

Acquisition of ICU data: concepts and demands.

Science.gov (United States)

Imhoff, M

1992-12-01

As the issue of data overload is a problem in critical care today, it is of utmost importance to improve acquisition, storage, integration, and presentation of medical data, which appears only feasible with the help of bedside computers. The data originates from four major sources: (1) the bedside medical devices, (2) the local area network (LAN) of the ICU, (3) the hospital information system (HIS) and (4) manual input. All sources differ markedly in quality and quantity of data and in the demands of the interfaces between source of data and patient database. The demands for data acquisition from bedside medical devices, ICU-LAN and HIS concentrate on technical problems, such as computational power, storage capacity, real-time processing, interfacing with different devices and networks and the unmistakable assignment of data to the individual patient. The main problem of manual data acquisition is the definition and configuration of the user interface that must allow the inexperienced user to interact with the computer intuitively. Emphasis must be put on the construction of a pleasant, logical and easy-to-handle graphical user interface (GUI). Short response times will require high graphical processing capacity. Moreover, high computational resources are necessary in the future for additional interfacing devices such as speech recognition and 3D-GUI. Therefore, in an ICU environment the demands for computational power are enormous. These problems are complicated by the urgent need for friendly and easy-to-handle user interfaces. Both facts place ICU bedside computing at the vanguard of present and future workstation development leaving no room for solutions based on traditional concepts of personal computers.(ABSTRACT TRUNCATED AT 250 WORDS)

ICU-Onset Clostridium difficile infection in a university hospital in China: a prospective cohort study.

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Xiaohui Wang

Full Text Available A prospective study was conducted to investigate the incidence, clinical profiles and outcome of ICU-onset CDI in a 50-bed medical ICU at a university hospital in China. Stools were collected from patients who developed ICU-onset diarrhea and was screened for tcdA (toxin A gene and tcdB (toxin B gene by PCR. CDI cases were compared with the ICU-onset non-CDI diarrhea cases for demographics, comorbidities, potential risk factors, major laboratory findings and outcomes. Stool samples from CDI cases were subjected to C. difficile culture and C. difficile isolates were screened for tcdA, tcdB and the binary toxin genes (cdtA and cdtB using multiplex PCR. Strain typing of toxigenic C. difficile isolates was performed using multilocus sequence typing. There were 1,277 patients in the ICU during the study period and 124 (9.7% developed ICU-onset diarrhea, of which 31 patients had CDI. The incidence of ICU-onset CDI was 25.2 cases per 10,000 ICU days. ICU-onset CDI cases had similar features with ICU-onset non-CDI diarrhea cases including the use of proton pump inhibitors and antibacterial agents. The crude mortality rate of ICU-onset CDI was 22.6%, but the attributable mortality rate of ICU-onset CDI was only 3.2% here. Toxigenic C. difficile isolates were recovered from 28 out of the 31 patients with CDI. cdtA and cdtB were found in two strains. Seventeen STs including 11 new STs were identified. All of the 11 new STs were single-locus variants of known STs and the 17 STs identified here could be clustered into 3 clades. The incidence of ICU-onset CDI here is similar to those in Europe and North America, suggesting that CDI is likely to be a common problem in China. Toxigenic C. difficile here belonged to a variety of STs, which may represent a significant clonal expansion rather than the true clonal diversity.

Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses.

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Ng, George Wing Yiu; Pun, Jack Kwok Hung; So, Eric Hang Kwong; Chiu, Wendy Wai Hang; Leung, Avis Siu Ha; Stone, Yuk Han; Lam, Chung Ling; Lai, Sarah Pui Wa; Leung, Rowlina Pui Wah; Luk, Hing Wah; Leung, Anne Kit Hung; Au Yeung, Kin Wah; Lai, Kang Yiu; Slade, Diana; Chan, Engle Angela

2017-08-11

Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up. A mixed-methods design with quantitative and sequential qualitative components was used. Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices. The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases. Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context. © Article author(s) (or their employer(s) unless otherwise stated in the

[Pain and fear in the ICU].

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Chamorro, C; Romera, M A

2015-10-01

Pain and fear are still the most common memories that refer patients after ICU admission. Recently an important politician named the UCI as the branch of the hell. It is necessary to carry out profound changes in terms of direct relationships with patients and their relatives, as well as changes in environmental design and work and visit organization, to banish the vision that our society about the UCI. In a step which advocates for early mobilization of critical patients is necessary to improve analgesia and sedation strategies. The ICU is the best place for administering and monitoring analgesic drugs. The correct analgesia should not be a pending matter of the intensivist but a mandatory course. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Validity and reliability of the Thai version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU

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Pipanmekaporn T

2014-05-01

Full Text Available Tanyong Pipanmekaporn,1 Nahathai Wongpakaran,2 Sirirat Mueankwan,3 Piyawat Dendumrongkul,2 Kaweesak Chittawatanarat,3 Nantiya Khongpheng,3 Nongnut Duangsoy31Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 3Division of Surgical Critical Care and Trauma, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, ThailandPurpose: The purpose of this study was to determine the validity and reliability of the Thai version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU, when compared to the diagnoses made by delirium experts.Patients and methods: This was a cross-sectional study conducted in both surgical intensive care and subintensive care units in Thailand between February–June 2011. Seventy patients aged 60 years or older who had been admitted to the units were enrolled into the study within the first 48 hours of admission. Each patient was randomly assessed as to whether they had delirium by a nurse using the Thai version of the CAM-ICU algorithm (Thai CAM-ICU or by a delirium expert using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.Results: The prevalence of delirium was found to be 18.6% (n=13 by the delirium experts. The sensitivity of the Thai CAM-ICU’s algorithms was found to be 92.3% (95% confidence interval [CI] =64.0%-99.8%, while the specificity was 94.7% (95% CI =85.4%-98.9%. The instrument displayed good interrater reliability (Cohen’s κ=0.81; 95% CI =0.64-0.99. The time taken to complete the Thai CAM-ICU was 1 minute (interquatile range, 1-2 minutes.Conclusion: The Thai CAM-ICU demonstrated good validity, reliability, and ease of use when diagnosing delirium in a surgical intensive care unit setting. The use of this diagnostic tool should be encouraged for daily, routine use, so as to promote the early detection

Structured information during the ICU stay to reduce anxiety: study protocol of a multicenter randomized controlled trial

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Horbach Annegret

2009-09-01

Full Text Available Abstract Background ICU stay is often associated with negative experiences for the individual patient. Many patients are disabled and their communication is restricted during the ICU stay. Specific information on procedures, sensations and coping behavior are thought to reduce anxiety on the ICU. Until now information programs to reduce anxiety were mainly delivered preoperatively, completely neglecting informational needs of non-elective ICU patients. Methods The trial is designed as a prospective multicenter randomized controlled trial in the cities of Marburg, Halle and Stuttgart. Elective and non-elective ICU patients will be included. The trial includes an intervention and a control group on the ICU. The control group receives a trivial conversation without any ICU-specific information. The intervention group receives an information program with specific procedural, sensory and coping information about their ICU stay. Both conversations take place in the ICU and are planned to take about 10 minutes. Discussion In contrast to former trials on information programs on the ICU-stay our intervention will take place in the ICU itself. This approach will ensure to compensate for memory effects due to anesthesia or preoperative stress. Further the results will be applicable to non-elective ICU-patients. Trial Registration ClinicalTrials NCT00764933

Tracheal cuff pressure monitoring in the ICU: a literature review and survey of current practice in Queensland.

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Talekar, C R; Udy, A A; Boots, R J; Lipman, J; Cook, D

2014-11-01

The application of tracheal cuff pressure monitoring is likely to vary between institutions. The aim of this study was therefore to review current evidence concerning this intervention in the intensive care unit (ICU) and to appraise regional practice by performing a state-wide survey. Publications for review were identified through searches of PubMed, EMBASE and Cochrane (1977 to 2014). All studies in English relevant to critical care and with complete data were included. Survey questions were developed by small-group consensus. Public and private ICUs across Queensland were contacted, with responses obtained from a representative member of the medical or nursing staff. Existing literature suggests significant variability in tracheal cuff pressure monitoring in the ICU, particularly in the applied technique, frequency of assessment and optimal intra-cuff pressures. Twenty-nine respondents completed the survey, representing 80.5% (29/36) of ICUs in Queensland. Twenty-eight out of twenty-nine respondents reported routinely monitoring tracheal cuff function, primarily employing cuff pressure measurement (26/28). Target cuff pressures varied, with 3/26 respondents aiming for 10 to 20 cmH2O, 10/26 for 21 to 25 cmH2O, and 13/26 for 26 to 30 cmH2O. Fifteen out of twenty-nine reported they had no current guideline or protocol for tracheal cuff management and only 16/29 indicated there was a dedicated area in the clinical record for reporting cuff intervention. Our results indicate that many ICUs across Queensland routinely measure tracheal cuff function, with most utilising pressure monitoring devices. Consistent with existing literature, the optimum cuff pressure remains uncertain. Most, however, considered that this should be a routine part of ICU care.

The quality of intensive care unit nurse handover related to end of life: a descriptive comparative international study.

Science.gov (United States)

Ganz, Freda DeKeyser; Endacott, Ruth; Chaboyer, Wendy; Benbinishty, Julie; Ben Nun, Maureen; Ryan, Helen; Schoter, Amanda; Boulanger, Carole; Chamberlain, Wendy; Spooner, Amy

2015-01-01

Quality ICU end-of-life-care has been found to be related to good communication. Handover is one form of communication that can be problematic due to lost or omitted information. A first step in improving care is to measure and describe it. The objective of this study was to describe the quality of ICU nurse handover related to end-of-life care and to compare the practices of different ICUs in three different countries. This was a descriptive comparative study. The study was conducted in seven ICUs in three countries: Australia (1 unit), Israel (3 units) and the UK (3 units). A convenience sample of 157 handovers was studied. Handover quality was rated based on the ICU End-of-Life Handover tool, developed by the authors. The highest levels of handover quality were in the areas of goals of care and pain management while lowest levels were for legal issues (proxy and advanced directives) related to end of life. Significant differences were found between countries and units in the total handover score (country: F(2,154)=25.97, p=studied. The total score was higher when quality of care might be deemed at greater risk (if the nurses did not know the patient or the patient was expected to die), indicating that nurses were exercising some form of discretionary decision making around handover communication; thus validating the measurement tool. Copyright © 2014. Published by Elsevier Ltd.

Biomechanical and nonfunctional assessment of physical capacity in male ICU survivors

DEFF Research Database (Denmark)

Poulsen, Jesper Brøndum; Rose, Martin Høyer; Jensen, Bente Rona

2013-01-01

: ICU admission is associated with decreased physical function for years after discharge. The underlying mechanisms responsible for this muscle function impairment are undescribed. The aim of this study was to describe the biomechanical properties of the quadriceps muscle in ICU survivors 12 months...

Epidemiology, Characteristics, and Outcomes of ICU-Managed Homeless Patients: A Population-Based Study

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Lavi Oud

2018-01-01

Full Text Available Background. The population-level demand for critical care services among the homeless (H remains unknown, with only sparse data on the characteristics and outcomes of those managed in the ICU. Methods. The Texas Inpatient Public Use Data File and annual federal reports were used to identify H hospitalizations and annual estimates of the H population between 2007 and 2014. The incidence of ICU admissions in the H population, the characteristics of ICU-managed H, and factors associated with their short-term mortality were examined. Results. Among 52,206 H hospitalizations 15,553 (29.8% were admitted to ICU. The incidence of ICU admission among state H population rose between 2007 and 2014 from 28.0 to 96.6/1,000 (p<0.0001, respectively. Adults aged ≥ 45 years and minorities accounted for 70.2% and 57.6%, respectively, of the growth in volume of ICU admissions. Short-term mortality was 3.2%, with odds of death increased with age, comorbidity burden, and number of failing organs. Conclusions. The demand for critical care services was increasingly high among the H and was contrasted by low short-term mortality among ICU admissions. These findings, coupled with the persistent health disparities among minority H, underscore the need to effectively address homelessness and reduce barriers to longitudinal appropriate prehospital care among the H.

Swedish Energy Research 2009

Energy Technology Data Exchange (ETDEWEB)

2009-07-01

Swedish Energy Research 2009 provides a brief, easily accessible overview of the Swedish energy research programme. The aims of the programme are to create knowledge and skills, as needed in order to commercialise the results and contribute to development of the energy system. Much of the work is carried out through about 40 research programmes in six thematic areas: energy system analysis, the building as an energy system, the transport sector, energy-intensive industries, biomass in energy systems and the power system. Swedish Energy Research 2009 describes the overall direction of research, with examples of current research, and results to date within various thematic areas and highlights

Low incidence of nephropathy in surgical ICU patients receiving intravenous contrast : a retrospective analysis

NARCIS (Netherlands)

Haveman, Jan Willem; Gansevoort, Ron T.; Bongaerts, Alfons H. H.; Nijsten, Maarten W. N.

Objective: Various studies have documented a markedly high incidence of contrast-induced nephropathy (CIN). Most of these studies were conducted in patients not in the ICU. In ICU patients intravenous contrast may be withheld for fear of CIN. We investigated the incidence of CIN in ICU patients.

Determining the economic cost of ICU treatment: a prospective "micro-costing" study.

LENUS (Irish Health Repository)

McLaughlin, Anne Marie

2009-12-01

To prospectively assess the cost of patients in an adult intensive care unit (ICU) using bottom-up costing methodology and evaluate the usefulness of "severity of illness" scores in estimating ICU cost.

The potential of Swedish furniture companies in Vietnam : How Vietnamese consumers perceive the product values of Swedish furniture

OpenAIRE

Dinh, Thi Phuong Lan; Karlsson, Jonas

2012-01-01

Introduction: Swedish furniture companies have been quite successful in many parts of the world recently, with IKEA being a famous example of that. Meanwhile, Vietnam has one of the fastest-growing economies in South East Asia. However, there has not been any Swedish furniture company established on the Vietnamese market so far. Therefore, it would be useful to see if the Vietnamese furniture consumers would appreciate Swedish furniture, in order to analyze whether Swedish furniture companies...

The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families.

Science.gov (United States)

Ely, E Wesley

2017-02-01

Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called "the postintensive care syndrome." Patients with postintensive care syndrome are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care. This article explains the science and philosophy of liberating ICU patients and families from harm that is both inherent to critical illness and iatrogenic. ICU liberation is an extensive program designed to facilitate the implementation of the pain, agitation, and delirium guidelines using the evidence-based ABCDEF bundle. Participating ICU teams adapt data from hundreds of peer-reviewed studies to operationalize a systematic and reliable methodology that shifts ICU culture from the harmful inertia of sedation and restraints to an animated ICU filled with patients who are awake, cognitively engaged, and mobile with family members engaged as partners with the ICU team at the bedside. In doing so, patients are "liberated" from iatrogenic aspects of care that threaten his or her sense of self-worth and human dignity. The goal of this 2017 plenary lecture at the 47th Society of Critical Care Medicine Congress is to provide clinical ICU teams a synthesis of the literature that led to the creation of ICU liberation philosophy and to explain how this patient- and family-centered, quality improvement program is novel, generalizable, and practice changing.

Increased ICU resource needs for an academic emergency general surgery service*.

Science.gov (United States)

Lissauer, Matthew E; Galvagno, Samuel M; Rock, Peter; Narayan, Mayur; Shah, Paulesh; Spencer, Heather; Hong, Caron; Diaz, Jose J

2014-04-01

ICU needs of nontrauma emergency general surgery patients are poorly described. This study was designed to compare ICU utilization of emergency general surgery patients admitted to an acute care emergency surgery service with other general surgery patients. Our hypothesis is that tertiary care emergency general surgery patients utilize more ICU resources than other general surgical patients. Retrospective database review. Academic, tertiary care, nontrauma surgical ICU. All patients admitted to the surgical ICU over age 18 between March 2004 and June 2012. None. Six thousand ninety-eight patients were evaluated: 1,053 acute care emergency surgery, 1,964 general surgery, 1,491 transplant surgery, 995 facial surgery/otolaryngology, and 595 neurosurgery. Acute care emergency surgery patients had statistically significantly longer ICU lengths of stay than other groups: acute care emergency surgery (13.5 ± 17.4 d) versus general surgery (8.7 ± 12.9), transplant (7.8 ± 11.6), oral-maxillofacial surgery (5.5 ± 4.2), and neurosurgery (4.47 ± 9.8) (all psurgery patients: acute care emergency surgery 73.4% versus general surgery 64.9%, transplant 63.3%, oral-maxillofacial surgery 58.4%, and neurosurgery 53.1% (all p surgery patients: acute care emergency surgery 10.8% versus general surgery 4.3%, transplant 6.6%, oral-maxillofacial surgery 0%, and neurosurgery 0.5% (all p surgery patients were more likely interhospital transfers for tertiary care services than general surgery or transplant (24.5% vs 15.5% and 8.3% respectively, p surgery (13.7% vs 6.7% and 3.5%, all p surgery and general surgery, whereas transplant had fewer. Emergency general surgery patients have increased ICU needs in terms of length of stay, ventilator usage, and continuous renal replacement therapy usage compared with other services, perhaps due to the higher percentage of transfers and emergent surgery required. These patients represent a distinct population. Understanding their resource needs

Development and validation of a new tool measuring nurses self-reported professional competence--the nurse professional competence (NPC) Scale.

Science.gov (United States)

Nilsson, Jan; Johansson, Eva; Egmar, Ann-Charlotte; Florin, Jan; Leksell, Janeth; Lepp, Margret; Lindholm, Christina; Nordström, Gun; Theander, Kersti; Wilde-Larsson, Bodil; Carlsson, Marianne; Gardulf, Ann

2014-04-01

To develop and validate a new tool intended for measuring self-reported professional competence among both nurse students prior to graduation and among practicing nurses. The new tool is based on formal competence requirements from the Swedish Board of Health and Welfare, which in turn are based on WHO guidelines. A methodological study including construction of a new scale and evaluation of its psychometric properties. 1086 newly graduated nurse students from 11 universities/university colleges. The analyses resulted in a scale named the NPC (Nurse Professional Competence) Scale, consisting of 88 items and covering eight factors: "Nursing care", "Value-based nursing care", "Medical/technical care", "Teaching/learning and support", "Documentation and information technology", "Legislation in nursing and safety planning", "Leadership in and development of nursing care" and "Education and supervision of staff/students". All factors achieved Cronbach's alpha values greater than 0.70. A second-order exploratory analysis resulted in two main themes: "Patient-related nursing" and "Nursing care organisation and development". In addition, evidence of known-group validity for the NPC Scale was obtained. The NPC Scale, which is based on national and international professional competence requirements for nurses, was comprehensively tested and showed satisfactory psychometrical properties. It can e.g. be used to evaluate the outcomes of nursing education programmes, to assess nurses' professional competences in relation to the needs in healthcare organisations, and to tailor introduction programmes for newly employed nurses. © 2013.

A Novel Computerized Test for Detecting and Monitoring Visual Attentional Deficits and Delirium in the ICU.

Science.gov (United States)

Green, Cameron; Hendry, Kirsty; Wilson, Elizabeth S; Walsh, Timothy; Allerhand, Mike; MacLullich, Alasdair M J; Tieges, Zoë

2017-07-01

Delirium in the ICU is associated with poor outcomes but is under-detected. Here we evaluated performance of a novel, graded test for objectively detecting inattention in delirium, implemented on a custom-built computerized device (Edinburgh Delirium Test Box-ICU). A pilot study was conducted, followed by a prospective case-control study. Royal Infirmary of Edinburgh General ICU. A pilot study was conducted in an opportunistic sample of 20 patients. This was followed by a validation study in 30 selected patients with and without delirium (median age, 63 yr; range, 23-84) who were assessed with the Edinburgh Delirium Test Box-ICU on up to 5 separate days. Presence of delirium was assessed using the Confusion Assessment Method for the ICU. The Edinburgh Delirium Test Box-ICU involves a behavioral assessment and a computerized test of attention, requiring patients to count slowly presented lights. Thirty patients were assessed a total of 79 times (n = 31, 23, 15, 8, and 2 for subsequent assessments; 38% delirious). Edinburgh Delirium Test Box-ICU scores (range, 0-11) were lower for patients with delirium than those without at the first (median, 0 vs 9.5), second (median, 3.5 vs 9), and third (median, 0 vs 10.5) assessments (all p Delirium Test Box-ICU score less than or equal to 5 was 100% sensitive and 92% specific to delirium across assessments. Longitudinally, participants' Edinburgh Delirium Test Box-ICU performance was associated with delirium status. These findings suggest that the Edinburgh Delirium Test Box-ICU has diagnostic utility in detecting ICU delirium in patients with Richmond Agitation and Sedation Scale Score greater than -3. The Edinburgh Delirium Test Box-ICU has potential additional value in longitudinally tracking attentional deficits because it provides a range of scores and is sensitive to change.

Data envelopment analysis model for the appraisal and relative performance evaluation of nurses at an intensive care unit.

Science.gov (United States)

Osman, Ibrahim H; Berbary, Lynn N; Sidani, Yusuf; Al-Ayoubi, Baydaa; Emrouznejad, Ali

2011-10-01

The appraisal and relative performance evaluation of nurses are very important and beneficial for both nurses and employers in an era of clinical governance, increased accountability and high standards of health care services. They enhance and consolidate the knowledge and practical skills of nurses by identification of training and career development plans as well as improvement in health care quality services, increase in job satisfaction and use of cost-effective resources. In this paper, a data envelopment analysis (DEA) model is proposed for the appraisal and relative performance evaluation of nurses. The model is validated on thirty-two nurses working at an Intensive Care Unit (ICU) at one of the most recognized hospitals in Lebanon. The DEA was able to classify nurses into efficient and inefficient ones. The set of efficient nurses was used to establish an internal best practice benchmark to project career development plans for improving the performance of other inefficient nurses. The DEA result confirmed the ranking of some nurses and highlighted injustice in other cases that were produced by the currently practiced appraisal system. Further, the DEA model is shown to be an effective talent management and motivational tool as it can provide clear managerial plans related to promoting, training and development activities from the perspective of nurses, hence increasing their satisfaction, motivation and acceptance of appraisal results. Due to such features, the model is currently being considered for implementation at ICU. Finally, the ratio of the number DEA units to the number of input/output measures is revisited with new suggested values on its upper and lower limits depending on the type of DEA models and the desired number of efficient units from a managerial perspective.

[Inadequate ICU-admissions : A 12-month prospective cohort study at a German University Hospital].

Science.gov (United States)

Bangert, K; Borch, J; Ferahli, S; Braune, S A; de Heer, G; Kluge, S

2016-05-01

Intensive care medicine (ICM) is increasingly utilized by a growing number of critically ill patients worldwide. The reasons for this are an increasingly ageing and multimorbid population and technological improvements in ICM. Inappropriate patient admissions to the intensive care unit (ICU) can be a threat to rational resource allocation and to patient autonomy. In this study, the incidence, characteristics, and resource utilization of patients inappropriately admitted to ICUs are studied. This prospective study included all consecutive patients admitted from 01 September 2012 to 31 August 2013 to the Department of Intensive Care Medicine of a German university hospital comprised of 10 ICUs and 120 beds. Inappropriate admission was defined according to category 4B of the recommendations of the Society of Critical Care Medicine (SCCM; "futility of ICU treatment" or "ICU declined by patient") and was determined in each suspected case by structured group discussions between the study team and all involved care givers including the referring team. In all, 66 of 6452 ICU admissions (1 %) were suspected to have been inappropriate on retrospective evaluation the day after admission. In 50 patients (0.8 %), an interdisciplinary consensus was reached on the inappropriateness of the ICU admission. Of these 50 patients, 41 (82 %) had previously declined ICU treatment in principle. This information was based on the patient's presumed wish as expressed by next of kin (56 %) or in a written advanced directive (26 %). In 9 patients (18 %), ICU treatment was considered futile. In all cases, a lack of information regarding a patient's wishes or clinical prognosis was the reason for inappropriate ICU admission. In this study, patients were regularly admitted to the ICU despite their contrary wish/directive or an unfavorable clinical condition. Although this was registered in only 1 % of all admissions, optimizing preICU admission information flow with regard to

Post-Traumatic Stress Symptoms in Post-ICU Family Members: Review and Methodological Challenges.

Science.gov (United States)

Petrinec, Amy B; Daly, Barbara J

2016-01-01

Family members of intensive care unit (ICU) patients are at risk for symptoms of post-traumatic stress disorder (PTSD) following ICU discharge. The aim of this systematic review is to examine the current literature regarding post-ICU family PTSD symptoms with an emphasis on methodological issues in conducting research on this challenging phenomenon. An extensive review of the literature was performed confining the search to English language studies reporting PTSD symptoms in adult family members of adult ICU patients. Ten studies were identified for review published from 2004 to 2012. Findings demonstrate a significant prevalence of family PTSD symptoms in the months following ICU hospitalization. However, there are several methodological challenges to the interpretation of existing studies and to the conduct of future research including differences in sampling, identification of risk factors and covariates of PTSD, and lack of consensus regarding the most appropriate PTSD symptom measurement tools and timing. © The Author(s) 2014.

Nosocomial pneumonia in the ICU: a prospective cohort study.

Science.gov (United States)

Hyllienmark, Petra; Gårdlund, Bengt; Persson, Jan-Olov; Ekdahl, Karl

2007-01-01

Ventilator-associated pneumonia (VAP) is the most common intensive care unit (ICU)-acquired infection among patients requiring mechanical ventilation. A prospective surveillance programme of all patients has been implemented at the ICU, Karolinska University Hospital, Sweden since 2001. Within this programme, incidence and risk factors for ICU-acquired pneumonia and associated death over a 2-y period have been studied. Of 329 patients enrolled in the study, 221 required mechanical ventilation. 33 of 221 patients (15%) developed VAP, corresponding to a rate of 29 VAP/1000 ventilator d. Risk factors for VAP were aspiration (hazard ratio 3.79; 95% CI 1.48-9.68), recent surgery (HR 3.58; 95% CI 1.15-11.10) and trauma (HR 3.00; 95% CI 1.03-8.71). 11 patients of 33 (33%) with VAP died within 28 d compared to 46 of 288 (16%) without ICU-acquired pneumonia (odds ratio 2.73; 95% CI 0.97-7.63). We conclude that: 1) incidence of VAP was 15% and the most important risk factor was aspiration; 2) APACHE II score > or = 20 is a stronger predictor for poor outcome than VAP; 3) a minority of patients with APACHE II score > or = 20 develop VAP; and 4) continuous surveillance programmes are feasible and provide valuable data for improvement of quality of care.

Preliminary Identification of Coping Profiles Relevant to Surrogate Decision Making in the ICU.

Directory of Open Access Journals (Sweden)

Jorie M Butler

Full Text Available The Intensive Care Unit (ICU is a stressful environment for families of critically ill patients and these individuals are at risk to develop persistent psychological morbidity. Our study objective was to identify individual differences in coping with stress and information presentation preferences of respondents exposed to a simulated ICU experience.Participants were recruited from a university and two community populations. Participants completed questionnaires that measured demographic information and characteristics that may be relevant to an individual's ICU experience. Quality of life was measured by the EQ-5D, personality dimensions were examined with the abbreviated Big Five inventory, coping with stress was assessed with Brief COPE. Shared decision making preferences were assessed by the Degner Control Preferences Scale (CPS and information seeking style was assessed with the Miller Behavioral Style Scale (MBSS. Social support was examined using an abbreviated version of the Social Relationship Index. Participants also completed a vignette-based simulated ICU experience, in which they made a surrogate decision on behalf of a loved one in the ICU.Three hundred forty-three participants completed the study. Three distinct coping profiles were identified: adaptive copers, maladaptive copers, and disengaged copers. Profiles differed primarily on coping styles, personality, quality of their closest social relationship, and history of anxiety and depression. Responses to the simulated ICU decision making experience differed across profiles. Disengaged copers (15% were more likely to elect to refuse dialysis on behalf of an adult sibling compared to adaptive copers (7% or maladaptive copers (5% (p = 0.03. Notably, the MBSS and the CPS did not differ by coping profile.Distinct coping profiles are associated with differences in responses to a simulated ICU experience. Tailoring communication and support to specific coping profiles may represent an

Infection control and quality assurance of health services provided in ICU: development of an ICU website.

Science.gov (United States)

Diomidous, Marianna; Ponirou, Paraskevi; Mpizopoulou, Zoi; Tzalera, Vaia; Mechili, Aggelos

2013-01-01

The aim of this study is to examine the infections control methods in ICU as well as the issue of quality in health services provided, as they constitute an important quality assurance indicator. Moreover, nowadays the causes of Nosocomial infections are known and so do the measures for their control. There is a need however for an information resource that will promote specialized and general guidelines. The measures include the appropriate use of gloves, cleaning and disinfection of the ICU environment and hand washing which is the most important of all. Therefore an effort was made to develop an easy to navigate webpage with practical and comprehensible clinical guidelines. Additionally, it gives to all visitors the opportunity for further information research with the use of the included links. For the development of the web side existing clinical guide lines were scrutinizes as well as studies that concern the effectiveness of the measures mentioned and for the identification of quality assurance criteria.

Duration of colonization with antimicrobial-resistant bacteria after ICU discharge.

Science.gov (United States)

Haverkate, Manon R; Derde, Lennie P G; Brun-Buisson, Christian; Bonten, Marc J M; Bootsma, Martin C J

2014-04-01

Readmission of patients colonized with antimicrobial-resistant bacteria (AMRB) is important in the nosocomial dynamics of AMRB. We assessed the duration of colonization after discharge from the intensive care unit (ICU) with highly resistant Enterobacteriaceae (HRE), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). Data were obtained from a cluster-randomized trial in 13 ICUs in 8 European countries (MOSAR-ICU trial, 2008-2011). All patients were screened on admission and twice weekly for AMRB. All patients colonized with HRE, MRSA, or VRE and readmitted to the same ICU during the study period were included in the current analysis. Time between discharge and readmission was calculated, and the colonization status at readmission was assessed. Because of interval-censored data, a maximum likelihood analysis was used to calculate the survival function, taking censoring into account. A nonparametric two-sample test was used to test for differences in the survival curves. The MOSAR-ICU trial included 14,390 patients, and a total of 64,997 cultures were taken from 8,974 patients admitted for at least 3 days. One hundred twenty-five unique patients had 141 episodes with AMRB colonization and at least 1 readmission. Thirty-two patients were colonized with two or more AMRBs. Median times until clearance were 4.8 months for all AMRB together, 1.4 months for HRE, <1 month for MRSA, and 1.5 months for VRE. There were no significant differences between the survival curves. Fifty percent of the patients had lost colonization when readmitted 2 or more months after previous ICU discharge.

Satisfaction with quality of ICU care for patients and families

DEFF Research Database (Denmark)

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

2017-01-01

as reflective indicators was supported by analysis of a factor representing satisfaction with communication, measured with a combination of causal and reflective indicators. CONCLUSIONS: Most family members were moderately or very satisfied with patient care, family care, information and decision-making...... in and support during decision-making processes. Exploratory factor analysis suggested four underlying factors, but confirmatory factor analysis failed to yield a multi-factor model with between-country measurement invariance. A hypothesis that this failure was due to misspecification of causal indicators......BACKGROUND: Families' perspectives are of great importance in evaluating quality of care in the intensive care unit (ICU). This Danish-Dutch study tested a European adaptation of the "Family Satisfaction in the ICU" (euroFS-ICU). The aim of the study was to examine assessments of satisfaction...

Nurse staffing, medical staffing and mortality in Intensive Care: An observational study.

Science.gov (United States)

West, Elizabeth; Barron, David N; Harrison, David; Rafferty, Anne Marie; Rowan, Kathy; Sanderson, Colin

2014-05-01

To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact on the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital. Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal. Information about patients, including the outcome of care (whether the patient lived or died) came from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. An Audit Commission survey of ICUs conducted in 1998 gave information about staffing levels. The merged dataset had information on 65 ICUs and 38,168 patients. This is currently the best available dataset for testing the relationship between staffing and outcomes in UK ICUs. A cross-sectional, retrospective, risk adjusted observational study. Multivariable, multilevel logistic regression. ICU and in-hospital mortality. After controlling for patient characteristics and workload we found that higher numbers of nurses per bed (odds ratio: 0.90, 95% confidence interval: [0.83, 0.97]) and higher numbers of consultants (0.85, [0.76, 0.95]) were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death (0.98, [0.96, 0.99]) whereas the effect of medical staffing was unchanged across the range of patient acuity (1.00, [0.97, 1.03]). No relationship between patient outcomes and the number of support staff (administrative, clerical, technical and scientific staff) was found. Distinguishing between direct care and supernumerary nurses and restricting the analysis to patients who had been in the unit for more than 8h made little difference to the results. Separate analysis of in-unit and in-hospital survival showed that the clinical workforce in intensive care had a greater impact on ICU mortality than on

Introducing the nurse practitioner into the surgical ward: an ethnographic study of interprofessional teamwork practice.

Science.gov (United States)

Kvarnström, Susanne; Jangland, Eva; Abrandt Dahlgren, Madeleine

2017-08-22

The first nurse practitioners in surgical care were introduced into Swedish surgical wards in 2014. Internationally, organisations that have adopted nurse practitioners into care teams are reported to have maintained or improved the quality of care. However, close qualitative descriptions of teamwork practice may add to existing knowledge of interprofessional collaboration when introducing nurse practitioners into new clinical areas. The aim was to report on an empirical study describing how interprofessional teamwork practice was enacted by nurse practitioners when introduced into surgical ward teams. The study had a qualitative, ethnographic research design, drawing on a sociomaterial conceptual framework. The study was based on 170 hours of ward-based participant observations of interprofessional teamwork practice that included nurse practitioners. Data were gathered from 2014 to 2015 across four surgical sites in Sweden, including 60 interprofessional rounds. The data were analysed with an iterative reflexive procedure involving inductive and theory-led approaches. The study was approved by a Swedish regional ethics committee (Ref. No.: 2014/229-31). The interprofessional teamwork practice enacted by the nurse practitioners that emerged from the analysis comprised a combination of the following characteristic role components: clinical leader, bridging team colleague and ever-present tutor. These role components were enacted at all the sites and were prominent during interprofessional teamwork practice. The participant nurse practitioners utilised the interprofessional teamwork practice arrangements to enact a role that may be described in terms of a quality guarantee, thereby contributing to the overall quality and care flow offered by the entire surgical ward team. © 2017 Nordic College of Caring Science.

Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS).

Science.gov (United States)

Ely, E Wesley; Truman, Brenda; Shintani, Ayumi; Thomason, Jason W W; Wheeler, Arthur P; Gordon, Sharon; Francis, Joseph; Speroff, Theodore; Gautam, Shiva; Margolin, Richard; Sessler, Curtis N; Dittus, Robert S; Bernard, Gordon R

2003-06-11

Goal-directed delivery of sedative and analgesic medications is recommended as standard care in intensive care units (ICUs) because of the impact these medications have on ventilator weaning and ICU length of stay, but few of the available sedation scales have been appropriately tested for reliability and validity. To test the reliability and validity of the Richmond Agitation-Sedation Scale (RASS). Prospective cohort study. Adult medical and coronary ICUs of a university-based medical center. Thirty-eight medical ICU patients enrolled for reliability testing (46% receiving mechanical ventilation) from July 21, 1999, to September 7, 1999, and an independent cohort of 275 patients receiving mechanical ventilation were enrolled for validity testing from February 1, 2000, to May 3, 2001. Interrater reliability of the RASS, Glasgow Coma Scale (GCS), and Ramsay Scale (RS); validity of the RASS correlated with reference standard ratings, assessments of content of consciousness, GCS scores, doses of sedatives and analgesics, and bispectral electroencephalography. In 290-paired observations by nurses, results of both the RASS and RS demonstrated excellent interrater reliability (weighted kappa, 0.91 and 0.94, respectively), which were both superior to the GCS (weighted kappa, 0.64; P<.001 for both comparisons). Criterion validity was tested in 411-paired observations in the first 96 patients of the validation cohort, in whom the RASS showed significant differences between levels of consciousness (P<.001 for all) and correctly identified fluctuations within patients over time (P<.001). In addition, 5 methods were used to test the construct validity of the RASS, including correlation with an attention screening examination (r = 0.78, P<.001), GCS scores (r = 0.91, P<.001), quantity of different psychoactive medication dosages 8 hours prior to assessment (eg, lorazepam: r = - 0.31, P<.001), successful extubation (P =.07), and bispectral electroencephalography (r = 0.63, P

Creating a Meeting Point of Understanding: Interpreters' Experiences in Swedish Childhood Cancer Care.

Science.gov (United States)

Granhagen Jungner, Johanna; Tiselius, Elisabet; Lützén, Kim; Blomgren, Klas; Pergert, Pernilla

2016-01-01

Children and families with a foreign background and limited Swedish proficiency have to communicate through interpreters in childhood cancer care centers in Sweden. Interpreter-mediated events deal with many difficulties that potentially hinder the transfer of information. The purpose of our study was to explore interpreters' experiences of interpreting between health care staff and limited Swedish proficiency patients/families in childhood cancer care. Using purposive samples, we interviewed 11 interpreters individually. The interviews were analyzed using qualitative content analysis. Analyses of the data resulted in the main theme of creating a meeting point of understanding, constructed from 3 subthemes: balancing between cultures, bridging the gaps of knowledge, and balancing between compassion and professionalism. Our result shows that in order to create a sustainable meeting point of understanding, it is necessary to explain both the context and cultural differences. These results suggest that the responsibility for information transfer lies with both the health care profession and the interpreters. Tools have to be developed for both parties to contribute to creating the meeting point of understanding. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

The impact of personality on person-centred care: a study of care staff in Swedish nursing homes.

Science.gov (United States)

Elfstrand Corlin, Tinna; Kajonius, Petri J; Kazemi, Ali

2017-06-01

In this study, we explore how personal and situational factors relate to the provision of person-centred care (PCC) in nursing homes. Specifically, we focus on the relationship between the care staff's personality traits and provision of PCC and to what extent perceptions of the working environment influences this relationship. The ultimate goal of elderly care is to meet the older person's needs and individual preferences (PCC). Interpersonal aspects of care and the quality of relationship between the care staff and the older person are therefore central in PCC. A cross-sectional Swedish sample of elderly care staff (N = 322) completed an electronic survey including measures of personality (Mini-IPIP) and person-centred care (Individualized Care Inventory, ICI). A principal component analysis was conducted on the ICI-data to separate the user orientation (process quality) of PCC from the preconditions (structure quality) of PCC. Among the five factors of personality, neuroticism was the strongest predictor of ICI user orientation. ICI preconditions significantly mediated this relationship, indicating the importance of a supportive working environment. In addition, stress was introduced as a potential explanation and was shown to mediate the impact of neuroticism on ICI preconditions. Personality traits have a significant impact on user orientation, and the perception of a supportive and stress free working environment is an important prerequisite for achieving high-quality person-centred elderly care. Understanding how personality is linked to the way care staff interacts with the older person adds a new perspective on provision of person-centred elderly care. © 2016 John Wiley & Sons Ltd.

The Swedish Energy Market 2005

International Nuclear Information System (INIS)

2005-10-01

The Swedish Energy Market, 2005 is an annual publication that presents information and statistics on the network based energy markets in Sweden, i.e. the markets for electricity, natural gas and district heating. It also provides an overview of the issues that have arisen on these markets during the second half of 2004 and the first half of 2005. Considerable work is being carried out in the EU on creating a single market for electricity and natural gas. This publication therefore describes expansion of the Swedish market towards a Nordic and a European market. The publication normally includes a theme chapter, describing some event of particular interest for the Swedish energy market during the year. This year, the theme chapter is devoted to the Storm Gudrun, which struck the south of the country at the beginning of January, and its effects on electricity supply throughout the country. The chapter is based on the report submitted to the Government by the Energy Markets Inspectorate in the spring of 2005, and also includes a summary of the Inspectorate's proposals for measures to improve the security of electricity transmission. Energy in Sweden, which is another of the Swedish Energy Agency's annual publications, provides information and statistics on the development of the entire Swedish energy system

A research-based didactic model for education to promote culturally competent nursing care in Sweden.

Science.gov (United States)

Gebru, Kerstin; Willman, Ania

2003-01-01

As Sweden changes toward a multicultural society, scientific knowledge of transcultural nursing care becomes increasingly important. Earlier studies in Swedish nursing education have demonstrated a lack of knowledge base in transcultural nursing. Through an extensive review of the literature, a didactic model was developed to help facilitate the establishment of this body of knowledge in transcultural nursing. The article demonstrates how the model applies the content and structure of Leininger's theory of culture care diversity and universality and ethnonursing method in a 3-year nursing program in theory as well as clinical education. The model includes a written guide for faculty members, with references to scientific articles and documents to be used.

Oral and endotracheal tubes colonization by periodontal bacteria: a case-control ICU study.

Science.gov (United States)

Porto, A N; Cortelli, S C; Borges, A H; Matos, F Z; Aquino, D R; Miranda, T B; Oliveira Costa, F; Aranha, A F; Cortelli, J R

2016-03-01

Periodontal infection is a possible risk factor for respiratory disorders; however, no studies have assessed the colonization of periodontal pathogens in endotracheal tubes (ET). This case-control study analyzed whether periodontal pathogens are able to colonize ET of dentate and edentulous patients in intensive care units (ICU) and whether oral and ET periodontal pathogen profiles have any correlation between these patients. We selected 18 dentate and 18 edentulous patients from 78 eligible ICU patients. Oral clinical examination including probing depth, clinical attachment level, gingival index , and plaque index was performed by a single examiner, followed by oral and ET sampling and processing by quantitative polymerase chain reaction (total bacterial load, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia). Data were statistically analyzed by Mann-Whitney U, two-way analysis of variance (p Periodontal pathogens can colonize ET and the oral cavity of ICU patients. Periodontal pathogen profiles tend to be similar between dentate and edentulous ICU patients. In ICU patients, oral cavity represents a source of ET contamination. Although accompanied by higher oral bacterial levels, teeth do not seem to influence ET bacterial profiles.

Winning the war against ICU-acquired weakness: new innovations in nutrition and exercise physiology.

Science.gov (United States)

Wischmeyer, Paul E; San-Millan, Inigo

2015-01-01

Over the last 10 years we have significantly reduced hospital mortality from sepsis and critical illness. However, the evidence reveals that over the same period we have tripled the number of patients being sent to rehabilitation settings. Further, given that as many as half of the deaths in the first year following ICU admission occur post ICU discharge, it is unclear how many of these patients ever returned home. For those who do survive, the latest data indicate that 50-70% of ICU "survivors" will suffer cognitive impairment and 60-80% of "survivors" will suffer functional impairment or ICU-acquired weakness (ICU-AW). These observations demand that we as intensive care providers ask the following questions: "Are we creating survivors ... or are we creating victims?" and "Do we accomplish 'Pyrrhic Victories' in the ICU?" Interventions to address ICU-AW must have a renewed focus on optimal nutrition, anabolic/anticatabolic strategies, and in the future employ the personalized muscle and exercise evaluation techniques utilized by elite athletes to optimize performance. Specifically, strategies must include optimal protein delivery (1.2-2.0 g/kg/day), as an athlete would routinely employ. However, as is clear in elite sports performance, optimal nutrition is fundamental but alone is often not enough. We know burn patients can remain catabolic for 2 years post burn; thus, anticatabolic agents (i.e., beta-blockers) and anabolic agents (i.e., oxandrolone) will probably also be essential. In the near future, evaluation techniques such as assessing lean body mass at the bedside using ultrasound to determine nutritional status and ultrasound-measured muscle glycogen as a marker of muscle injury and recovery could be utilized to help find the transition from the acute phase of critical illness to the recovery phase. Finally, exercise physiology testing that evaluates muscle substrate utilization during exercise can be used to diagnose muscle mitochondrial dysfunction and

Expanding technology in the ICU: the case for the utilization of telemedicine.

Science.gov (United States)

Deslich, Stacie; Coustasse, Alberto

2014-05-01

Telemedicine has been utilized in various healthcare areas to achieve better patient outcomes, lower costs of providing services, and increase patient access to care. Tele-intensive care unit (ICU) technology has been introduced as a way to provide effective ICU services to patients with reduced access, as well as to decrease costs and improve patient care. The methodology for this qualitative study was a literature search and review of case studies. The search was limited to sources published in the last 10 years (2003-2013) in the English language. In total, 55 references were used for this research exploration inquiry. Tele-ICU was found to be an effective way to use technology to decrease costs of providing intensive care, while improving patient outcomes such as mortality and length of stay. Several case studies supported the use of telemedicine in ICUs to provide intensive care to patients who lived in rural areas and lacked access to traditional ICUs. Furthermore, it was noted that, although the initial costs for tele-ICU startup were significant, as much as $100,000 per bed, the benefits of the utilization of this technology can offset those costs by reducing costs by 24% via decreased length of stay for patients. The findings of this study have suggested that the implementation of tele-ICU may have been more beneficial than costly, and it may have provided healthcare organizations the opportunity to increase quality of care and decrease mortality, while it might have decreased costs of delivering ICU services in both rural and urban areas.

Environmental assessment of Swedish agriculture

International Nuclear Information System (INIS)

Engstroem, Rebecka; Finnveden, Goeran; Wadeskog, Anders

2007-01-01

This article describes an environmental assessment of Swedish agriculture, including upstream and downstream effects. The analysis is based on environmentally extended input-output analysis, but it is also supplemented with data from other sources. The analysis shows that direct effects by the Swedish agriculture are the most important, while indirect effects from other sources including mobile and impacts abroad are also considerable. The most important impacts from Swedish agriculture according to the analysis are eutrophication, global warming and resource use. The agricultural sector produces a large share of the Swedish emissions causing both global warming and eutrophication. In addition, current agricultural practice causes problems with loss of biodiversity. The most important actors in the sector are agriculture itself, but also all actors using fossil fuels: primarily the transport sector and the energy sector. In addition, consumers are important since they can influence the composition of agricultural production. The analysis shows the importance of including upstream and downstream effects when analysing the environmental impacts from a sector. (author)

Temporal Informative Analysis in Smart-ICU Monitoring: M-HealthCare Perspective.

Science.gov (United States)

Bhatia, Munish; Sood, Sandeep K

2016-08-01

The rapid introduction of Internet of Things (IoT) Technology has boosted the service deliverance aspects of health sector in terms of m-health, and remote patient monitoring. IoT Technology is not only capable of sensing the acute details of sensitive events from wider perspectives, but it also provides a means to deliver services in time sensitive and efficient manner. Henceforth, IoT Technology has been efficiently adopted in different fields of the healthcare domain. In this paper, a framework for IoT based patient monitoring in Intensive Care Unit (ICU) is presented to enhance the deliverance of curative services. Though ICUs remained a center of attraction for high quality care among researchers, still number of studies have depicted the vulnerability to a patient's life during ICU stay. The work presented in this study addresses such concerns in terms of efficient monitoring of various events (and anomalies) with temporal associations, followed by time sensitive alert generation procedure. In order to validate the system, it was deployed in 3 ICU room facilities for 30 days in which nearly 81 patients were monitored during their ICU stay. The results obtained after implementation depicts that IoT equipped ICUs are more efficient in monitoring sensitive events as compared to manual monitoring and traditional Tele-ICU monitoring. Moreover, the adopted methodology for alert generation with information presentation further enhances the utility of the system.

Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.

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Sudduth, Christopher L; Overton, Elizabeth C; Lyu, Peter F; Rimawi, Ramzy H; Buchman, Timothy G

2017-06-01

Using administrative codes and minimal physiologic and laboratory data, we sought a high-specificity identification strategy for patients whose sepsis initially appeared during their ICU stay. We studied all patients discharged from an academic hospital between September 1, 2013 and October 31, 2014. Administrative codes and minimal physiologic and laboratory criteria were used to identify patients at high risk of developing the onset of sepsis in the ICU. Two clinicians then independently reviewed the patient record to verify that the screened-in patients appeared to become septic during their ICU admission. Clinical chart review verified sepsis in 437/466 ICU stays (93.8%). Of these 437 encounters, only 151 (34.6%) were admitted to the ICU with neither SIRS nor evidence of infection and therefore appeared to become septic during their ICU stay. Selected administrative codes coupled to SIRS criteria and applied to patients admitted to ICU can yield up to 94% authentic sepsis patients. However, only 1/3 of patients thus identified appeared to become septic during their ICU stay. Studies that depend on high-intensity monitoring for description of the time course of sepsis require clinician review and verification that sepsis initially appeared during the monitoring period. Copyright © 2017 Elsevier Inc. All rights reserved.

Exploring unplanned ICU admissions: a systematic review.

Science.gov (United States)

Vlayen, Annemie; Verelst, Sandra; Bekkering, Geertruida E; Schrooten, Ward; Hellings, Johan; Claes, Nerée

Adverse events are unintended patient injuries or complications that arise from healthcare management resulting in death, disability or prolonged hospital stay. Adverse events that require critical care are a considerable financial burden to the healthcare system. Medical record review seems to be a reliable method for detecting adverse events. To synthesize the best available evidence regarding the estimates of the incidence and preventability of adverse events that necessitate intensive care admission; to determine the type and consequences (patient harm, mortality, length of ICU stay and direct medical costs) of these adverse events. MEDLINE (from 1966 to present), EMBASE (from 1974 to present) and CENTRAL (version 1-2010) were searched for studies reporting on unplanned admissions to intensive care units (ICUs). Databases of reports, conference proceedings, grey literature, ongoing research, relevant patient safety organizations and two journals were searched for additional studies. Reference lists of retrieved papers were searched and authors were contacted in an attempt to find any further published or unpublished work. Only quantitative studies that used chart review for the detection of adverse events requiring intensive care admission were considered for eligibility. Studies that were published in the English, Dutch, German, French or Spanish language were included. Two reviewers independently extracted data and assessed the methodological quality of the included studies. 28 studies in the English language and one study in French were included. Of these, two were considered duplicate publications and therefore 27 studies were reviewed. Meta-analysis of the data was not appropriate due to statistical heterogeneity between studies; therefore, results are presented in a descriptive way. Studies were categorized according to the population and the providers of care. 1) The majority of the included studies investigated unplanned intensive care admissions after

Effectiveness and Safety of an Extended ICU Visitation Model for Delirium Prevention: A Before and After Study.

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Rosa, Regis Goulart; Tonietto, Tulio Frederico; da Silva, Daiana Barbosa; Gutierres, Franciele Aparecida; Ascoli, Aline Maria; Madeira, Laura Cordeiro; Rutzen, William; Falavigna, Maicon; Robinson, Caroline Cabral; Salluh, Jorge Ibrain; Cavalcanti, Alexandre Biasi; Azevedo, Luciano Cesar; Cremonese, Rafael Viegas; Haack, Tarissa Ribeiro; Eugênio, Cláudia Severgnini; Dornelles, Aline; Bessel, Marina; Teles, José Mario Meira; Skrobik, Yoanna; Teixeira, Cassiano

2017-10-01

To evaluate the effect of an extended visitation model compared with a restricted visitation model on the occurrence of delirium among ICU patients. Prospective single-center before and after study. Thirty-one-bed medical-surgical ICU. All patients greater than or equal to 18 years old with expected length of stay greater than or equal to 24 hours consecutively admitted to the ICU from May 2015 to November 2015. Change of visitation policy from a restricted visitation model (4.5 hr/d) to an extended visitation model (12 hr/d). Two hundred eighty-six patients were enrolled (141 restricted visitation model, 145 extended visitation model). The primary outcome was the cumulative incidence of delirium, assessed bid using the confusion assessment method for the ICU. Predefined secondary outcomes included duration of delirium/coma; any ICU-acquired infection; ICU-acquired bloodstream infection, pneumonia, and urinary tract infection; all-cause ICU mortality; and length of ICU stay. The median duration of visits increased from 133 minutes (interquartile range, 97.7-162.0) in restricted visitation model to 245 minutes (interquartile range, 175.0-272.0) in extended visitation model (p < 0.001). Fourteen patients (9.6%) developed delirium in extended visitation model compared with 29 (20.5%) in restricted visitation model (adjusted relative risk, 0.50; 95% CI, 0.26-0.95). In comparison with restricted visitation model patients, extended visitation model patients had shorter length of delirium/coma (1.5 d [interquartile range, 1.0-3.0] vs 3.0 d [interquartile range, 2.5-5.0]; p = 0.03) and ICU stay (3.0 d [interquartile range, 2.0-4.0] vs 4.0 d [interquartile range, 2.0-6.0]; p = 0.04). The rate of ICU-acquired infections and all-cause ICU mortality did not differ significantly between the two study groups. In this medical-surgical ICU, an extended visitation model was associated with reduced occurrence of delirium and shorter length of delirium/coma and ICU stay.

Skin Conductance Response in ICU patients with various stressors: a case series

NARCIS (Netherlands)

Tjan, D.H.T.; Schellaars, R.; Volders, J.; Weda, J.; Johnson, M.T.; Lubberding, M.; Dijk, E.O.; Ouwerkerk, M.; Van Zanten, A.R.H.

2012-01-01

Measuring stress levels in the ICU is not well defined and lacks reliable and valid methods of detection. ICU patients experience different kinds of stress like pain, dyspnoea, anxiety and general discomfort. Skin conductance has recently been shown to be a promising physiological indicator of pain

Tricyclic antidepressant overdose necessitating ICU admission ...

African Journals Online (AJOL)

Tricyclic antidepressant (TCA) overdose necessitating intensive care unit (ICU) admission remains a significant problem in the Western Cape. In this retrospective study, we reviewed the course of life-threatening TCA overdose in our centre to identify potential prognostic indicators. TCA levels >1 000 ng/ml were associated ...

Downsizing and reorganization: demands, challenges and ambiguity for registered nurses.

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Hertting, Anna; Nilsson, Kerstin; Theorell, Töres; Larsson, Ullabeth Sätterlund

2004-01-01

The 1990s were characterized by substantial financial cuts, and related staff redundancies and reorganizations in the Swedish health care sector. A large hospital in Sweden was selected for the study, in which downsizing had occurred between 1995 and 1997. The number of staff in the hospital was reduced by an average of 20%, and 10% were relocated to other departments. The aims of this study were to explore registered nurses' experiences of psychosocial 'stressors' and 'motivators', and how they handled their work situations, following a period of personnel reductions and ongoing reorganization. Interviews were undertaken with 14 nurses working in one Swedish hospital. Nurses were interviewed in 1997 about the recent and last round of redundancies, and were followed up 1 year later in 1998 and again in 2001. Interviews were audiotaped, transcribed and analysed for thematic content. Five themes emerged in relation to nurses' perceived stressors, motivators, and coping options: 'distrust towards the employer', 'concurrent demands and challenges', 'professional ambiguity, 'a wish for collaboration', and 'efforts to gain control'. A common feature was duality and ambiguity in nurses' descriptions of the phenomena studied, meaning that identified themes had underlying sub-themes with both negative and positive dimensions. The concurrence of 'ever-growing job demands' and 'work going unrewarded' contributed to a feeling of being taken advantage of by the employer. The 'waste of human resources' and 'competence drain' that followed redundancies provoked anger. Unfulfilled collaboration with doctors was a major stress producer, which related to both the downsized work organization, and the complex 'deference-dominance' doctor-nurse relationship. The well-being of nurses depends on being an equal/parallel health professional in a comprehensive team that shares knowledge and improves collaborative care of patients. A consciously formulated nursing philosophy emerged as a

"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.

Muscle mass and physical recovery in ICU: innovations for targeting of nutrition and exercise.

Science.gov (United States)

Wischmeyer, Paul E; Puthucheary, Zudin; San Millán, Iñigo; Butz, Daniel; Grocott, Michael P W

2017-08-01

We have significantly improved hospital mortality from sepsis and critical illness in last 10 years; however, over this same period we have tripled the number of 'ICU survivors' going to rehabilitation. Furthermore, as up to half the deaths in the first year following ICU admission occur post-ICU discharge, it is unclear how many of these patients ever returned home or a meaningful quality of life. For those who do survive, recent data reveals many 'ICU survivors' will suffer significant functional impairment or post-ICU syndrome (PICS). Thus, new innovative metabolic and exercise interventions to address PICS are urgently needed. These should focus on optimal nutrition and lean body mass (LBM) assessment, targeted nutrition delivery, anabolic/anticatabolic strategies, and utilization of personalized exercise intervention techniques, such as utilized by elite athletes to optimize preparation and recovery from critical care. New data for novel LBM analysis technique such as computerized tomography scan and ultrasound analysis of LBM are available showing objective measures of LBM now becoming more practical for predicting metabolic reserve and effectiveness of nutrition/exercise interventions. 13C-Breath testing is a novel technique under study to predict infection earlier and predict over-feeding and under-feeding to target nutrition delivery. New technologies utilized routinely by athletes such as muscle glycogen ultrasound also show promise. Finally, the role of personalized cardiopulmonary exercise testing to target preoperative exercise optimization and post-ICU recovery are becoming reality. New innovative techniques are demonstrating promise to target recovery from PICS utilizing a combination of objective LBM and metabolic assessment, targeted nutrition interventions, personalized exercise interventions for prehabilitation and post-ICU recovery. These interventions should provide hope that we will soon begin to create more 'survivors' and fewer victim's post-ICU

New Swedish environmental and sustainable education research

Directory of Open Access Journals (Sweden)

Johan Öhman

2011-01-01

Full Text Available This special issue of Education & Democracy presents examples froma new generation of Swedish research on environmental and sustainability education and thereby complement the picture of the current Swedish environmental and sustainability education research outlined in the recent Danish-Swedish special issue of Environmental EducationResearch (Vol 16, No 1 and the anthology Democracy and Values inEducation for Sustainable Development – Contributions from Swedish Research (Öhman 2008. All the contributors to this issue are associatedwith the Graduate School in Education and Sustainable Development (GRESD, either as PhD students or as supervisors.

The Swedish Energy Market 2005

Energy Technology Data Exchange (ETDEWEB)

NONE

2005-10-01

The Swedish Energy Market, 2005 is an annual publication that presents information and statistics on the network based energy markets in Sweden, i.e. the markets for electricity, natural gas and district heating. It also provides an overview of the issues that have arisen on these markets during the second half of 2004 and the first half of 2005. Considerable work is being carried out in the EU on creating a single market for electricity and natural gas. This publication therefore describes expansion of the Swedish market towards a Nordic and a European market. The publication normally includes a theme chapter, describing some event of particular interest for the Swedish energy market during the year. This year, the theme chapter is devoted to the Storm Gudrun, which struck the south of the country at the beginning of January, and its effects on electricity supply throughout the country. The chapter is based on the report submitted to the Government by the Energy Markets Inspectorate in the spring of 2005, and also includes a summary of the Inspectorate's proposals for measures to improve the security of electricity transmission. Energy in Sweden, which is another of the Swedish Energy Agency's annual publications, provides information and statistics on the development of the entire Swedish energy system.

Recall of ICU Stay in Patients Managed With a Sedation Protocol or a Sedation Protocol With Daily Interruption.

Science.gov (United States)

Burry, Lisa; Cook, Deborah; Herridge, Margaret; Devlin, John W; Fergusson, Dean; Meade, Maureen; Steinberg, Marilyn; Skrobik, Yoanna; Olafson, Kendiss; Burns, Karen; Dodek, Peter; Granton, John; Ferguson, Niall; Jacka, Michael; Tanios, Maged; Fowler, Robert; Reynolds, Steven; Keenan, Sean; Mallick, Ranjeeta; Mehta, Sangeeta

2015-10-01

To 1) describe factual, emotional, and delusional memories of ICU stay for patients enrolled in the SLEAP (Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol) trial; 2) compare characteristics of patients with and without ICU recall, and patients with and without delusional memories; and 3) determine factors associated with delusional memories 28 days after ICU discharge. Prospective cohort. Sixteen North American medical and surgical ICUs. Critically ill, mechanically ventilated adults randomized in the SLEAP trial. Post-ICU interviews on days 3, 28, and 90 using the validated ICU Memory Tool. Overall, 289 of 297 ICU survivors (97%) (146 protocolized sedation and 143 protocolized sedation plus daily interruption patients) were interviewed at least once. Because there were no differences in recall status or types of memories between the two sedation groups, we present the findings for all patients rather than by study group. On days 3, 28, and 90, 28%, 26%, and 36% of patients, respectively, reported no recall of being in the ICU (overall perception, self-reported) (p = 0.75). Mean daily doses of benzodiazepines and opioids were lower in patients with no ICU recall than those with recall (p patients reporting no recall of ICU stay on day 3, 97% and 90% reported at least one factual and one emotional memory from ICU, respectively. Emotional memories declined with time after ICU discharge, particularly panic and confusion. Delusional memories 28 days after discharge were common (70%) yet unrelated to delirium (p = 0.84), recall status (p = 0.15), total dose of benzodiazepine (p = 0.78), or opioid (p = 0.21). Delusional memories were less likely with longer duration of mechanical ventilation (odds ratio, 0.955; 95% CI, 0.91-1.00; p = 0.04). Recall of ICU stay and types of memories reported were not influenced by the trial sedation strategy. Lack of ICU recall and delusional memories were common after ICU

Acute renal failure in the medical ICU still predictive of high mortality ...

African Journals Online (AJOL)

Background. We aimed to determine the outcome and certain predictors of outcome for acute renal failure (ARF) in the medical intensive care unit (ICU) at Tygerberg Hospital. Method. We conducted a retrospective, single-centre cohort study over 12 months comprising all patients admitted to the medical ICU with all causes ...

Outcome analysis of a research-based didactic model for education to promote culturally competent nursing care in Sweden--a questionnaire study.

Science.gov (United States)

Gebru, Kerstin; Khalaf, Azzam; Willman, Ania

2008-09-01

To describe and analyse to what extent the goals of the education in promoting culturally competent nursing care have been achieved from a student perspective. As Sweden has transformed into a multicultural society over the past 50 years, there is a need to specify, at all levels of the nursing programme, transcultural concepts for the success of integration. A research-based didactic model was designed for the nursing programme at Malmö University and this was followed by investigations of its outcome. The study is a prospective cohort study with an outcome analysis. A descriptive research study with a longitudinal design was performed, with the focus on Swedish nursing students' experiences of transcultural nursing knowledge and their attitudes before and after implementation of the didactic model. The students evaluate highly their competence to meet demands of multicultural health and medical service. Additionally, their ability to recognise and understand the consequences of international migration on health also received a high mean. The study revealed the knowledge and experience acquired by Swedish students in transcultural nursing. The assumption was that a visible development of knowledge should occur during the three years of education. Interpreting the findings, such effectiveness can be found and hopefully the students will be able to give holistic nursing care based on a person's individual culture.

Nursing home residents' views on dying and death: nursing home employee's perspective.

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Dwyer, Lise-Lotte; Hansebo, Görel; Andershed, Birgitta; Ternestedt, Britt-Marie

2011-12-01

To reveal nursing home employees' views on dying and death among older people they cared for. Palliative care stakeholders recently included more groups in their definition of palliative care; older people constitute one such group. Consequently, palliative care systems, which will serve a large, aging cohort, will require new skills. The first stage in skills acquisition is to gather current views on dying and death. Qualitative descriptive study that uses focus group discussions for data collection; 20 employees in 4 Swedish nursing homes participated. Data were analysed using qualitative content analysis. The following categories were conceptualised: alleviating suffering and pain; finding meaning in everyday life; revealing thoughts and attitudes about death; taking care of the dead person's body; and coping with the gap between personal ideals and reality. A deeper understanding of the palliative care philosophy is needed to further develop and tailor care for the dying persons in nursing homes. To get public support for palliative care, the silence surrounding dying and death must be broken. Employees must receive education to prepare for all aspects of their work, and management must account for employees' situation when planning the care. © 2010 Blackwell Publishing Ltd.

Personality, stress and coping in intensive care nurses: a descriptive exploratory study.

Science.gov (United States)

Burgess, Lorraine; Irvine, Fiona; Wallymahmed, Akhtar

2010-01-01

The aim of the study was to investigate the relationship between personality traits, perception of workplace stress and coping among intensive care unit (ICU) nurses. Research has indicated that ICUs are stressful environments. There is a tendency for research studies to investigate causes of stress and ways of coping, but few studies, particularly in recent years, have considered the personality traits of the staff who thrive in this challenging environment, the work stress they perceive and the coping strategies they use. A convenience sample of critical care nurses (n = 46) completed three standardised questionnaires during September 2007: the revised NEO personality inventory (NEO-PI-R); the nurses stress scale (NSI) and the Brief Coping Orientations to Problems Experienced (COPE) scale. ICU nurses did not perceive their workplaces to be stressful. Certain personality traits, openness, agreeableness and conscientiousness, were associated with problem-solving coping strategies such as active planning and reframing. Openness and extraversion were associated with less perceived stress from the 'patients and relatives' dimension of the NSI; there were also negative correlations between conscientiousness and the 'workload stress' and stress from lack of 'confidence and competence' dimensions of the NSI. Certain personality traits may have a buffering effect on workplace stress. Pre-employment screening to identify staff that exhibit personality and coping traits associated with low perceived stress may be considered as part of the recruitment strategy to address problems relating to stress, sickness and retention. The retention and recruitment of staff who have lower perceived workplace stress and who utilise problem-focused coping may result in less reported absences and fewer critical incidents and errors.

Nursing leadership in intensive care units and its relationship to the work environment

Directory of Open Access Journals (Sweden)

Alexandre Pazetto Balsanelli

2015-02-01

Full Text Available AIM: To establish whether there is any relationship between the work environment and nursing leadership at intensive care units (ICUs.METHOD: Correlational study conducted at four ICUs in southern São Paulo (SP, Brazil. The study population was comprised of 66 pairs (nurses and nursing technicians established by lottery. The nurses responded to three instruments: 1 characterization; 2 a validated Portuguese version of the Nursing Work Index Revised (B-NWI-R; and 3 Grid & Leadership in Nursing: ideal behavior. The nursing technicians responded to 1 characterization and to 2 Grid and Leadership in Nursing: actual behavior, relative to the corresponding randomly-assigned nurse. The data were analyzed by means of analysis of variance (ANOVA at p ≤ 0.05.RESULTS: The work environment was not associated with actual nursing leadership (p = 0.852. The public or private nature of the institutions where the investigated ICUs were located had no significant effect on leadership (p = 0.437. Only the nurse-physician relationship domain stood out (p = 0.001.CONCLUSION: The choice of leadership styles by nurses should match the ICU characteristics. Leadership skills could be developed, and the work environment did not exert any influence on the investigated population.

Perceptions of perioperative nursing competence: a cross-country comparison.

Science.gov (United States)

Gillespie, Brigid M; Harbeck, Emma B; Falk-Brynhildsen, Karin; Nilsson, Ulrica; Jaensson, Maria

2018-01-01

Throughout many countries, professional bodies rely on yearly self-assessment of competence for ongoing registration; therefore, nursing competence is pivotal to safe clinical practice. Our aim was to describe and compare perioperative nurses' perceptions of competence in four countries, while examining the effect of specialist education and years of experience in the operating room. We conducted a secondary analysis of cross-sectional surveys from four countries including; Australia, Canada, Scotland, and Sweden. The 40-item Perceived Perioperative Competence Scale-Revised (PPCS-R), was used with a total sample of 768 respondents. We used a factorial design to examine the influence of country, years of experience in the operating room and specialist education on nurses' reported perceived perioperative competence. Regardless of country origin, nurses with specialist qualifications reported higher perceived perioperative competence when compared to nurses without specialist education. However, cross-country differences were dependent on nurses' number of years of experience in the operating room. Nurses from Sweden with 6-10 years of experience in the operating room reported lower perceived perioperative competence when compared to Australian nurses. In comparing nurses with > 10 years of experience, Swedish nurses reported significantly lower perceived perioperative competence when compared to nurses from Australia, Canada and Scotland. Researchers need to consider educational level and years of experience in the perioperative context when examining constructs such as competence.

Preventing persistent organ support in ICU patients

NARCIS (Netherlands)

de Lange, D W; Flaatten, H

Editorial to: Mehoff et al. Use of life support in acutely admitted ICU patients. An international cohort study. Acta Anaesthesiologica Scandinavica 2017;….etc. Conflict of interest Both authors declared no conflict of interest regarding the preparation of this manuscript.

Demographic and occupational predictors of stress and fatigue in French intensive-care registered nurses and nurses' aides: a cross-sectional study.

Science.gov (United States)

Jones, Gabrielle; Hocine, Mounia; Salomon, Jérôme; Dab, William; Temime, Laura

2015-01-01

Healthcare workers (HCWs) working in intensive-care units (ICUs) are exposed to high physical and mental demands potentially affecting their health or having repercussions on patient care. Although several studies have explored the links between some aspects of working conditions in hospitals and HCW health, the complex dynamics at play are not fully understood. This study aimed to explore the impact of a wide array of demographic, employment and organizational factors related to fatigue and stress of French ICU HCWs. A cross-sectional study was conducted in ICUs of Paris-area hospitals between January 18, 2013 and April 2, 2013. All types of adult ICUs were included (medical, surgical and polyvalent). Included in the study were HCWs with patient contact (doctors, residents, registered nurses, nurse's aides and physical therapists). Participation was proposed to all eligible HCWs present during on-site visits. Temporary staff not typically assigned to the given ICU was excluded. Data were collected using an individual questionnaire administered in interviews during day and night shifts (N=682). Stress and fatigue outcomes included the 10-item Perceived Stress Scale (PSS10), the Nottingham Health Profile sleep and energy level rubrics and the current fatigue state at the interview. Multivariate analysis was restricted to nurse and nurse's aide data (n=536). Doctors and residents reported fewer sleep difficulties but were more likely to report a tired current state. Female gender was associated with higher stress levels and greater fatigue for all outcomes, while greater social support of supervisor or colleagues decreased stress and fatigue. At the organizational level, longer shifts (12 h vs. 8 h) were associated with tired current state and greater sleep difficulties. Personnel on rotating shifts had lower stress and a better current state, while those on night shifts had greater sleep and energy level difficulties. Even when controlling for demographic factors

[Ulysses network: an approach to integral post-ICU treatment of patients with multiple organ dysfunction syndrome].

Science.gov (United States)

Nolla-Salas, M; Monmany-Roca, J; Vázquez-Mata, G

2007-01-01

The concept of continuity of care by intensivists as an element of quality control in the medical care of Intensive Care Unit (ICU) patients surviving multiple organ dysfunction syndrome has led to a rethinking of the ICU model in recent years. We discuss the rationale to design and implement a hospital-based, prospective, randomized, multicenter Intervention/Control study in order to estimate the impact of an interdisciplinary intervention during the post-ICU recovery phase on medium-term medical outcomes in ICU patients with multiple organ dysfunction.

Effect of Emergency Department and ICU Occupancy on Admission Decisions and Outcomes for Critically Ill Patients.

Science.gov (United States)

Mathews, Kusum S; Durst, Matthew S; Vargas-Torres, Carmen; Olson, Ashley D; Mazumdar, Madhu; Richardson, Lynne D

2018-05-01

ICU admission delays can negatively affect patient outcomes, but emergency department volume and boarding times may also affect these decisions and associated patient outcomes. We sought to investigate the effect of emergency department and ICU capacity strain on ICU admission decisions and to examine the effect of emergency department boarding time of critically ill patients on in-hospital mortality. A retrospective cohort study. Single academic tertiary care hospital. Adult critically ill emergency department patients for whom a consult for medical ICU admission was requested, over a 21-month period. None. Patient data, including severity of illness (Mortality Probability Model III on Admission), outcomes of mortality and persistent organ dysfunction, and hourly census reports for the emergency department, for all ICUs and all adult wards were compiled. A total of 854 emergency department requests for ICU admission were logged, with 455 (53.3%) as "accept" and 399 (46.7%) as "deny" cases, with median emergency department boarding times 4.2 hours (interquartile range, 2.8-6.3 hr) and 11.7 hours (3.2-20.3 hr) and similar rates of persistent organ dysfunction and/or death 41.5% and 44.6%, respectively. Those accepted were younger (mean ± SD, 61 ± 17 vs 65 ± 18 yr) and more severely ill (median Mortality Probability Model III on Admission score, 15.3% [7.0-29.5%] vs 13.4% [6.3-25.2%]) than those denied admission. In the multivariable model, a full medical ICU was the only hospital-level factor significantly associated with a lower probability of ICU acceptance (odds ratio, 0.55 [95% CI, 0.37-0.81]). Using propensity score analysis to account for imbalances in baseline characteristics between those accepted or denied for ICU admission, longer emergency department boarding time after consult was associated with higher odds of mortality and persistent organ dysfunction (odds ratio, 1.77 [1.07-2.95]/log10 hour increase). ICU admission decisions for

Shared responsibility: school nurses' experience of collaborating in school-based interprofessional teams.

Science.gov (United States)

Reuterswärd, Marina; Hylander, Ingrid

2017-06-01

The Swedish Education Act (2011) mandated a new combination of services to boost students' physical health, their mental health and special education through interprofessional pupil health and well-being (PH) teams. For Swedish school nurses, providing these services presents new challenges. To describe how Swedish school nurses experience their work and collaboration within the interprofessional PH teams. Twenty-five school nurses (SNs) were interviewed in five focus groups. Content analysis was used to examine the data and to explore SNs' workplace characteristics by using the components of the sense of coherence (SOC) framework. SNs' experiences of work and collaboration within PH teams can be described using three domains: the expectations of others regarding SNs' roles, SNs' contributions to pupils' health and well-being, and collaboration among SNs within PH teams. The results indicate a discrepancy between SNs' own experiences of their contribution and their experiences of other professionals' expectations regarding those contributions. Some duties were perceived as expected, comprehensible, manageable and meaningful, while other duties - though expected - were perceived as less meaningful, taking time away from school-related matters. Other duties that were not explicitly expected - promoting general health and creating safety zones for pupils, teachers and parents, for example - were nonetheless perceived as meaningful. Collaboration within PH teams was considered meaningful, comprehensible and manageable only if the objectives of the team meetings were clear, if other professionals were available and if professional roles on the team were clearly communicated. The SNs reported a lack of clarity regarding their role in PH and its implementation in schools, indicating that professionals in PH teams need to discuss collaboration so as to find their niche given the new conditions. SOC theory emerged as a useful framework for discussing concrete work

Improved communication in post-ICU care by improving writing of ICU discharge letters: a longitudinal before-after study

NARCIS (Netherlands)

Medlock, Stephanie; Eslami, Saeid; Askari, Marjan; van Lieshout, Erik Jan; Dongelmans, Dave A.; Abu-Hanna, Ameen

2011-01-01

The discharge letter is the primary means of communication at patient discharge, yet discharge letters are often not completed on time. A multifaceted intervention was performed to improve communication in patient hand-off from the intensive care unit (ICU) to the wards by improving the timeliness

Improved communication in post-ICU care by improving writing of ICU discharge letters: a longitudinal before-after study

NARCIS (Netherlands)

Medlock, S.; Eslami, S.; Askari, M.; van Lieshout, E.J.; Dongelmans, D.A.; Abu-Hanna, A.

2011-01-01

Background: The discharge letter is the primary means of communication at patient discharge, yet discharge letters are often not completed on time. A multifaceted intervention was performed to improve communication in patient hand-off from the intensive care unit (ICU) to the wards by improving the

Incidence and risk factors for delirium development in ICU patients - a prospective observational study.

Science.gov (United States)

Kanova, Marcela; Sklienka, Peter; Roman, Kula; Burda, Michal; Janoutova, Jana

2017-06-01

Delirium is an acute brain dysfunction and a frequent complication in critically ill patients. When present it significantly worsens the prognosis of patients. The aim of this study was to evaluate the incidence of delirium and risk factors for delirium in a mixed group of trauma, medical and surgical ICU patients. A prospective observational study was conducted in one of the six-bed Intensive Care Units of the University Hospital Ostrava in the Czech Republic during a 12-month period. We evaluated the incidence of delirium and its predisposing and precipitating risk factors. All patients were assessed daily using the Confusion Assessment Method for the ICU (CAM-ICU). Of the total of 332 patients with a median APACHE II (the Acute Physiology and Chronic Health Evaluation) score of 12, who were evaluated for delirium, 48 could not be assessed using CAM-ICU (47 due to prolonged coma, 1 due to language barriers). The incidence of delirium was 26.1%, with trauma and medical patients being more likely to develop delirium than surgical patients. Risk of delirium was significantly associated with age ≥ 65 years, and alcohol abuse in their anamnesis, with APACHE II score on admission, and with the use of sedatives and/or vasopressors. Delirious patients who remained in the ICU for a prolonged period showed a greater need for ventilator support and had a greater ICU-mortality.

CONTINUOUS EXHALED BREATH ANALYSIS ON THE ICU

International Nuclear Information System (INIS)

Bos, Lieuwe D. J.; Sterk, Peter J.; Schultz, Marcus J.

2011-01-01

During admittance to the ICU, critically ill patients frequently develop secondary infections and/or multiple organ failure. Continuous monitoring of biological markers is very much needed. This study describes a new method to continuously monitor biomarkers in exhaled breath with an electronic nose.

'It's easier to talk to a woman'. Aspects of gender in Swedish telenursing.

Science.gov (United States)

Höglund, Anna T; Holmström, Inger

2008-11-01

To describe and explore gender aspects in telenursing as experienced by Swedish telenurses. Telenurses at call centres in Sweden offer triage recommendations and self-care advice to the general public over the telephone, on a wide range of health problems. The demands on telenurses are multifaceted and competence is needed in many fields such as nursing, pharmacology, psychology and communication. Previous studies have shown that telenurses encounter many ethical dilemmas and that some of these are to do with gender related issues. Most telenurses, as well as most callers, are women. It is, therefore, reasonable to believe that gender plays an important role in the work of telenurses. Descriptive and explorative qualitative design. A purposive sample of 12 female telenurses in Sweden participated in in-depth interviews twice during 2004-2005. The transcribed interviews were analysed inductively with a stepwise thematic method. Five themes emerged from the interviews, namely: female subordination in the family, disrespect in dialogue with female nurses, distrust in fathers' competence, reluctant male callers and woman-to-woman connection. Gender construction and cultural gender norms seem to be at work in the encounter between Swedish telenurses and callers. Questions of power relations, the picture of the mother/woman as the primary carer for small children and distrusting men in their parental role were particularly highlighted. Telenurses should be aware of the risk of stereotyping their dialogues with callers in a way that seems to fit better with female callers' ways of communicating. Clinical supervision based on reflective practice and peer reviews of calls might diminish this risk. Telenurses also need more training in handling overt or covert power messages based on male superiority.

An empirical comparison of key statistical attributes among potential ICU quality indicators.

Science.gov (United States)

Brown, Sydney E S; Ratcliffe, Sarah J; Halpern, Scott D

2014-08-01

Good quality indicators should have face validity, relevance to patients, and be able to be measured reliably. Beyond these general requirements, good quality indicators should also have certain statistical properties, including sufficient variability to identify poor performers, relative insensitivity to severity adjustment, and the ability to capture what providers do rather than patients' characteristics. We assessed the performance of candidate indicators of ICU quality on these criteria. Indicators included ICU readmission, mortality, several length of stay outcomes, and the processes of venous-thromboembolism and stress ulcer prophylaxis provision. Retrospective cohort study. One hundred thirty-eight U.S. ICUs from 2001-2008 in the Project IMPACT database. Two hundred sixty-eight thousand eight hundred twenty-four patients discharged from U.S. ICUs. None. We assessed indicators' (1) variability across ICU-years; (2) degree of influence by patient vs. ICU and hospital characteristics using the Omega statistic; (3) sensitivity to severity adjustment by comparing the area under the receiver operating characteristic curve (AUC) between models including vs. excluding patient variables, and (4) correlation between risk adjusted quality indicators using a Spearman correlation. Large ranges of among-ICU variability were noted for all quality indicators, particularly for prolonged length of stay (4.7-71.3%) and the proportion of patients discharged home (30.6-82.0%), and ICU and hospital characteristics outweighed patient characteristics for stress ulcer prophylaxis (ω, 0.43; 95% CI, 0.34-0.54), venous thromboembolism prophylaxis (ω, 0.57; 95% CI, 0.53-0.61), and ICU readmissions (ω, 0.69; 95% CI, 0.52-0.90). Mortality measures were the most sensitive to severity adjustment (area under the receiver operating characteristic curve % difference, 29.6%); process measures were the least sensitive (area under the receiver operating characteristic curve % differences

[Development of nursing key performance indicators for an intensive care unit by using a balanced scorecard].

Science.gov (United States)

Choi, Yun Jeong; Lim, Ji Young; Lee, Young Whee; Kim, Hwa Soon

2008-10-01

The purpose of this study was to develop visions of nursing service, nursing strategies and key performance indicators (KPIs) for an intensive care unit (ICU) based on a Balanced Scorecard (BSC). This study was undertaken by using methodological research. The development process consisted of four phases; the first phase was to develop the vision of nursing in ICUs. The second phase was to develop strategies according to 4 perspectives of a BSC. The third phase was to develop KPIs according to the 4 perspectives of BSC and the final phase was to combine the nursing visions, strategies and KPIs of ICUs. Two main visions of nursing service for ICUs were established. These were 'realization of harmonized professional nursing with human respect' and 'recovery of health through specialized nursing' respectively. In order to reach the aim of developing nursing visions, thirteen practical strategies and nineteen KPIs were developed by four perspectives of the BSC. The results will be used as objective fundamental data to attain business outcomes for the achievement of nursing visions and strategies of ICUs.

Development and internal validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU)

DEFF Research Database (Denmark)

Granholm, A.; Perner, A.; Krag, M.

2018-01-01

Background: Intensive care unit (ICU) mortality prediction scores deteriorate over time, and their complexity decreases clinical applicability and commonly causes problems with missing data. We aimed to develop and internally validate a new and simple score that predicts 90-day mortality in adults...... upon acute admission to the ICU: the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). Methods: We used data from an international cohort of 2139 patients acutely admitted to the ICU and 1947 ICU patients with severe sepsis/septic shock from 2009 to 2016. We performed multiple...... imputations for missing data and used binary logistic regression analysis with variable selection by backward elimination, followed by conversion to a simple point-based score. We assessed the apparent performance and validated the score internally using bootstrapping to present optimism-corrected performance...

Cognitive changes in nurses working in intensive care units

Directory of Open Access Journals (Sweden)

Daniel Aragão Machado

Full Text Available ABSTRACT Objective: To measure the levels of stress, anxiety, and depression of nurses working in ICUs, relating them to levels of attention before and after 24 hours. Method: An observational, quantitative, analytical study with 18 nurses undergoing an inventory of stress, anxiety, and depression, as well as assessment of attention levels and psychomotor functioning. Results: Sixty-one percent showed positive for stress. Depression was observed in 33%; and anxiety in 99.9%. A strong correlation between stress and depression (ρ = 0.564 with p <0.05 and anxiety (ρ = 1 with p <0.05 was observed. There was a weak correlation between stress and task execution time in M2 (ρ = 0.055 for TMT A, a fact that did not occur in M0 (ρ = -0.249. Conclusion: The study shows that the workload of the nurses working in 24-hour shifts in the ICU is correlated with high levels of stress, decreases in the attention process, and psychomotor decline.

Educational Needs of Nurses in Intensive Care Unit for Poisoned Patients

Directory of Open Access Journals (Sweden)

Dadpour B

2013-10-01

Full Text Available 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. Studied scales included perceived importance and novelty of educational meeting, matching with professional and educational needs, illustration of practical and knowledge weaknesses and strength and finally satisfaction in holding regular workshops annually. Two, half day workshops were held and various items were taught with various methods. The knowledge of participants was assessed by pretests and post-tests consisting of 12 items related to workshop topics. The impact of these educational meetings was evaluated and the results were analyzed by the SPSS software. Results: According to the results, workshops improved awareness of nurses about their weakness and strength points, professional knowledge and their interest and attention; likewise all participants had the same opinion about a strong need to hold similar workshops more than once and preferably 2 to 3 times annually. Conclusion: It seems that short educational courses in small groups for reviewing the old data and recent findings in the context of critical care are useful in order to promote the knowledge and skills of ICU staff in taking care of poisoned patients

Strategies to address management challenges in larger intensive care units.

Science.gov (United States)

Matlakala, M C; Bezuidenhout, M C; Botha, A D H

2015-10-01

To illustrate the need for and suggest strategies that will enhance sustainable management of a large intensive care unit (ICU). The challenges faced by intensive care nursing in South Africa are well documented. However, there appear to be no strategies available to assist nurses to manage large ICUs or for ICU managers to deal with problems as they arise. Data sources to illustrate the need for strategies were challenges described by ICU managers in the management of large ICUs. A purposive sample of managers was included in individual interviews during compilation of evidence regarding the challenges experienced in the management of large ICUs. The challenges were presented at the Critical Care Society of Southern Africa Congress held on 28 August to 2 September 2012 in Sun City North-West province, South Africa. Five strategies are suggested for the challenges identified: divide the units into sections; develop a highly skilled and effective nursing workforce to ensure delivery of quality nursing care; create a culture to retain an effective ICU nursing team; manage assets; and determine the needs of ICU nurses. ICUs need measures to drive the desired strategies into actions to continuously improve the management of the unit. Future research should be aimed at investigating the effectiveness of the strategies identified. This research highlights issues relating to large ICUs and the strategies will assist ICU managers to deal with problems related to large unit sizes, shortage of trained ICU nurses, use of agency nurses, shortage of equipment and supplies and stressors in the ICU. The article will make a contribution to the body of nursing literature on management of ICUs. © 2014 John Wiley & Sons Ltd.

Supporting the scholar role in intensive care nursing.

Science.gov (United States)

Melles, M; Freudenthal, A; de Ridder, H

2012-01-01

This study investigates how future informatics applications can support and challenge intensive care nurses (ICU nurses) to grow and learn continuously. To this end a research-and-design tool is introduced which is based on a model of the nursing process that starts from the idea that a nurse fulfills three different roles: the role of practitioner (using information immediately to base actions upon), the role of scholar (using information later on to learn from) and the role of human (coping with stress and dealing with emotions). In this paper the focus is on the scholar role. Twenty-eight intensive care staff members from six different hospitals were asked to recount an imposing experience from the perspective of each role. Regarding the scholar role, the participants mentioned 77 learning strategies they adopt for individual as well as organizational learning. Individual learning concerned reflection on former patient cases, reflection on current patient cases to anticipate a change in the patient's condition and reflection on personal behavior and decisions. Organizational learning concerned reflection on former patient cases. Examples of specific strategies were formal team evaluations focused on procedure and understanding the perspective of team members, being present at autopsies, and giving feedback on the nursing skills of colleagues. Based on these strategies design implications are defined for future nursing informatics applications, which will be presented.

Use of life support in acutely admitted ICU patients. An international cohort study

DEFF Research Database (Denmark)

Meyhoff, T S; Krag, M; Hjortrup, P B

2017-01-01

the first 3 days in ICU and the crude and adjusted association between its duration and 90-day mortality using logistic regression analyses. RESULTS: We included 690 patients; their 90-day mortality was 23%. During the first 3 days in ICU mechanical ventilation was used in 65%, vasopressors/inotropes in 57......% and renal replacement therapy in 13%. Renal replacement therapy for 3 days or more was associated with a higher 90-day mortality as compared with 1 day of renal replacement therapy [odds ratio 6.5 (95% confidence interval 1.3 to 32.8)]. For mechanical ventilation and vasopressors/inotropes the odds ratios...... were 2.2 [0.9 to 5.3] and 1.2 [0.5 to 2.6], respectively. CONCLUSIONS: Among acutely admitted adult ICU patients, a higher number of days of renal replacement therapy in the initial ICU stay were associated with increased risk of death within 90 days. We did not observe such an association...

[Nursing practice in maternity intensive care units. Severe pre-eclampsia in a primigravida].

Science.gov (United States)

Carmona-Guirado, A J; Escaño-Cardona, V; García-Cañedo, F J

2015-01-01

39 year old woman, pregnant for 31+5 weeks, who came to our intensive care unit (ICU) referred from the emergency department of the hospital, having swollen ankles, headache and fatigue at moderate effort. We proceeded to take blood pressure (158/96 mmHg) and assess lower limb edema. The fetal heart rate monitoring was normal. Knowledgeable and user of healthy guidelines during her pregnancy, she did not follow any treatment. Single mother, she worried about her fetus (achieved through in vitro fertilization), her mother offered to help for any mishap. We developed an Individualized Care Plan. For data collection we used: Rating 14 Virginia Henderson Needs and diagnostic taxonomy NANDA, NOC, NIC. Nursing diagnoses of "fluid volume excess" and "risk of impaired maternal-fetal dyad" were detected, as well as potential complications such as eclampsia and fetal prematurity. Our overall objectives (NOC) were to integrate the woman in the process she faced and that she knew how to recognize the risk factors inherent in her illness. Nursing interventions (NIC) contemplated the awareness and treatment of her illness and the creation of new healthy habits. The work of nursing Maternal ICU allowed women to help maintain maximum maternal and fetal well-being by satisfying any of her needs. Mishandling of the situation leads into a framework of high morbidity and mortality in our units. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

Translation of oral care practice guidelines into clinical practice by intensive care unit nurses.

Science.gov (United States)

Ganz, Freda DeKeyser; Ofra, Raanan; Khalaila, Rabia; Levy, Hadassa; Arad, Dana; Kolpak, Orly; Ben Nun, Maureen; Drori, Yardena; Benbenishty, Julie

2013-12-01

The purpose of this study was to determine whether there was a change in the oral care practices of intensive care unit (ICU) nurses for ventilated patients after a national effort to increase evidence-based oral care practices. Descriptive comparison of ICU nurses in 2004-2005 and 2012. Two convenience national surveys of ICU nurses were collected in 2004-2005 (n = 218) and 2012 (n = 233). After the results of the initial survey were reported, a national effort to increase awareness of evidence-based oral care practices was conducted that included in-service presentations; publication of an evidence-based protocol in a national nursing journal; publication of the survey findings in an international nursing journal; and reports to the local press. A repeat survey was conducted 7 to 8 years later. The same survey instrument was used for both periods of data collection. This questionnaire included questions about demographic and personal characteristics and a checklist of oral care practices. Nurses rated their perceived priority level concerning oral care on a scale from 0 to 100. An evidence-based practice (EBP)[O4] score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the evidence. The EBP score, priority score, and oral care practices were compared between the two samples. A regression model was built based on those variables that were associated with the EBP score in 2012. There was a statistically significant increase in the use of EBPs as shown by the EBP score and in the perceived priority level of oral care. Increased EBPs were found in the areas of teeth brushing and oral assessment. Decreases were found in the use of non-evidence-based practices, such as the use of gauze pads, tongue depressors, lemon water, and sodium bicarbonate. No differences were found in the use of chlorhexidine, toothpaste, or the nursing documentation of oral care practices. A multiple regression model was

Swedish Cleantech Opportunities 2010

Energy Technology Data Exchange (ETDEWEB)

2011-07-01

A market overview from the Swedish Energy Agency. 'Cleantech (short for clean technologies) refers to energy and environmentally friendly related technologies. Global demand for this kind of products continues to grow and cleantech can thus generate new jobs, growth and tax revenues. The Swedish Energy Agency is active in the energy segment of cleantech and support companies in their early stages of development. This market overview outlines the current status of the sector, in Sweden and globally. It also presents business leaders and innovators in this field.'

Ethical decision making in intensive care units: a burnout risk factor? Results from a multicentre study conducted with physicians and nurses.

Science.gov (United States)

Teixeira, Carla; Ribeiro, Orquídea; Fonseca, António M; Carvalho, Ana Sofia

2014-02-01

Ethical decision making in intensive care is a demanding task. The need to proceed to ethical decision is considered to be a stress factor that may lead to burnout. The aim of this study is to explore the ethical problems that may increase burnout levels among physicians and nurses working in Portuguese intensive care units (ICUs). A quantitative, multicentre, correlational study was conducted among 300 professionals. The most crucial ethical decisions made by professionals working in ICU were related to communication, withholding or withdrawing treatments and terminal sedation. A positive relation was found between ethical decision making and burnout in nurses, namely, between burnout and the need to withdraw treatments (p=0.032), to withhold treatments (p=0.002) and to proceed to terminal sedation (p=0.005). This did not apply to physicians. Emotional exhaustion was the burnout subdimension most affected by the ethical decision. The nurses' lack of involvement in ethical decision making was identified as a risk factor. Nevertheless, in comparison with nurses (6%), it was the physicians (34%) who more keenly felt the need to proceed to ethical decisions in ICU. Ethical problems were reported at different levels by physicians and nurses. The type of ethical decisions made by nurses working in Portuguese ICUs had an impact on burnout levels. This did not apply to physicians. This study highlights the need for education in the field of ethics in ICUs and the need to foster inter-disciplinary discussion so as to encourage ethical team deliberation in order to prevent burnout.

Nurses' practice environment and work-family conflict in relation to burn out: a multilevel modelling approach.

Science.gov (United States)

Leineweber, Constanze; Westerlund, Hugo; Chungkham, Holendro Singh; Lindqvist, Rikard; Runesdotter, Sara; Tishelman, Carol

2014-01-01

To investigate associations between nurse work practice environment measured at department level and individual level work-family conflict on burnout, measured as emotional exhaustion, depersonalization and personal accomplishment among Swedish RNs. A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analysed here is based on a national sample of 8,620 RNs from 369 departments in 53 hospitals. Generally, RNs reported high values of personal accomplishment and lower values of emotional exhaustion and depersonalization. High work-family conflict increased the risk for emotional exhaustion, but for neither depersonalization nor personal accomplishment. On department level adequate staffing and good leadership and support for nurses reduced the risk for emotional exhaustion and depersonalization. Personal accomplishment was statistically significantly related to staff adequacy. The findings suggest that adequate staffing, good leadership, and support for nurses are crucial for RNs' mental health. Our findings also highlight the importance of hospital managers developing policies and practices to facilitate the successful combination of work with private life for employees.

The Transformation of Swedish Shipping, 1970-2010

OpenAIRE

Sjögren, Hans; Taro Lennerfors, Thomas; Taudal Poulsen, Rene

2012-01-01

Since the early 1970s, as shipping has undergone a period of structural change, Swedish shipping has rapidly declined from a position of global importance. The Swedish-controlled fleet has dwindled, and the structure of the industry itself has changed. This article explores the influence of shipping markets, shipping regulations, company strategies, maritime know-how, and financial resources on the development of Swedish shipping from 1970 to 2010. A comparison is made between, on the one han...

Post-ICU symptoms, consequences, and follow-up

DEFF Research Database (Denmark)

Svenningsen, Helle; Langhorn, Leanne; Ågård, Anne Sophie

2015-01-01

and rehabilitation in general hospital wards, rehabilitation facilities and at home. A prolonged stay in an ICU is associated with stressful memories that have long-term physical, mental and social consequences for health-related quality of life. We therefore conducted a data search to identify the programmes...

Economic Evaluation of a Patient-Directed Music Intervention for ICU Patients Receiving Mechanical Ventilatory Support.

Science.gov (United States)

Chlan, Linda L; Heiderscheit, Annette; Skaar, Debra J; Neidecker, Marjorie V

2018-05-04

Music intervention has been shown to reduce anxiety and sedative exposure among mechanically ventilated patients. Whether music intervention reduces ICU costs is not known. The aim of this study was to examine ICU costs for patients receiving a patient-directed music intervention compared with patients who received usual ICU care. A cost-effectiveness analysis from the hospital perspective was conducted to determine if patient-directed music intervention was cost-effective in improving patient-reported anxiety. Cost savings were also evaluated. One-way and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness. Midwestern ICUs. Adult ICU patients from a parent clinical trial receiving mechanical ventilatory support. Patients receiving the experimental patient-directed music intervention received a MP3 player, noise-canceling headphones, and music tailored to individual preferences by a music therapist. The base case cost-effectiveness analysis estimated patient-directed music intervention reduced anxiety by 19 points on the Visual Analogue Scale-Anxiety with a reduction in cost of $2,322/patient compared with usual ICU care, resulting in patient-directed music dominance. The probabilistic cost-effectiveness analysis found that average patient-directed music intervention costs were $2,155 less than usual ICU care and projected that cost saving is achieved in 70% of 1,000 iterations. Based on break-even analyses, cost saving is achieved if the per-patient cost of patient-directed music intervention remains below $2,651, a value eight times the base case of $329. Patient-directed music intervention is cost-effective for reducing anxiety in mechanically ventilated ICU patients.

Caring for dying and meeting death: Experiences of Iranian and Swedish nurses

Directory of Open Access Journals (Sweden)

Sedigheh Iranmanesh

2010-01-01

Full Text Available Objective: Our world is rapidly becoming a global community, which creates a need to further understand the universal phenomena of death and professional caring for dying persons. This study thus was conducted to describe the meaning of nurses′ experiences of caring for dying people in the cultural contexts of Iran and Sweden. Materials and Methods: Using a phenomenological approach, phenomenon of caring for dying people was studied. Eight registered nurses who were working in oncology units in Tehran, Iran and eight registered nurses working in hospital and home care in North part of Sweden were interviewed. The interviews were analyzed using the principles of phenomenological hermeneutics. Results: The findings were formulated based on two themes included: (1 "Sharing space and time to be lost", and (2 "Caring is a learning process. Conclusions: The results showed that being with dying people raise an ethical demand that calls for personal and professional response, regardless of sex, culture or context. The physical and organizational context must be supportive and enable nurses to stand up to the demands of close relationships. Specific units and teamwork across various personnel seem to be a solution that is missing in Iran.

Education for the nuclear power industry: Swedish perspective

International Nuclear Information System (INIS)

Blomgren, J.

2005-01-01

In the Swedish nuclear power industry staff, very few newly employed have a deep education in reactor technology. To remedy this, a joint education company, Nuclear Training and Safety Center (KSU), has been formed. To ensure that nuclear competence will be available also in a long-term perspective, the Swedish nuclear power industry and the Swedish Nuclear Power Inspectorate (SKI) have formed a joint center for support of universities, the Swedish Nuclear Technology Center (SKC). The activities of these organisations, their links to universities, and their impact on the competence development for the nuclear power industry will be outlined. (author)

Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings.

Science.gov (United States)

Anskär, Eva; Lindberg, Malou; Falk, Magnus; Andersson, Agneta

2018-03-07

Over the past decades, reorganizations and structural changes in Swedish primary care have affected time utilization among health care professionals. Consequently, increases in administrative tasks have substantially reduced the time available for face-to-face consultations. This study examined how work-time was utilized and the association between work time utilization and the perceived psychosocial work environment in Swedish primary care settings. This descriptive, multicentre, cross-sectional study was performed in 2014-2015. Data collection began with questionnaire. In the first section, respondents were asked to estimate how their workload was distributed between patients (direct and indirect patient work) and other work tasks. The questionnaire also comprised the Copenhagen Psychosocial Questionnaire, which assessed the psychosocial work environment. Next a time study was conducted where the participants reported their work-time based on three main categories: direct patient-related work, indirect patient-related work, and other work tasks. Each main category had a number of subcategories. The participants recorded the time spent (minutes) on each work task per hour, every day, for two separate weeks. Eleven primary care centres located in southeast Sweden participated. All professionals were asked to participate (n = 441), including registered nurses, primary care physicians, care administrators, nurse assistants, and allied professionals. Response rates were 75% and 79% for the questionnaires and the time study, respectively. All health professionals allocated between 30.9% - 37.2% of their work-time to each main category: direct patient work, indirect patient work, and other work. All professionals estimated a higher proportion of time spent in direct patient work than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress, and role conflicts. Among allied professionals, the proportion of

Cadmium exposure in the Swedish environment

Energy Technology Data Exchange (ETDEWEB)

NONE

1998-03-01

This report gives a thorough description of cadmium in the Swedish environment. It comprises three parts: Cadmium in Sweden - environmental risks;, Cadmium in goods - contribution to environmental exposure;, and Cadmium in fertilizers, soil, crops and foods - the Swedish situation. Separate abstracts have been prepared for all three parts

Oral Health Status of Older Adults in Sweden Receiving Elder Care: Findings From Nursing Assessments.

Science.gov (United States)

Johansson, Isabelle; Jansson, Henrik; Lindmark, Ulrika

2016-01-01

Frail elderly people often have poor oral hygiene, contributing to oral health problems that can detract significantly from quality of life. The aim of this study was to describe oral health status of frail elderly individuals using the Revised Oral Assessment Guide-Jönköping (ROAG-J), a mouth assessment instrument that can be used in daily nursing care. Data were obtained from the Swedish Senior Alert quality registry in one Swedish municipality. ROAG-J assessments on admission to elder care and one subsequent occasion were used. ROAG-J measurements documented oral health in nine areas: voice, lips, oral mucosa, tongue, gums, teeth, saliva, swallowing, and presence of any prostheses or implants. Assessments were made by nursing staff during the course of daily nursing care. Individuals 65 years of age or older and receiving elder care services (N = 667) were involved; 1,904 assessments made between November 2011 and March 2014 were used for the analysis. On the basis of both assessments, less than one third of participants had oral health problems. No significant difference in any of the oral health variables was found between first and subsequent assessments. At first assessment, men and women differed in tongue health (p oral health. Assessments made by nursing staff using the ROAG-J demonstrate that this tool can be used in daily nursing care, where different, important oral conditions may be encountered. However, knowledge about oral health conditions and the ROAG-J instrument is important to ensure high validity. The ROAG-J enables nursing staff to detect problems in the mouth and to guide decisions related to oral health interventions.

Patients' opinions on outcomes following critical illness

DEFF Research Database (Denmark)

Nedergaard, H K; Haberlandt, T; Reichmann, P D

2018-01-01

BACKGROUND: Our aim was to explore which outcomes are most important to patients following ICU-discharge, and to explore whether intensive care unit (ICU)-nurses and anesthesiologists are aware of patients' priorities. METHODS: First, interviews with adult ICU-survivors were conducted until data......, fatigue, and decreased walking distance. The top three for ICU-nurses (54 participants) were: fatigue, difficulties concentrating, sadness/depression, and for anesthesiologists (17 participants): fatigue, difficulties in activities of daily living, and lack of physical strength. CONCLUSION: Patients chose......-ICU discharge) rated the items, as did ICU-nurses and anesthesiologists. RESULTS: A total of 32 patients participated (44% women, medians: age 70.5, time since discharge 179 days, length of stay in ICU 9 days, APACHEII 19.5). The three most important outcomes defined by patients were: lack of physical strength...

Swedish Cleantech Opportunities 2010

Energy Technology Data Exchange (ETDEWEB)

2011-07-01

A market overview from the Swedish Energy Agency. 'Cleantech (short for clean technologies) refers to energy and environmentally friendly related technologies. Global demand for this kind of products continues to grow and cleantech can thus generate new jobs, growth and tax revenues. The Swedish Energy Agency is active in the energy segment of cleantech and support companies in their early stages of development. This market overview outlines the current status of the sector, in Sweden and globally. It also presents business leaders and innovators in this field.'

Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers.

Science.gov (United States)

Petrinec, Amy B; Mazanec, Polly M; Burant, Christopher J; Hoffer, Alan; Daly, Barbara J

2015-06-01

To assess the coping strategies used by family decision makers of adult critical care patients during and after the critical care experience and the relationship of coping strategies to posttraumatic stress symptoms experienced 60 days after hospitalization. A single-group descriptive longitudinal correlational study. Medical, surgical, and neurological ICUs in a large tertiary care university hospital. Consecutive family decision makers of adult critical care patients from August 2012 to November 2013. Study inclusion occurred after the patient's fifth day in the ICU. None. Family decision makers of incapacitated adult ICU patients completed the Brief COPE instrument assessing coping strategy use 5 days after ICU admission and 30 days after hospital discharge or death of the patient and completed the Impact of Event Scale-Revised assessing posttraumatic stress symptoms 60 days after hospital discharge. Seventy-seven family decision makers of the eligible 176 completed all data collection time points of this study. The use of problem-focused (p=0.01) and emotion-focused (pstress symptoms than coping strategies 5 days after ICU admission (R2=0.30, p=0.001) controlling for patient and decision-maker characteristics. The role of decision maker for a parent and patient death were the only noncoping predictors of posttraumatic stress symptoms. Avoidant coping use 30 days after hospitalization mediated the relationship between patient death and later posttraumatic stress symptom severity. Coping strategy use is a significant predictor of posttraumatic stress symptom severity 60 days after hospitalization in family decision makers of ICU patients.

Awareness of holistic care practices by intensive care nurses in north-western Saudi Arabia.

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Albaqawi, Hamdan M; Butcon, Vincent R; Molina, Roger R

2017-08-01

To examine awareness of holistic patient care by staff nurses in the intensive care units of hospitals in the city of Hail, Saudi Arabia.  Methods: A quantitative correlational study design was used to investigate relationships between intensive care nurse's awareness of holistic practices and nurses' latest performance review. Intensive care staff nurses (n=99) from 4 public sector hospitals in Hail were surveyed on their awareness of variables across 5 holistic domains: physiological, sociocultural, psychological, developmental, and spiritual. Data were collected between October and December 2015 using written survey, and performance evaluations obtained from the hospital administrations. Results were statistically analyzed and compared (numerical, percentage, Pearson's correlation, Chronbach's alpha). Results: The ICU staff nurses in Hail City were aware of the secular aspects of holistic care, and the majority had very good performance evaluations. There were no demographic trends regarding holistic awareness and nurse performance. Further, awareness of holistic care was not associated with nurse performance.  Conclusion: A caring-enhancement workshop and a mentoring program for non-Saudi nurses may increase holistic care awareness and enhance its practice in the ICUs.

Assessing and developing critical-thinking skills in the intensive care unit.

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Swinny, Betsy

2010-01-01

A lot of resources are spent on the development of new staff in the intensive care unit (ICU). These resources are necessary because the environment in the ICU is complex and the patients are critically ill. Nurses need an advanced knowledge base, the ability to accurately define and change priorities rapidly, good communication and teamwork skills, and the ability to work in a stressful environment in order to succeed and give their patients quality care. Critical thinking helps the nurse to navigate the complex and stressful environment of the ICU. Critical thinking includes more than just nursing knowledge. It includes the ability to think through complex, multifaceted problems to anticipate needs, recognize potential and actual complications, and to expertly communicate with the team. A nurse who is able to think critically will give better patient care. Various strategies can be used to develop critical thinking in ICU nurses. Nurse leaders are encouraged to support the development of critical-thinking skills in less experienced staff with the goal of improving the nurse's ability to work in the ICU and improving patient outcomes.

Effect of Inhalation of Lavender Essential Oil on Vital Signs in Open Heart Surgery ICU.

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Salamati, Armaiti; Mashouf, Soheyla; Mojab, Faraz

2017-01-01

This study evaluated the effects of inhalation of Lavender essential oil on vital signs in open heart surgery ICU. The main complaint of patients after open-heart surgery is dysrhythmia, tachycardia, and hypertension due to stress and pain. Due to the side effects of chemical drugs, such as opioids, use of non-invasive methods such as aromatherapy for relieving stress and pain parallel to chemical agents could be an important way to decrease the dose and side effects of analgesics. In a multicenter, single-blind trial, 40 patients who had open-heart surgery were recruited. Inclusion criteria were full consciousness, lack of hemorrhage, heart rate >60 beats/min, systolic blood pressure > 100 mmHg, and diastolic blood pressure > 60 mmHg, not using beta blockers in the operating room or ICU, no history of addiction to opioids or use of analgesics in regular, spontaneous breathing ability and not receiving synthetic opioids within 2 h before extubation. Ten minutes after extubation, the patients› vital signs [including BP, HR, Central Venous Pressure (CVP), SPO2, and RR] were measured. Then, a cotton swab, which was impregnated with 2 drops of Lavender essential oil 2%, was placed in patients' oxygen mask and patients breathed for 10 min. Thirty minutes after aromatherapy, the vital signs were measured again. Main objective of this study was the change in vital sign before and after aromatherapy. Statistical significance was accepted for P 0.001), diastolic blood pressure (p = 0.001), and heart rate (p = 0.03) before and after the intervention using paired t-test. Although, the results did not show any significant difference in respiratory rate (p = 0.1), SpO2 (p = 0.5) and CVP (p = 0.2) before and after inhaling Lavender essential oil. Therefore, the aromatherapy could effectively reduce blood pressure and heart rate in patients admitted to the open heart surgery ICU and can be used as an independent nursing intervention in stabilizing mentioned vital signs. The

The pharmacokinetics of propofol in ICU patients undergoing long-term sedation.

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Smuszkiewicz, Piotr; Wiczling, Paweł; Przybyłowski, Krzysztof; Borsuk, Agnieszka; Trojanowska, Iwona; Paterska, Marta; Matysiak, Jan; Kokot, Zenon; Grześkowiak, Edmund; Bienert, Agnieszka

2016-11-01

The aim of this study was to characterize the pharmacokinetics (PK) of propofol in ICU patients undergoing long-term sedation and to assess the influence of routinely collected covariates on the PK parameters. Propofol concentration-time profiles were collected from 29 patients. Non-linear mixed-effects modelling in NONMEM 7.2 was used to analyse the observed data. The propofol pharmacokinetics was best described with a three-compartment disposition model. Non-parametric bootstrap and a visual predictive check were used to evaluate the adequacy of the developed model to describe the observations. The typical value of the propofol clearance (1.46 l/min) approximated the hepatic blood flow. The volume of distribution at steady state was high and was equal to 955.1 l, which is consistent with other studies involving propofol in ICU patients. There was no statistically significant covariate relationship between PK parameters and opioid type, SOFA score on the day of admission, APACHE II, predicted death rate, reason for ICU admission (sepsis, trauma or surgery), gender, body weight, age, infusion duration and C-reactive protein concentration. The population PK model was developed successfully to describe the time-course of propofol concentration in ICU patients undergoing prolonged sedation. Despite a very heterogeneous group of patients, consistent PK profiles were observed. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Safety Assessment - Swedish Nuclear Power Plants

Energy Technology Data Exchange (ETDEWEB)

Kjellstroem, B. [Luleaa Univ. of Technology (Sweden)

1996-12-31

After the reactor accident at Three Mile Island, the Swedish nuclear power plants were equipped with filtered venting of the containment. Several types of accidents can be identified where the filtered venting has no effect on the radioactive release. The probability for such accidents is hopefully very small. It is not possible however to estimate the probability accurately. Experiences gained in the last years, which have been documented in official reports from the Nuclear Power Inspectorate indicate that the probability for core melt accidents in Swedish reactors can be significantly larger than estimated earlier. A probability up to one in a thousand operating years can not be excluded. There are so far no indications that aging of the plants has contributed to an increased accident risk. Maintaining the safety level with aging nuclear power plants can however be expected to be increasingly difficult. It is concluded that the 12 Swedish plants remain a major threat for severe radioactive pollution of the Swedish environment despite measures taken since 1980 to improve their safety. Closing of the nuclear power plants is the only possibility to eliminate this threat. It is recommended that until this is done, quantitative safety goals, same for all Swedish plants, shall be defined and strictly enforced. It is also recommended that utilities distributing misleading information about nuclear power risks shall have their operating license withdrawn. 37 refs.

Safety Assessment - Swedish Nuclear Power Plants

International Nuclear Information System (INIS)

Kjellstroem, B.

1996-01-01

After the reactor accident at Three Mile Island, the Swedish nuclear power plants were equipped with filtered venting of the containment. Several types of accidents can be identified where the filtered venting has no effect on the radioactive release. The probability for such accidents is hopefully very small. It is not possible however to estimate the probability accurately. Experiences gained in the last years, which have been documented in official reports from the Nuclear Power Inspectorate indicate that the probability for core melt accidents in Swedish reactors can be significantly larger than estimated earlier. A probability up to one in a thousand operating years can not be excluded. There are so far no indications that aging of the plants has contributed to an increased accident risk. Maintaining the safety level with aging nuclear power plants can however be expected to be increasingly difficult. It is concluded that the 12 Swedish plants remain a major threat for severe radioactive pollution of the Swedish environment despite measures taken since 1980 to improve their safety. Closing of the nuclear power plants is the only possibility to eliminate this threat. It is recommended that until this is done, quantitative safety goals, same for all Swedish plants, shall be defined and strictly enforced. It is also recommended that utilities distributing misleading information about nuclear power risks shall have their operating license withdrawn. 37 refs

Factors Associated with ICU Admission following Blunt Chest Trauma

Directory of Open Access Journals (Sweden)

Andrea Bellone

2016-01-01

Full Text Available Background. Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Methods. The study population consisted of patients hospitalized with at least 3 rib fractures (RF and at least one pulmonary contusion and/or at least one pneumothorax lower than 2 cm. Results. A total of 140 patients were retrospectively analyzed. Ten patients (7.1% were admitted to intensive care unit (ICU within the first 72 hours, because of deterioration of the clinical conditions and gas exchange with worsening of chest X-ray/thoracic ultrasound/chest computed tomography. On univariable analysis and multivariable analysis, obliged orthopnea (p=0.0018 and the severity of trauma score (p<0.0002 were associated with admission to ICU. Conclusions. Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma. The main therapeutic approach associated with improved outcome is the prevention of pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure.

Sulfur problems in Swedish agriculture

Energy Technology Data Exchange (ETDEWEB)

Johansson, O

1959-01-01

The present paper deals with some aspects of the sulfur situation in Swedish agriculture with special emphasis on the importance of and relationships among various sources of sulfur supply. An inventory of the sulfur content of Swedish soils and hay crops includes 649 soil samples and a corresponding number of hay samples from 59 locations. In a special investigation the samples were found to be representative of normal Swedish farm land. It is concluded that the amount of sulfur compounds in the air is the primary factor which determines the amount of sulfur added to the soil from the atmosphere. Compared with values obtained in other countries, the amount of sulfur added by the precipitation in Sweden is very low. The distribution in air and precipitation of sulfur from an industrial source was studied in a special investigation. An initial reason for the present study was the damage to vegetation caused by smoke from an industrial source. It was concluded that the average conditions in the vicinity of the industrial source with respect to smoke constituents in the air and precipitation were unfavorable only to the plants directly within a very narrow region. Relationships among the sulfur contents of air, of precipitation, of soils and of plants have been subject to special investigations. In the final general discussion and conclusions it is pointed out that the results from these investigations indicate evident differences in the sulfur status of Swedish soils. The present trend toward the use of more highly concentrated fertilizers poor in sulfur may be expected to cause a considerable change in the sulfur situation in Swedish agriculture. 167 references, 40 figures, 44 tables.

Tight glycemic control in the ICU - is the earth flat?

Science.gov (United States)

Steil, Garry M; Agus, Michael S D

2014-06-27

Tight glycemic control in the ICU has been shown to reduce mortality in some but not all prospective randomized control trials. Confounding the interpretation of these studies are differences in how the control was achieved and underlying incidence of hypoglycemia, which can be expected to be affected by the introduction of continuous glucose monitoring (CGM). In this issue of Critical Care, a consensus panel provides a list of the research priorities they believe are needed for CGM to become routine practice in the ICU. We reflect on these recommendations and consider the implications for using CGM today.

Life values as predictors of pain, disability and sick leave among Swedish registered nurses: a longitudinal study

Directory of Open Access Journals (Sweden)

Denison Eva

2011-09-01

Full Text Available Abstract Background Prospective studies on high-risk populations, such as subgroups of health care staff, are limited, especially prospective studies among staff not on sick-leave. This paper is a report of a longitudinal study conducted to describe and compare the importance and consistency of life domains among registered nurses (RNs working in a Swedish hospital and evaluate a model based on the consistency of valued life domains for prediction of pain, disability and sick leave. Method Importance and consistency ratings of life values, in 9 domains, were collected during 2003 and 2006 from 196 RNs using the Valued Living Questionnaire (VLQ. Logistic regression analyses were used for prediction of pain, disability and sick leave at the three-year follow-up. The predictors family relations, marriage couples/intimate relations, parenting, friends/social life, work, education, leisure time, psychological well-being, and physical self-care were used at baseline. Results RNs rated life values regarding parenting as most important and with the highest consistency both at baseline and at follow-up. No significant differences were found between RNs' ratings of importance and consistency over the three-year period, except for friends/social relations that revealed a significant decrease in importance at follow-up. The explanatory models for pain, disability and sick leave significantly predicted pain and disability at follow-up. The odds of having pain were significantly increased by one consistency rating (psychological well-being, while the odds were significantly decreased by physical self-care. In the model predicting disability, consistency in psychological well-being and education significantly increased the odds of being disabled, while consistency in physical self-care significantly decreased the odds. Conclusion The results suggest that there might be a link between intra-individual factors reflecting different aspects of appraised life

Accuracy of Laboratory Data Communication on ICU Daily Rounds Using an Electronic Health Record.

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Artis, Kathryn A; Dyer, Edward; Mohan, Vishnu; Gold, Jeffrey A

2017-02-01

Accurately communicating patient data during daily ICU rounds is critically important since data provide the basis for clinical decision making. Despite its importance, high fidelity data communication during interprofessional ICU rounds is assumed, yet unproven. We created a robust but simple methodology to measure the prevalence of inaccurately communicated (misrepresented) data and to characterize data communication failures by type. We also assessed how commonly the rounding team detected data misrepresentation and whether data communication was impacted by environmental, human, and workflow factors. Direct observation of verbalized laboratory data during daily ICU rounds compared with data within the electronic health record and on presenters' paper prerounding notes. Twenty-six-bed academic medical ICU with a well-established electronic health record. ICU rounds presenter (medical student or resident physician), interprofessional rounding team. None. During 301 observed patient presentations including 4,945 audited laboratory results, presenters used a paper prerounding tool for 94.3% of presentations but tools contained only 78% of available electronic health record laboratory data. Ninty-six percent of patient presentations included at least one laboratory misrepresentation (mean, 6.3 per patient) and 38.9% of all audited laboratory data were inaccurately communicated. Most misrepresentation events were omissions. Only 7.8% of all laboratory misrepresentations were detected. Despite a structured interprofessional rounding script and a well-established electronic health record, clinician laboratory data retrieval and communication during ICU rounds at our institution was poor, prone to omissions and inaccuracies, yet largely unrecognized by the rounding team. This highlights an important patient safety issue that is likely widely prevalent, yet underrecognized.

Cumulative lactate and hospital mortality in ICU patients

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