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Sample records for swedish icu nurses

  1. Occupational health hazards in ICU nursing staff

    National Research Council Canada - National Science Library

    Shimizu, Helena Eri; Couto, Djalma Ticiani; Merchán-Hamann, Edgar; Branco, Anadergh Barbosa

    2010-01-01

    This study analyzed occupational health hazards for Intensive Care Unit (ICU) nurses and nursing technicians, comparing differences in the number and types of hazards which occur at the beginning and end of their careers...

  2. Occupational Health Hazards in ICU Nursing Staff

    National Research Council Canada - National Science Library

    Shimizu, Helena Eri; Couto, Djalma Ticiani; Merchán-Hamann, Edgar; Branco, Anadergh Barbosa

    2010-01-01

    This study analyzed occupational health hazards for Intensive Care Unit (ICU) nurses and nursing technicians, comparing differences in the number and types of hazards which occur at the beginning and end of their careers...

  3. Occupational Health Hazards in ICU Nursing Staff

    OpenAIRE

    Helena Eri Shimizu; Djalma Ticiani Couto; Edgar Merchán-Hamann; Anadergh Barbosa Branco

    2011-01-01

    This study analyzed occupational health hazards for Intensive Care Unit (ICU) nurses and nursing technicians, comparing differences in the number and types of hazards which occur at the beginning and end of their careers. A descriptive cross-sectional study was carried out with 26 nurses and 96 nursing technicians from a public hospital in the Federal District, Brazil. A Likert-type work-related symptom scale (WRSS) was used to evaluate the presence of physical, psychological, and social risk...

  4. ICU nurses' experiences in providing terminal care.

    Science.gov (United States)

    Espinosa, Laura; Young, Anne; Symes, Lene; Haile, Brenda; Walsh, Teresa

    2010-01-01

    At least 1 in 5 Americans die while using intensive care service-a number that is expected to increase as society ages. Many of these deaths involve withholding or withdrawing life-sustaining therapies. In these situations, the role of intensive care nurses shifts from providing aggressive care to end-of-life care. While hospice and palliative care nurses typically receive specialized support to cope with death and dying, intensive care nurses usually do not receive this support. Understanding the experiences of intensive care nurses in providing care at the end of life is an important first step to improving terminal care in the intensive care unit (ICU). This phenomenological research study explores the experiences of intensive care nurses who provide terminal care in the ICU. The sample consisted of 18 registered nurses delivering terminal care in an ICU that participated in individual interviews and focus groups. Colaizzi's steps for data analysis were used to identify themes within the context of nursing. Three major themes consisted of (1) barriers to optimal care, (2) internal conflict, and (3) coping. Providing terminal care creates significant personal and professional struggles among ICU nurses.

  5. Occupational Health Hazards in ICU Nursing Staff

    Directory of Open Access Journals (Sweden)

    Helena Eri Shimizu

    2010-01-01

    Full Text Available This study analyzed occupational health hazards for Intensive Care Unit (ICU nurses and nursing technicians, comparing differences in the number and types of hazards which occur at the beginning and end of their careers. A descriptive cross-sectional study was carried out with 26 nurses and 96 nursing technicians from a public hospital in the Federal District, Brazil. A Likert-type work-related symptom scale (WRSS was used to evaluate the presence of physical, psychological, and social risks. Data were analyzed with the use of the SPSS, version 12.0, and the Kruskal-Wallis test for statistical significance and differences in occupational health hazards at the beginning and at the end of the workers' careers. As a workplace, ICUs can cause work health hazards, mostly physical, to nurses and nursing technicians due to the frequent use of physical energy and strength to provide care, while psychological and social hazards occur to a lesser degree.

  6. Occupational health hazards in ICU nursing staff.

    Science.gov (United States)

    Shimizu, Helena Eri; Couto, Djalma Ticiani; Merchán-Hamann, Edgar; Branco, Anadergh Barbosa

    2010-01-01

    This study analyzed occupational health hazards for Intensive Care Unit (ICU) nurses and nursing technicians, comparing differences in the number and types of hazards which occur at the beginning and end of their careers. A descriptive cross-sectional study was carried out with 26 nurses and 96 nursing technicians from a public hospital in the Federal District, Brazil. A Likert-type work-related symptom scale (WRSS) was used to evaluate the presence of physical, psychological, and social risks. Data were analyzed with the use of the SPSS, version 12.0, and the Kruskal-Wallis test for statistical significance and differences in occupational health hazards at the beginning and at the end of the workers' careers. As a workplace, ICUs can cause work health hazards, mostly physical, to nurses and nursing technicians due to the frequent use of physical energy and strength to provide care, while psychological and social hazards occur to a lesser degree.

  7. Attitudes towards organ donor advocacy among Swedish intensive care nurses.

    Science.gov (United States)

    Forsberg, Anna; Lennerling, Annette; Fridh, Isabell; Rizell, Magnus; Lovén, Charlotte; Flodén, Anne

    2015-05-01

    To explore the attitudes of Swedish intensive care nurses towards organ donor advocacy. The concept of organ donor advocacy is critical to nurses who care for potential donors in order to facilitate organ donation (OD). A retrospective cross-sectional study was employed. Inclusion criteria in this survey were to be a registered nurse and to work in a Swedish intensive care unit (ICU). Participants were identified by the Swedish association of health professionals. A number of 502 Swedish ICU nurses answered the 32-item questionnaire Attitudes Towards Organ Donor Advocacy Scale (ATODAS), covering the five dimensions of organ donor advocacy: attitudes towards championing organ donation at a structural hospital level, or at a political and research level, attitudes towards actively and personally safeguarding the will and wishes of the potential organ donor, or by using a more professional approach and finally to safeguard the will and wishes of the relatives. Data were analysed with the SPSS version 18·0 and the results were assessed by using Student's t-test and post hoc test, analysis of variance (ANOVA), χ(2) , Pearson's correlation and regression analysis. The most favoured advocacy action was safeguarding the POD's will and wishes by a professional approach, closely followed by actively and personally safeguarding the POD's will and wishes. Nurses at local hospitals reported a more positive attitude towards organ donor advocacy overall compared with nurses at larger regional or university hospitals. Important factors leading to positive attitudes were seniority, working experience, participating in conversations with relatives, caring for brain-dead persons and private experiences from OD or organ transplantation. Intensive and critical care nurses with short working experience in university hospitals showed the least positive attitude towards organ donor advocacy. This is problematic because many ODs and all transplantations are performed in university

  8. Nurses knowledge, attitude and practice in prevention of ICU syndrome

    OpenAIRE

    Ali Dadgari; Farede Yaghmaie; Jasman Shahnazarian; Leyla Dadvar

    2007-01-01

    Introduction: Intensive care unit ICU syndrome is a disorder, in which patients in an ICU or a similar setting experience anxiety, hallucination and become paranoid, severely disoriented in time and place, very agitated, or even violent, etc. The aim of this study was to assess knowledge, attitude and practice (KAP) of nurses with regards to prevention of ICU syndrome (Delirium). Methods: Subjects of this research were 56 nurses with including criteria of registration in nursing, university d...

  9. ICU nurse allocation in a cardiothoracic ICU: How many hands do ...

    African Journals Online (AJOL)

    Aim. To determine the nurse/patient ratios required to render safe, competent ICU nursing. Method. A patient classification system (CritScore) was used to compile an objective 3-month patient profile. The number (of full-time and agency staff) and the professional profiles of nursing staff allocated to the unit during this period ...

  10. Saudi Arabian ICU safety culture and nurses' attitudes.

    Science.gov (United States)

    Alayed, Abdulrahman S; Lööf, Helena; Johansson, Unn-Britt

    2014-01-01

    The purpose of this paper is to examine nurses' attitudes towards safety culture in six Saudi Arabian intensive care units (ICUs). The study is descriptive with a cross-sectional design. The Safety Attitude Questionnaire (SAQ)-ICU version was distributed and 216 completed questionnaires were returned. The findings provide a basis for further research on Saudi Arabian ICU safety culture. This study showed that the SAQ-ICU can be used to measure safety climate to identify areas for improvement according to nurse attitudes and perceptions. Findings indicate that ICU safety culture is an important issue that hospital managers should prioritise. The SAQ-ICU questionnaire, used to measure safety climate in Saudi Arabian ICUs, identifies service strengths and improvement areas according to attitudes and perceptions. To the knowledge, this is the first study to use SAQ to examine nurses' safety culture attitudes in Saudi Arabian ICUs. The present findings provide a baseline and further details about Saudi Arabian ICU safety. Study participants represented nine nationalities, indicating the nursing workforce's diversity, which is expected to continue in the future. Such a nursing cultural heterogeneity calls for further studies to examine and evaluate attitudes and values to improve ICU safety culture.

  11. Measuring the nursing workload per shift in the ICU

    NARCIS (Netherlands)

    Debergh, Dieter P.; Myny, Dries; Van Herzeele, Isabelle; Van Maele, Georges; Miranda, Dinis Reis; Colardyn, Francis

    In the intensive care unit (ICU) different strategies and workload measurement tools exist to indicate the number of nurses needed. The gathered information is always focused on manpower needed per 24 h. However, a day consists of several shifts, which may be unequal in nursing workload. The aim of

  12. Communication skills in ICU and adult hospitalisation unit nursing staff.

    Science.gov (United States)

    Ayuso-Murillo, D; Colomer-Sánchez, A; Herrera-Peco, I

    In this study researchers are trying to analyse the personality factors related to social skills in nurses who work in: Intensive Care Units, ICU, and Hospitalisation units. Both groups are from the Madrid Health Service (SERMAS). The present investigation has been developed as a descriptive transversal study, where personality factors in ICU nurses (n=29) and those from Hospitalisation units (n=40) were compared. The 16PF-5 questionnaire was employed to measure the personality factors associated with communication skills. The comparison of the personality factors associated to social skills, communication, in both groups, show us that nurses from ICU obtain in social receptivity: 5,6 (A+), 5,2 (C-), 6,2 (O+), 5,1 (H-), 5,3 (Q1-), and emotional control: 6,1 (B+), 5,9 (N+). Meanwhile the data doesn't adjust to the expected to emotional and social expressiveness, emotional receptivity and social control, there are not evidence. The personality factors associated to communication skills in ICU nurses are below those of hospitalisation unit nurses. The present results suggest the necessity to develop training actions, focusing on nurses from intensive care units to improve their communication social skills. Copyright © 2016 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Nurses' views of shared leadership in ICU: a case study.

    Science.gov (United States)

    Rosengren, Kristina; Bondas, Terese; Nordholm, Lena; Nordström, Gun

    2010-08-01

    New management models develop; one of them is shared leadership where two nurse managers share tasks and responsibility for a unit. The overall aim of this study was to describe the view of the staff about shared leadership at an ICU in Sweden and to study if there were any differences in perceptions between staff groups. This unit had changed the management organisation from single leadership (one nurse manager) to shared leadership (two nurse managers). Sixty-four (79%) registered nurses and assistant nurses responded to a 72 item questionnaire measuring social and organisational factors at work, especially leadership and shared leadership. The results showed that staff reported positive views in relation to the dimensions 'Organisational culture', 'Social interactions', 'Work satisfaction', 'Leadership', 'Shared leadership' and 'Work motives'. Registered nurses reported more positive views than assistant nurses in relation to the dimensions: 'Organisational culture', 'Social interactions', 'Work satisfaction' and 'Leadership'. Further, females had more positive views than males on the dimension 'Social interactions'. Staff described that shared leadership positively influenced the work in terms of confidence. In conclusion, staff reported positive views of work and the model shared leadership in the investigated ICU. One implication is that nurse managers have to be conscious of different health professionals in the unit and it is important to offer a good working environment for all staff. However, more research is needed within the area of shared leadership. A future research project could be to add a qualitative research question about how work and shared leadership affects different health professionals in the day to day practice both at the managerial as well as the team level to improve health care. Copyright 2010 Elsevier Ltd. All rights reserved.

  14. Ethnic Swedish parents' experiences of minority ethnic nurses' cultural competence in Swedish paediatric care.

    Science.gov (United States)

    Tavallali, Azar G; Kabir, Zarina Nahar; Jirwe, Maria

    2014-06-01

    Sweden has a population of a little more than 9.4 million. The rapid growth of immigration in Sweden has resulted in an increased number of minority ethnic patients and minority ethnic nurses in the Swedish healthcare system. This also applies to paediatric care. The purpose of this study was to explore how parents with ethnic Swedish backgrounds experience minority ethnic nurses' cultural competence and the care the nurses provide in a Swedish paediatric care context. This exploratory qualitative study is of 14 parents with an ethnic Swedish background whose child was in a ward at a children's hospital in Stockholm County Council. Data were collected using semi-structured interviews to identify parents' perceptions and experiences of minority ethnic nurses' cultural competence. The interviews were analysed by qualitative content analysis. The analyses of the interviews led to four main categories: influence of nurses' ethnicity; significance of cross-cultural communication; cross-cultural skills; and the importance of nursing education. Nurses' ethnicity did not have much impact on parents' satisfaction with their child's care. The parents attached importance to nurses' language skills and to their adaptation and awareness of Swedish culture. They also attached weight to nurses' professional knowledge and personal attributes. The role of nursing education to increase nurses' cultural awareness was highlighted too. © 2013 Nordic College of Caring Science.

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

    African Journals Online (AJOL)

    Additional education about DNR orders as well as policies to guide its implementation could assist ICU nurses in their difficult work. S Afr J Crit ... body of knowledge. The purpose of the study was to explore the lived experiences of nurses caring for a patient with a DNR order in an ICU in Kigali, Rwanda. Methods. Using a ...

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

    OpenAIRE

    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...

  17. Workload and main activities of consultative ICU nurses: long-term experience in a large teaching hospital in the Netherlands

    NARCIS (Netherlands)

    Top, W. M. C.; Schultz, M. J.; Jurrjens, F. H.; Rommes, J. H.; Spronk, P. E.

    2006-01-01

    BACKGROUND: Early recognition and prompt treatment of deteriorating patients outside the intensive care unit (ICU) improves hospital survival. Over the past decade, consultative services have been implemented in many institutions. This service is frequently performed by ICU nurses, while little

  18. End-of-life decisions in the Intensive Care Unit (ICU) - Exploring the experiences of ICU nurses and doctors - A critical literature review.

    Science.gov (United States)

    Flannery, Liz; Ramjan, Lucie Michelle; Peters, Kath

    2016-05-01

    End-of-life decision making in the Intensive Care Unit (ICU), can be emotionally challenging and multifaceted. Doctors and nurses are sometimes placed in a precarious position where they are required to make decisions for patients who may be unable to participate in the decision-making process. There is an increasing frequency of the need for such decisions to be made in ICU, with studies reporting that most ICU deaths are heralded by a decision to withdraw or withhold life-sustaining treatment. The purpose of this paper is to critically review the literature related to end-of-life decision making among ICU doctors and nurses and focuses on three areas: (1) Who is involved in end-of-life decisions in the ICU?; (2) What challenges are encountered by ICU doctors and nurses when making decisions?; and (3) Are these decisions a source of moral distress for ICU doctors and nurses? This review considered both qualitative and quantitative research conducted from January 2006 to March 2014 that report on the experiences of ICU doctors and nurses in end-of-life decision making. Studies with a focus on paediatrics, family/relatives perspectives, advance care directives and euthanasia were excluded. A total of 12 papers were identified for review. There were differences reported in the decision making process and collaboration between doctors and nurses (which depended on physician preference or seniority of nurses), with overall accountability assigned to the physician. Role ambiguity, communication issues, indecision on futility of treatment, and the initiation of end-of-life discussions were some of the greatest challenges. The impact of these decisions included decreased job satisfaction, emotional and psychological 'burnout'. Further research is warranted to address the need for a more comprehensive, standardised approach to support clinicians (medical and nursing) in end-of-life decision making in the ICU. Copyright © 2015 Australian College of Critical Care Nurses Ltd

  19. Patients and ICU nurses' perspectives of non-pharmacological interventions for pain management.

    Science.gov (United States)

    Gélinas, Céline; Arbour, Caroline; Michaud, Cécile; Robar, Lauren; Côté, José

    2013-11-01

    Pain is a major stressor for critically ill patients. To maximize pain relief, non-pharmacological interventions are an interesting avenue to explore. The study aim was to describe the perspectives of patients/family members and nurses about the usefulness, relevance and feasibility of non-pharmacological interventions for pain management in the intensive care unit (ICU). A qualitative descriptive design was used. Patients/family members (n = 6) with a previous experience of ICU hospitalization and ICU nurses (n = 32) were recruited. Using a semi-structured discussion guide, participants were asked to share their perspective about non-pharmacological interventions that they found useful, relevant and feasible for pain management in the ICU. Interventions were clustered into five categories: a) cognitive-behavioural, b) physical, c) emotional support, d) helping with activities of daily living and, e) creating a comfortable environment. A total of eight focus groups (FGs) with patients/family members (two FGs) and ICU nurses (six FGs) were conducted. Overall, 33 non-pharmacological interventions were discussed. The top four non-pharmacological interventions found to be useful, relevant and feasible in at least half of the FGs were music therapy and distraction (cognitive-behavioural category), simple massage (physical category) and family presence facilitation (emotional support category). Interestingly, patients/family members and nurses showed different interests towards some interventions. For instance, patients discussed more about active listening/reality orientation, while nurses talked mostly about teaching/positioning. Four non-pharmacological interventions reached consensus in patients and nurses' FGs to be useful, relevant and feasible for pain management in the ICU. Other interventions seemed to be influenced by personal experience or professional role of the participants. While more evidence is required to conclude to their effectiveness, ICU nurses can

  20. Perbandingan Abdominal Massage dengan Teknik Swedish Massage dan Teknik Effleurage terhadap Kejadian Konstipasi pada Pasien yang Terpasang Ventilasi Mekanik di ICU

    Directory of Open Access Journals (Sweden)

    Arimbi Karunia Estri

    2017-10-01

    Full Text Available Konstipasi merupakan komplikasi yang sering terjadi pada pasien yang dirawat di Intensive Care Unit (ICU. Teknik abdominal massage yang dapat digunakan untuk mencegah konstipasi adalah swedish massage dan effleurage, namun demikian belum ada penelitian lanjutan yang menunjukkan teknik yang paling efektif diantara kedua teknik abdominal massage tersebut terhadap kejadian konstipasi. Penelitian ini bertujuan untuk mengetahui perbedaan kejadian konstipasi antara kelompok yang dilakukan abdominal massage dengan teknik swedish massage dan kelompok yang dilakukan abdominal massage dengan teknik effleurage. Penelitian ini merupakan penelitian quasi eksperimen dengan total jumlah sampel pada dua kelompok sebanyak 22 responden yang didapatkan melalui teknik consecutive sampling. Penelitian ini dilakukan dari bulan Januari sampai Maret 2016 di ruang ICU RS Panti Rapih Yogyakarta. Data dikumpulkan melalui observasi menggunakan lembar observasi defekasi. Data dianalisis menggunakan uji Fisher’s Exact. Kejadian konstipasi pada kelompok abdominal massage dengan teknik swedish massage sebanyak 45,4%, sedangkan kejadian konstipasi pada kelompok abdominal massage dengan teknik effleurage sebanyak 27,2%, dan secara statistik tidak ada perbedaan kejadian konstipasi (p = 0,659 antara kelompok abdominal massage dengan teknik swedish massage dan kelompok abdominal massage dengan teknik effleurage. Walaupun kejadian konstipasi antara kelompok abdominal massage dengan teknik swedish massage dan kelompok abdominal massage dengan teknik effleurage tidak berbeda, namun abdominal massage dengan teknik effleurage waktu lebih efisien, energi yang dikeluarkan lebih minimal dan meningkatkan kenyamanan. Oleh karena itu, abdominal massage dengan teknik effleurage dan teknik swedish massage disarankan untuk menjadi pilihan intervensi bagi perawat ICU.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    African Journals Online (AJOL)

    unit in a 200-bed private hospital in KwaZulu-Natal, SA, where a new ... and were assured that no responses were viewed as being incorrect. A ... Nursing participants explained that the AMS programme in the ICU was a nursing initiative designed to monitor antibiotic/antifungal use in the unit. There was minimal knowledge ...

  3. Quality of Care of Nursing from Brain Death Patient in ICU Wards

    Directory of Open Access Journals (Sweden)

    Seyedeh Toktam Masoumian Hoseini

    2015-04-01

    Full Text Available Introduction: Nowadays, Intensive Care Unit (ICU nurses play a significant and key role in the care of brain dead patients and their families, therefore their Practice extremely important to the success of organ donation. To assess ICU nurse's practice in relation to nurse's role in the organ donation process from brain dead patients in Iran. Materials and Methods:In a cross-sectional analytical study 90 ICU nurses in Ghaem and Imam Reza Hospitals in Mashhad through stratified random sampling allocation method were selected. Data collection tools included a questionnaire on demographic information, factors influencing nurse's practice during the organ donation process and surveying "nurse's practice in relation to their roles in the organ donation process." Results: 90 nurses participated in this study. (70.0% of the research subjects had spoken with their own families about organ donation, and (20.0% had organ donation cards. Practice scores were calculated on a scale of 100. The mean score of nurses' practice was (6.04± 3.66. 96.7% of nurses’ weak practice in terms of their roles in the organ donation process. Conclusion: As a result, they do not have adequate practice regard nurse's role in organ donation process and in relation to brain death patient and their families. Therefore it is suggested to include nursing courses in the organ donation process and organ transplantation as well as educational programs to acquaint nurses with their roles in the process to improve their practice by different training methods.

  4. Nurses Contribution to Swedish eHealth Strategy.

    Science.gov (United States)

    Törnvall, Eva

    2012-01-01

    In 2005 the Swedish government identified the need of common development of information and communication technology in health and social care. The purpose of this paper is to describe nurses' contribution to the establishment of a national cooperation concerning eHealth development in health and social care. The Swedish strategy of eHealth have six actions areas eServices for accessibility and empowerment, Usable and accessible information (for staff), Knowledge management, innovation and learning, Creating a common technical infrastructure, Creating a common information structure and Bringing laws and regulations into line with extended use of ICT. Nurses are involved in all action areas and emphasize the empowerment and safety of the patient and account of ethical values. Patients' possibility to take part of the information and adding information in their own patient health record, nurses' education and safe IT support in medication are areas that need further development.

  5. MEASURING WORKLOAD OF ICU NURSES WITH A QUESTIONNAIRE SURVEY: THE NASA TASK LOAD INDEX (TLX)

    Science.gov (United States)

    Hoonakker, Peter; Carayon, Pascale; Gurses, Ayse; Brown, Roger; McGuire, Kerry; Khunlertkit, Adjhaporn; Walker, James M.

    2012-01-01

    High workload of nurses in Intensive Care Units (ICUs) has been identified as a major patient safety and worker stress problem. However, relative little attention has been dedicated to the measurement of workload in healthcare. The objectives of this study are to describe and examine several methods to measure workload of ICU nurses. We then focus on the measurement of ICU nurses’ workload using a subjective rating instrument: the NASA TLX. We conducted secondary data analysis on data from two, multi-side, cross-sectional questionnaire studies to examine several instruments to measure ICU nurses’ workload. The combined database contains the data from 757 ICU nurses in 8 hospitals and 21 ICUs. Results show that the different methods to measure workload of ICU nurses, such as patient-based and operator-based workload, are only moderately correlated, or not correlated at all. Results show further that among the operator-based instruments, the NASA TLX is the most reliable and valid questionnaire to measure workload and that NASA TLX can be used in a healthcare setting. Managers of hospitals and ICUs can benefit from the results of this research as it provides benchmark data on workload experienced by nurses in a variety of ICUs. PMID:22773941

  6. Perbandingan Abdominal Massage dengan Teknik Swedish Massage dan Teknik Effleurage terhadap Kejadian Konstipasi pada Pasien yang Terpasang Ventilasi Mekanik di ICU

    OpenAIRE

    Arimbi Karunia Estri; Sari Fatimah; Ayu Prawesti

    2017-01-01

    Konstipasi merupakan komplikasi yang sering terjadi pada pasien yang dirawat di Intensive Care Unit (ICU). Teknik abdominal massage yang dapat digunakan untuk mencegah konstipasi adalah swedish massage dan effleurage, namun demikian belum ada penelitian lanjutan yang menunjukkan teknik yang paling efektif diantara kedua teknik abdominal massage tersebut terhadap kejadian konstipasi. Penelitian ini bertujuan untuk mengetahui perbedaan kejadian konstipasi antara kelompok yang dilaku...

  7. Perbandingan Abdominal Massage Dengan Teknik Swedish Massage Dan Teknik Effleurage Terhadap Kejadian Konstipasi Pada Pasien Yang Terpasang Ventilasi Mekanik Di ICU

    OpenAIRE

    Estri, Arimbi Karunia; Fatimah, Sari; Prawesti, Ayu

    2016-01-01

    Konstipasi merupakan komplikasi yang sering terjadi pada pasien yang dirawat di Intensive Care Unit (ICU).Teknik abdominal massage yang dapat digunakan untuk mencegah konstipasi adalah swedish massage daneffleurage, namun demikian belum ada penelitian lanjutan yang menunjukkan teknik yang paling efektifdiantara kedua teknik abdominal massage tersebut terhadap kejadian konstipasi. Penelitian ini bertujuanuntuk mengetahui perbedaan kejadian konstipasi antara kelompok yang dilakukan abdominal ma...

  8. Hope of patient recovery in the ICU from the viewpoint of Iranian nurses: concept analysis.

    Science.gov (United States)

    Jahantigh, Mojgan; Rezaee, Nasrin; Rezaei, Nahid

    2014-07-15

    Nurses' care quality for patients in the ICU depends on their degree/ level of hope to improving patient, but there is no consensus on the concept "hoping to improve patient." The purpose of the present study is to analyze the concept nurses hoping to improving patient in the ICU. To analyze this concept, hybrid model is used which consists of theoretical phase, field work phase, and final analytical phase. In field phase work, semi-structured, face to face and individual interviews were done for nurses working in the ICU, and the data gathered from the interviews were analyzed using inductive content analysis. In theoretical phase, the concept hoping to improve patient was characterized by being available, being professional, expecting positively, and being future- oriented. The scientific definition of this concept was explained through properties which are necessary for qualified nursing care. In field work phase, the categories include nursing care, inner feeling, belief and consequences. In final analytical phase, final definition of the concept was explained through properties such as dynamic expectation, being realistic, and being goal- oriented which is a better function and attitude in effective nursing care accompanying peace of mind for nurses. Concept analysis showed that nurse's awareness of hoping to improve patient helps the nurse do his job in the best way and with peace of mind.

  9. ICU nurses' perceptions of potential constraints and anticipated support to practice defibrillation: a qualitative study.

    Science.gov (United States)

    Hui, George C M; Low, Lisa P L; Lee, Iris S F

    2011-08-01

    The study examines the experience of intensive care nurses in caring for patients in cardiac arrest, and their perceptions of introducing nurse-led defibrillation. This was a descriptive, exploratory and qualitative study at an intensive care unit (ICU) of an acute regional hospital in Hong Kong. Twelve registered nurses were purposefully selected for interview. Although all the participants were trained in basic life support, only 50% were trained in advanced cardiac life support (ACLS), and those trained in ACLS described having limited opportunities to apply their defibrillation knowledge. Whilst participants believed that they were theoretically prepared to influence the patient's resuscitation outcomes, newly qualified nurses were reluctant to be accountable for defibrillation. In contrast, experienced nurses were more willing to perform nurse-led defibrillation. Support from management, cooperation between nurses and doctors, regular in-hospital 'real-drill' programmes, sponsorship for training, and the use of alternative defibrillation equipment should be considered to encourage nurse-led defibrillation in ICU settings. Nurse-led defibrillation is an approach of delivering prompt care to critically ill patients, and a way ahead for intensive care nursing in Hong Kong. Emphasis on a consistent policy to promote nurse-led defibrillation practice is needed. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Palliative Care Communication in the ICU: Implications for an Oncology-Critical Care Nursing Partnership.

    Science.gov (United States)

    Boyle, Deborah A; Barbour, Susan; Anderson, Wendy; Noort, Janice; Grywalski, Michelle; Myer, Jeannette; Hermann, Heather

    2017-10-26

    To describe the development, launch, implementation, and outcomes of a unique multisite collaborative (ie, IMPACT-ICU [Integrating Multidisciplinary Palliative Care into the ICU]) to teach ICU nurses communication skills specific to palliative care. To identify options for collaboration between oncology and critical care nurses when integrating palliation into nursing care planning. Published literature and collective experiences of the authors in the provision of onco-critical-palliative care. While critical care nurses were the initial focus of education, oncology, telemetry, step-down, and medical-surgical nurses within five university medical centers subsequently participated in this learning collaborative. Participants reported enhanced confidence in communicating with patients, families, and physicians, offering emotional support and involvement in family meetings. Communication education is a vital yet missing element of undergraduate nursing education. Programs should be offered in the work setting to address this gap in needed nurse competency, particularly within the context of onco-critical-palliative care. Copyright © 2017. Published by Elsevier Inc.

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

    Science.gov (United States)

    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).

  12. Indian ICU nurses' perceptions of and attitudes towards organ donation.

    Science.gov (United States)

    Vijayalakshmi, Poreddi; Nagarajaiah; Ramachandra; Math, Suresh Bada

    Nurses play a significant role in identifying and securing potential organ donors in the clinical environment. Research among Indian nurses related to organ donation is sparse. The present study aimed to investigate nurses' attitudes towards organ donation. A cross-sectional descriptive survey was carried out among nurses (n=184) at a tertiary care centre. Data were collected through self-report questionnaire. A majority (81%) of the respondents were 'willing to sign the card' for organ donation; however, only 3.8% (n=7) of them actually 'signed the organ donation card'. There were significant associations found between intentions to sign the organ donation card and gender (x2=5.852; porgan donation. Furthermore, nurse administrators must take the initiative to develop guidelines clarifying the role of nurses in the organ donation and transplantation process to promote organ donation and improve rates.

  13. Education of ICU nurses regarding invasive mechanical ventilation: findings from a cross-sectional survey.

    Science.gov (United States)

    Guilhermino, Michelle Copede; Inder, Kerry J; Sundin, Deborah; Kuzmiuk, Leila

    2014-08-01

    Continuing education for intensive care unit nurses on invasive mechanical ventilation is fundamental to the acquisition and maintenance of knowledge and skills to optimise patient outcomes. We aimed to determine how intensive care unit nurses perceived current education provided on mechanical ventilation, including a self-directed learning package and a competency programme; identify other important topics and forms of education; and determine factors associated with the completion of educational programmes on invasive mechanical ventilation. A cross-sectional, 30-item, self-administered and semi-structured survey on invasive mechanical ventilation education was distributed to 160 intensive care nurses. Analysis included descriptive statistics and logistic regression was used to determine factors associated with current education completion, reported as adjusted odds ratios (AOR) and 95% confidence intervals (CIs). Eighty three intensive care unit nurses responded and the majority (63%) reported not receiving education about mechanical ventilation prior to working in intensive care. Using a Likert rating scale the self-directed learning package and competency programme were perceived as valuable and beneficial. Hands-on-practice was perceived as the most important form of education and ventilator settings as the most important topic. Multivariate analysis determined that older age was independently associated with not completing the self-directed learning package (AOR 0.20, 95% CI 0.04, 0.93). For the competency programme, 4-6 years intensive care experience was independently associated with completion (AOR 17, 95% CI 1.7, 165) and part-time employment was associated with non-completion (AOR 0.23, 95% CI 0.08, 0.68). Registered nurses are commencing their ICU experience with limited knowledge of invasive MV therefore the education provided within the ICU workplace becomes fundamental to safe and effective practice. The perception of continuing education by ICU

  14. Involving relatives in ICU patient care: critical care nursing challenges.

    Science.gov (United States)

    McConnell, Bridget; Moroney, Tracey

    2015-04-01

    To identify the barriers critical care nurses experience to relative involvement in intensive care unit patient care. Previous studies have discussed the experiences of relatives visiting an intensive care unit, the needs of relatives in the intensive care environment, critical care nurse and relative interaction, intensive care unit visiting policies and the benefits of including relatives in patient care. The barriers that critical care nurses experience to relative involvement in patient care have received minimal exploration. Critical care nurses were recruited for a mixed methods study. An explanatory mixed method design was used, with two phases. Phase 1 was Quantitative and Phase 2 was Qualitative. Data collection occurred over five months in 2012-2013. Phase 1 used an online questionnaire (n = 70), and semi-structured interviews (n = 6) were conducted in Phase 2. Phase 1 participants were 70 critical care nurses working in Australian intensive care units and six critical care nurses were recruited from a single Sydney intensive care unit for Phase 2. Through sequential data collection, Phase 1 results formed the development of Phase 2 interview questions. Participants reported various barriers to relative involvement in critically ill patient care. Factors related to the intensive care unit patient, the intensive care unit relative, the critical care nurse and the intensive care environment contributed to difficulties encompassing relative involvement. This study has identified that when considering relative involvement in patient care, critical care nurses take on a paternalistic role. The barriers experienced to relative involvement result in the individual critical care nurse deciding to include or exclude relatives from patient care. Knowledge of the barriers to relative involvement in critically ill patient care may provide a basis for improving discussion on this topic and may assist intensive care units to implement strategies to reduce barriers.

  15. Phenomenological study of ICU nurses' experiences caring for dying patients.

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    King, Phyllis Ann; Thomas, Sandra P

    2013-11-01

    This existential phenomenological study explored caring for the dying based on the philosophical works of Merleau-Ponty. Fourteen critical care nurses were asked to describe lived experiences of caring for dying patients. An encompassing theme of Promises to Keep emerged, with five subthemes, including the following: (a) promise to be truthful: "Nurses are in the game of reality," (b) promise to provide comfort: "I'll make him comfortable," (c) promise to be an advocate: "Just one more day," (d) "Promise that couldn't be kept," and (e) "Promise to remain connected." The essence of intensive care nurses' lived experience of caring for dying patients is captured in the theme Promises to Keep. Nurses accept the reality of death and express strong commitment to making it as comfortable, peaceful, and dignified as possible, despite critical care unit environments that foster a "paradigm of curing" rather than a "paradigm of caring.".

  16. International Education and Reflection: Transition of Swedish and American Nursing Students to Authenticity.

    Science.gov (United States)

    Lepp, Margret; Zorn, CeCelia R.; Duffy, Patricia R.; Dickson, Rana J.

    2003-01-01

    A nursing course connected U.S. and Swedish sites via interactive videoconferencing and used reflective methods (journaling, drama, photo language) and off-air group discussion. Evaluation by five Swedish and seven U.S. students suggested how reflection moved students toward greater authenticity and professionalism in nursing practice. (Contains…

  17. ICU Bedside Nurses' Involvement in Palliative Care Communication: A Multicenter Survey.

    Science.gov (United States)

    Anderson, Wendy G; Puntillo, Kathleen; Boyle, Deborah; Barbour, Susan; Turner, Kathleen; Cimino, Jenica; Moore, Eric; Noort, Janice; MacMillan, John; Pearson, Diana; Grywalski, Michelle; Liao, Solomon; Ferrell, Bruce; Meyer, Jeannette; O'Neil-Page, Edith; Cain, Julia; Herman, Heather; Mitchell, William; Pantilat, Steven

    2016-03-01

    Successful and sustained integration of palliative care into the intensive care unit (ICU) requires the active engagement of bedside nurses. To describe the perspectives of ICU bedside nurses on their involvement in palliative care communication. A survey was designed, based on prior work, to assess nurses' perspectives on palliative care communication, including the importance and frequency of their involvement, confidence, and barriers. The 46-item survey was distributed via e-mail in 2013 to bedside nurses working in ICUs across the five academic medical centers of the University of California, U.S. The survey was sent to 1791 nurses; 598 (33%) responded. Most participants (88%) reported that their engagement in discussions of prognosis, goals of care, and palliative care was very important to the quality of patient care. A minority reported often discussing palliative care consultations with physicians (31%) or families (33%); 45% reported rarely or never participating in family meeting discussions. Participating nurses most frequently cited the following barriers to their involvement in palliative care communication: need for more training (66%), physicians not asking their perspective (60%), and the emotional toll of discussions (43%). ICU bedside nurses see their involvement in discussions of prognosis, goals of care, and palliative care as a key element of overall quality of patient care. Based on the barriers participants identified regarding their engagement, interventions are needed to ensure that nurses have the education, opportunities, and support to actively participate in these discussions. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  18. Characters of physician and nurse staffing in Thai intensive care units (ICU-Resource I study).

    Science.gov (United States)

    Chittawatanarat, Kaweesak; Bhurayanontachai, Rungsun; Thongchai, Chaweewan

    2014-01-01

    There have been no data available on physicians and nurses who are vital human resources in Thailand. The objective of this study is to describe these characteristics as well as their working patterns in Thai ICUs. Data were retrieved from the ICU RESOURCE I study. Physician and nurse characteristics, working patterns and workloads in participating ICUs were recorded. After hour consultations, nurse staff years of experience, nurse specialist training and patient to bedside nurse ratios (PNR) were collected. One hundred and fifty-five hospitals are included in this study. Intensivists are available in 53 hospitals with a median of 0-1 intensivist per unit. Most intensivists are working in academic ICUs. The two specialties most involved in surgical ICUs were in critical care (34.1%) and surgical recovery (47.7%). Almost all pediatric ICUs were covered by pediatricians and only a quarter of them had been staffed with critical care pediatricians (28.6%). Less than 30 percent of Thai ICUs are covered by intensivists. About 42.3% of Thai ICUs have no night shift physician and the units contact the attending physicians directly. Experienced (more than 5 years) nurses staffing ICUs are at 62.5 percent. A total of 85.2% of the ICUs have certificated critical care nurses. Only 23.2% of all ICUs have an advance practice nurse (APN). The median PNR was 2.1 with an exception in academic ICUs. Intensivists continue to be only scarcely available in Thai ICUs. Nurse workloads in non-academic ICUs were higher than those in academic ICUs. Specialty training for certified critical care nurses is in place for only one-third of the total number of ICU nurses. APNs are available in 25% of participating ICUs (Thai Clinical Trial Registry: TCTR201200005).

  19. The application of quality control circle in neurosurgery ICU nurses in raising compliance of the head of a bed

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    Na LI

    2014-11-01

    Full Text Available Objective: To explore the application of quality control circle in raising compliance of the head of a bed in neurosurgery ICU nurses. Methods: The quality control circle was made up of 4 ICU nurses, determine the subject in order to improve the neurosurgery ICU nurses in raising compliance of the head of a bed, according to the QCC activity steps to formulate plans, including grasp the current situation, goal setting, through analysis, circle members develop strategy and plan implementation and review, finally compared the situation before and after neurosurgery ICU nurses raised bed activities compliance. Results: After implementation of QCC, neurosurgery ICU nurses raised bed to 30 ~ 45 degrees. After activities, circle members in the team cooperation ability, cohesion, to accept new things ability, and innovative thinking ability and to raise the understanding of the relevant knowledge of the head of a bed has improved significantly. Conclusion: The application of quality management circle activity improves the neurosurgery ICU nurses effectively raise the compliance of the head of a bed, improve the comprehensive quality of the clinical nurses.

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

    Science.gov (United States)

    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…

  1. A pilot study of key nursing aspects with different cooling methods and devices in the ICU.

    Science.gov (United States)

    Våga, Astrid; Busch, Michael; Karlsen, Tom Erik; Nilsen, Odd Bjarte; Søreide, Eldar

    2008-01-01

    Therapeutic hypothermia (TH) has become an integrated part of neurointensive care. Still, little data exists on the actual experience with cooling patients in the ICU from the intensive care nurse (ICN) perspective. The purpose of this survey was to evaluate important nursing aspects with different cooling methods and devices in ICU use. The ICNs used a four-point rating scale (1=worst, 4=best possible) to evaluate (a) ease of application, (b) visual patient monitoring, (c) work load, (d) hygiene and (e) noise level with four cooling methods used in our ICU. Our simple, initial method of towels soaked in iced water spread over the torso was compared to three commercial cooling methods used; (1) Coolgard 3000 (Alsius, Irvine, USA), (2) Thermowrap (MTRE, Yavne, Israel) and (3) Artic Sun (Medivance, Louisville, USA). There were significant differences in how the ICNs rated the nursing aspects of the different cooling methods. Ice-water soaked towels over the torso scored high with respect to ease of application and noise level. For work-load, all the three commercial devices scored significantly better than ice-water soaked towels (Pice-water soaked towels for visual patient monitoring (PArtic Sun and Coolgard scored significantly higher than the others (P<0.05). Overall, the ICNs involved felt they had a general good understanding of TH but were only partly prepared in terms of training and knowledge of protocols and complications when TH was introduced in our ICU. The majority felt the new cooling protocol was acceptable. We identified significant differences in the rating of key nursing aspects of the different cooling methods. More studies on implementation of new cooling methods and devices seem warranted.

  2. Swedish and Chinese nurses' conceptions of ethical problems: a comparative study.

    Science.gov (United States)

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

    2009-05-01

    To investigate Swedish and Chinese nurses' conceptions of ethical problems and workplace stress and ascertain whether there are differences between the nurses in the two countries and between types of clinics. Nursing can be regarded as an ethical practice and ethical problems are one type of problems nurses have to deal with. The research design was comparative and quantitative. A questionnaire was used. The study was carried out at one hospital in China and two hospitals in Sweden. One hundred and thirty-six Chinese nurses and 137 Swedish nurses participated. There was a statistical difference between nurses working in the different countries regarding commonest stated ethical problem. The Swedish nurses indicated a greater number of ethical problems than the Chinese nurses. The latter felt irritated, dissatisfied or sad at work or after work more often than the Swedish nurses. Forty-one per cent of the nurses in both countries thought there was a modest or rather big difference between the current and the desired quality of nursing. The findings were partially the same in the two countries and this underlines the importance of looking at ethical problems from an organisational perspective. The findings also show the need for a reduction of nurses' workload as well as the importance of assuring that nurses have the knowledge they need to carry out their work. The communication between nurses and other members of the health-care team, patients and relatives also needs to be improved.

  3. Clinical decision support systems for patient safety: a focus group needs assessment with Korean ICU nurses.

    Science.gov (United States)

    Choi, Mona; Choi, Ran; Bae, Young-Ran; Lee, Sun-Mi

    2011-11-01

    An ICU is known as a data-rich environment, and information technology can improve the quality of care by utilizing stored clinical data and providing decision support effectively and in a timely manner to clinicians. The necessity of clinical decision support systems is emphasized now more than ever because patient safety and nursing-sensitive outcomes in the clinical setting have become a critical issue. The purpose of this study was to explore nursing-sensitive outcomes issues related to patient safety in critical care and to understand the types and contents of clinical decision support systems that nurses desire in a clinical practice setting. Focus group interviews were conducted with 37 nurses who worked in one university hospital system in Korea. Our findings are summarized into threats to patient safety, nursing-sensitive outcomes, and the types and contents of clinical decision support systems, which are categorized into the following groups: (1) reminders, notification, alert, and warning systems; (2) point-of-care guidelines; and (3) references for information/guidelines. Nurses consistently stated that clinical decision support systems can help improve nursing outcomes by applying standardized nursing care. Our study is expected to provide a practical suggestion for developing and designing a new clinical decision support system or for refining an existing one.

  4. [Assessment of concordance between CAM-ICU scale and nursing delirium scale in postoperative period of ICU patients after cardiac surgery].

    Science.gov (United States)

    Alcoba Pérez, Á; Ciria Poza, S; Carracedo Catalán, C; García Fernández, A; Marcos Vidal, J M

    2014-01-01

    To evaluate concordance between the scale of delirium assessment CAM-ICU and the Nursing Delirium Screening Scale (NDSS) in postoperative cardiac surgery. Prospective study in tertiary hospital with consecutive selection of patients after cardiac surgery. During the stay in the Intensive Care Unit, CAM-ICU and NDSS were administered by the same researcher. For demographic and preoperative risk factors of delirium, descriptive statistical analysis was performed. Concordance was assessed using kappa index. 106 patients were included, performing 214 evaluations. Incidence of delirium with the CAM-ICU scale was of 8.4%, and of 16.8% with NDSS. The concordance expressed by the index Kappa was of 0.541. The concordance between the CAM-ICU scale and the NDSS in the postoperative cardiac surgery and during the stay in the Intensive Care Unit is low. Currently, the use of the CAM-ICU was recommended in this context, but it must not be replaced for the NDSS. Copyright © 2013 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

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

    Science.gov (United States)

    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.

  6. 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.

  7. Nurses' experiences of what constitutes the encounter with children visiting a sick parent at an adult ICU.

    Science.gov (United States)

    Knutsson, Susanne; Enskär, Karin; Golsäter, Marie

    2017-04-01

    Despite a cultural change in visitation policies for children (0-17 years) at the intensive care unit (ICU) to a more open approach, children are still restricted from visiting for various reasons. To overcome these obstacles, it is vital to determine what is needed while encountering a child. To elucidate nurses' experiences of what constitutes the encounter with children visiting a sick parent at an adult ICU. An explorative inductive qualitative design was used, entailing focus group interviews with 23 nurses working at a general ICU. The interviews were analysed according to inductive content analysis. The findings show components that constitute the encounter with children as relatives at the ICU, as experienced by ICU nurses: nurses need to be engaged and motivated; parents need to be motivated; the child needs individual guidance; and a structured follow-up is needed. This reflects a child-focused encounter. Nurses need to adopt a holistic view, learn to see and care for the child individually, and be able to engage parents in supporting their children. To accomplish this the nurses need engagement and motivation, and must have knowledge about what constitutes a caring encounter, in order to achieve a caring child-focused encounter. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. The First Step toward Data Reuse: Disambiguating Concept Representation of the Locally Developed ICU Nursing Flowsheets

    Science.gov (United States)

    Kim, Hyeoneui; Harris, Marcelline R.; Savova, Guergana K.; Chute, Christopher G.

    2009-01-01

    Although an unambiguous and consistent representation is the foundation of data reuse, a locally developed documentation system such as nursing flowsheets often fails to meet the requirement. This article presents the domain modeling process of the ICU nursing flowsheet to clarify the meaning that its contents represent and the lessons learned during the activity. This study has been done as a first step toward reusing the data documented in a computerized nursing flowsheet for an algorithmic decision making. Following the ontology development processes proposed by other researchers a conceptual model was developed using Protégé. Then the existing information model was refined by fully specifying the embedded information structures and by establishing linkages to the conceptual model at the finest-grained concept level. Domain knowledge that the experienced nurses provided was critical to correctly interpret the meaning of the flowsheet contents as well as to verify the newly developed models. This study reassured the importance of the roles of a nurse informatician to develop a computerized nursing documentation system that accurately represents the information needs in nursing practice. PMID:18769183

  9. The Staff Nurse Clinical Leader at the Bedside: Swedish Registered Nurses' Perceptions.

    Science.gov (United States)

    Larsson, Inga E; Sahlsten, Monika J M

    2016-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  13. [Dialectics for humanized care in ICU's: contradictions between professional nursing discourse and practice].

    Science.gov (United States)

    de Pinho, Leandro Barbosa; dos Santos, Silvia Maria Azevedo

    2008-03-01

    This study attempts to unveil contradictions in humanized nursing care in ICUs. It is a qualitative, dialectic-based study involving 7 nurses, 4 family members and one patient of the Adult ICU of the Hospital of the Federal Universityof Santa Catarina. Participatory observation and semi-structured interviews were applied to collect the data. Marxist and Gramscian ideas of contradiction were used as the theoretical-philosophical reference. This study demonstrates that humanized care is part of a complex network, in which care knowledge seems to give way to closer network ties, while care practicefollows an impersonalized strategy within the logic of partitioned and routine health care production. The dissociation between knowledge and practice also contemplates the difficulties in dealing with the burdens of suffering and institutional-professional limitations. The conclusion is that knowledge of this reality should be a renewed, yet age-old challenge for the nurse in the search for the constant construction/ reconstruction of Nursing in terms of practice, knowledge and work relations.

  14. Unplanned extubation in the ICU: Impact on outcome and nursing workload

    Directory of Open Access Journals (Sweden)

    Krayem Ayman

    2006-01-01

    Full Text Available PURPOSE: To determine the incidence and factors associated with unplanned extubation (UE in the intensive care unit (ICU and its relationship with nursing workload. MATERIALS AND METHODS: A retrospective case-control study was carried out within a cohort of ventilated patients in two teaching hospital medical-surgical ICUs. A total of 50 adult patients with UE were studied. Controls were subjects without UE who were matched to the cases on the following Five factors: age, gender, admission diagnostic category, admission date (within 3 months and duration of mechanical ventilation. Other data including patient demographics, comorbid conditions, APACHE III score, ventilation parameters, use of sedation, re-intubation, mortality rate and ICU/hospital length of stay were collected. Nine equivalents of nursing manpower use score (NEMS and multiple organ dysfunction score (MODS were calculated in both, cases and controls, 24 h before and after the event. RESULTS: Sixty-eight episodes of UE occurred in 66 patients during the 24-month study period (1.1%. Patients with UE were more agitated ( P P =0.023 than their controls. UE was associated with a higher rate of re-intubation compared to the control group ( P P >0.05. The mean NEMS were not significantly different between the two groups 24 h before ( P =0.69 and after ( P =0.99 the extubation event. Also, the mean MODS were similar between both groups 24 h before ( P =0.69 and after ( P =0.74 extubation. CONCLUSION: In this study, agitation and greater use of benzodiazepines were frequently associated with UE and potentially can be used as risk factors for UE. We have found no significant impact of UE on increasing mortality and, in a manner not shown before, nursing workload.

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

    Science.gov (United States)

    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.

  16. Music therapy as an autonomous intervention of nurses for pain control in icu: integrative review

    Directory of Open Access Journals (Sweden)

    Lara Cardoso

    2017-09-01

    Objective: To understand the relevance of music therapy, as an autonomous nursing intervention, in controlling the pain of patients hospitalized in ICU’s. Methods: Integrative review of the literature, through the electronic research on the B-ON platform and the PubMed electronic database, conducted in January 2016, using the descriptors "nursing", "music", "pain" and "intensive care". Inclusion criteria were articles published between 2011 and 2015, with a qualitative or quantitative approach, in full text, Portuguese, Spanish or English, referring to adult patients and in intensive care unit, obtaining a total of 818 articles of which seven were included in the study. Results: Obtained studies are representative of a total of 1818 participants, mostly patients, from three continents. The articles showed that music therapy is effective in controlling pain, through musical preferences, the type of music and the volume of the music. Conclusions: Music therapy is an autonomous nursing intervention that can be used as a non-pharmacological intervention in pain control in patients with specific needs inherent to an ICU.

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

    Science.gov (United States)

    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.

  18. 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.

  19. Internationalisation in the Swedish Nurse Education from the Perspective of Teachers Involved: An Interview Study

    Science.gov (United States)

    Svensson, Lennart; Wihlborg, Monne

    2007-01-01

    This paper presents results from an interview investigation with teachers in Swedish nurse education especially interested in internationalising the education. The aim has been to study teachers' understandings and experiences of internationalisation against the backdrop of the strong concern for internationalisation expressed in policy documents.…

  20. Swedish registered nurses' and nurse managers' attitudes towards patient advocacy in community care of older patients.

    Science.gov (United States)

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

    2013-07-01

    To describe and compare registered nurses' (RNs) and nurse managers' (NMs) attitudes towards patient advocacy in the community care of older patients. RNs may act as patients' advocates in the care of older patients. NMs should support patient advocacy in order to make the best care available to patients. A modified Attitudes towards Patient Advocacy Scale was used to collect data from 207 RNs and 23 NMs in the Swedish community care of older patients. The response rate was 52%. Descriptive and inferential statistics were used. Both RNs and NMs showed positive attitudes towards patient advocacy. They were more positive towards patient advocacy for patients unable to help themselves than for competent patients. This study showed that RNs and NMs did not differ in their attitudes towards patient advocacy. This result is consistent with the idea of giving the neediest and vulnerable patients greater care. It is important for NMs to clarify their own and RNs attitudes towards patient advocacy as disparities may affect cooperation between the groups. Any effects on cooperation may, by extension, affect the quality of care. © 2012 John Wiley & Sons Ltd.

  1. Caring for dying people: attitudes among Iranian and Swedish nursing students.

    Science.gov (United States)

    Iranmanesh, Sedigheh; Axelsson, Karin; Häggström, Terttu; Sävenstedt, Stefan

    2010-09-01

    To compare the attitudes of Iranian and Swedish nursing students toward caring for dying persons. Their attitudes were measured with the Frommelt's Attitude Toward Caring of the Dying and the Death Attitude Profile Revised. The results indicated that the participating Iranian students were more afraid of death and less likely to give care to dying persons than the Swedish participants. It is suggested that theoretical education should be individualized and culturally sensitive in order to positively influence the students' attitudes, and promote professional development.

  2. Caring for dying people: Attitudes among Iranian and Swedish nursing students

    Directory of Open Access Journals (Sweden)

    Sedigheh Iranmanesh

    2010-01-01

    Full Text Available Aim: To compare the attitudes of Iranian and Swedish nursing students toward caring for dying persons. Materials and Methods: Their attitudes were measured with the Frommelt′s Attitude Toward Caring of the Dying and the Death Attitude Profile Revised. Results: The results indicated that the participating Iranian students were more afraid of death and less likely to give care to dying persons than the Swedish participants. Conclusion: It is suggested that theoretical education should be individualized and culturally sensitive in order to positively influence the students′ attitudes, and promote professional development.

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

    Science.gov (United States)

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

    2017-01-01

    ABSTRACT 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. PMID:28452605

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

    Science.gov (United States)

    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.

  5. 4-Nonylphenol and bisphenol A in Swedish food and exposure in Swedish nursing women.

    Science.gov (United States)

    Gyllenhammar, Irina; Glynn, Anders; Darnerud, Per Ola; Lignell, Sanna; van Delft, Rob; Aune, Marie

    2012-08-01

    4-Nonylphenol (NP) and bisphenol A (BPA) are phenolic substances used in high volumes by the industry. Studies on cells and in experimental animals have shown that both these compounds can be classified as estrogenic hormone disrupters. Information about the exposure of humans to NP and BPA is still scarce, especially regarding levels in human blood. The first aim of this study was to investigate possible sources of NP and BPA exposure from food, by analyzing the levels of NP and BPA from a Swedish food market basket, based on the Swedish per capita food consumption. A second aim was to investigate blood serum levels of NP and BPA, as well as NP-ethoxylates, among young women in Sweden (n=100). Moreover, associations between food consumption and blood NP and BPA levels were studied. In food, NP was to some extent found at levels above limit of quantification (LOQ 20 ng/g fresh weight) in fruits, cereal products, vegetables, and potatoes. BPA levels above LOQ (2 ng/g fresh weight) were found in fish, meats, potatoes, and dairy products. The estimated mean intakes per capita were (medium bound) 27 μg NP/day and 3.9 μg BPA/day, showing that food is a source of BPA and NP in the general Swedish population. In blood serum, free NP above limit of detection (LOD 0.5 ng/g) was detected in 46% of the study participants while detectable levels of total NP (LOD 0.8 ng/g) were observed in 43%. The corresponding percentages for BPA were 25% and 22%, respectively. The results indicate that there is a continuous source of exposure to NP and BPA that is high enough for free NP and BPA to be detected in some consumers. Among the participants with quantifiable levels of free and total NP (n=38), 85% (median, range: 38-112%) of the NP was present as free NP. For BPA 76% (49-109%) was detected as free BPA (n=15). All women had levels of ethoxylates of NP below LOD (0.1-0.7 ng/g). A significantly higher total consumption of fruits and vegetables was reported in questionnaires by

  6. 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.

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

    Science.gov (United States)

    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.

  8. 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.

  9. A literature review of the results from nursing and psychosocial research within Swedish pediatric oncology

    OpenAIRE

    Enskär, Karin; Knutsson, Susanne; Huus, Karina; Granlund, Mats; Darcy, Laura; Björk, Maria

    2014-01-01

    The body of research-based knowledge in paediatric caring science has been increasing leading to dramaticimprovements in treatment. The purpose of this manuscript was to analyze results as stated by the researchers', inrecently published articles on nursing and psychosocial research, within Swedish pediatric oncology setting. Thiswas done through a review of 137 published articles about paediatric oncology related to caring science in Sweden.The result shows that the illness has affected, in ...

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

    Science.gov (United States)

    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.

  11. ICU delirium: a survey into nursing and medical staff knowledge of current practices and perceived barriers towards ICU delirium in the intensive care unit.

    Science.gov (United States)

    Elliott, Sara R

    2014-12-01

    Delirium is an independent predictor of mortality and morbidity in the intensive care unit and is associated with a prolonged hospital and intensive care unit stay. National guidelines suggest that intensive care unit delirium is screened for daily using the confusion assessment method for the intensive care unit validated screening tool. Research suggests that there is a lack of knowledge on intensive care unit delirium, its screening tools and that it is inadequately screened for. The aim of the study is to assess nursing and medical staff knowledge, understanding and management of intensive care unit delirium and assess the perceived barriers associated with intensive care unit delirium screening using a validated screening tool. A survey design was used and a questionnaire designed to collect the data. The sample consisted of 149 nursing and medical staff working in three district intensive care units within the United Kingdom. The data yielded reveals that 44% (n = 33) of the respondents were not educated on ICU delirium. Furthermore the confusion assessment method for the intensive care unit was only being used in one out of the three sites surveyed and this was found to be at best sporadic, this fails to adhere to current delirium guidelines (NICE, 2010). Those using a non structured way of detecting delirium observed for hallucinations and agitation. Common associated barriers quoted in the literature such as time restraints did not appear to be an issue in this study. This study has shown that despite national guidelines screening with a validated delirium screening tool is not being performed in two of the intensive care unit surveyed and one site employs the confusion assessment method for the intensive care however screening is sporadic. This study contributes to the evidence base suggesting that intensive care unit delirium is under recognised and screened for despite current guidelines. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Nursing staff's experiences of working in an evidence-based designed ICU patient room-An interview study.

    Science.gov (United States)

    Sundberg, Fredrika; Olausson, Sepideh; Fridh, Isabell; Lindahl, Berit

    2017-12-01

    It has been known for centuries that environment in healthcare has an impact, but despite this, environment has been overshadowed by technological and medical progress, especially in intensive care. Evidence-based design is a concept concerning integrating knowledge from various research disciplines and its application to healing environments. The aim was to explore the experiences of nursing staff of working in an evidence-based designed ICU patient room. Interviews were carried out with eight critical care nurses and five assistant nurses and then subjected to qualitative content analysis. The experience of working in an evidence-based designed intensive care unit patient room was that the room stimulates alertness and promotes wellbeing in the nursing staff, fostering their caring activities but also that the interior design of the medical and technical equipment challenges nursing actions. The room explored in this study had been rebuilt in order to create and evaluate a healing environment. This study showed that the new environment had a great impact on the caring staffs' wellbeing and their caring behaviour. At a time when turnover in nurses is high and sick leave is increasing, these findings show the importance of interior design ofintensive care units. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Swedish Nurse Anesthetists' Experiences of the WHO Surgical Safety Checklist.

    Science.gov (United States)

    Rönnberg, Linda; Nilsson, Ulrica

    2015-12-01

    The World Health Organization (WHO) surgical safety checklist aims to increase communication, build teamwork, and standardize routines in clinical practice in an effort to reduce complications and improve patient safety. The checklist has been implemented in surgical departments both nationally and internationally. The purpose of this study was to describe the registered nurse anesthetists' (RNA) experience with the use of the WHO surgical safety checklist. This was a cross-sectional study with a descriptive mixed methods design, involving nurse anesthetists from two different hospitals in Sweden. Data were collected using a study-specific questionnaire. Forty-seven RNAs answered the questionnaire. There was a statistically significant lower compliance to "Sign-in" compared with the other two parts, "Timeout" and "Sign-out." The RNAs expressed that the checklist was very important for anesthetic and perioperative care. They also expressed that by confirming their own area of expertise, they achieved an increased sense of being a team member. Thirty-four percent believed that the surgeon was responsible for the checklist, yet this was not the reality in clinical practice. Although 23% reported that they initiated use of the checklist, only one RNA believed that it was the responsibility of the RNA. Forty-three percent had received training about the checklist and its use. The WHO surgical checklist facilitates the nurse anesthetist's anesthetic and perioperative care. It allows the nurse anesthetist to better identify each patient's specific concerns and have an increased sense of being a team member. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. 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 ...

  16. Swedish version of measuring cultural awareness in nursing students: validity and reliability test.

    Science.gov (United States)

    Hadziabdic, Emina; Safipour, Jalal; Bachrach-Lindström, Margareta; Hultsjö, Sally

    2016-01-01

    Nearly 20 % of the Swedish population is foreign-born. Increased exposure of patients from diverse cultures means there is an urgent need to address their unique requirements and provide optimal health care to a diverse population. Nursing schools thus have an important goal of educating nurses to ensure they are culturally competent. Culturally competent care improves safety and equity for patients. To measure cultural awareness among nursing students in Sweden, the aim of this study was to translate, adapt and test the validity and reliability of the Swedish version of a cultural awareness scale which has not previously been tested. A total of 158 nursing students from three universities in Sweden completed the 36-item questionnaire on cultural awareness. Verification of face and content validity and a translation/reverse translation process were first carried out. The results indicate that one item (no 13) caused weak reliability and validity, and therefore it was removed. The reliability test result (with 35 items) showed Cronbach's Alpha ranged from 0.60 to 0.87. The Model ChiSq group fit for five factors was 50.44 (31.27-77.06; Df = 5; p cultural settings.

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

    Science.gov (United States)

    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.

  18. Changing essay writing in undergraduate nursing education through action research: a Swedish example.

    Science.gov (United States)

    Friberg, Febe; Lyckhage, Elisabeth Dahlborg

    2013-01-01

    This article describes the development of literature-based models for bachelor degree essays in Swedish undergraduate nursing education. Students' experiences in a course with literature-based models for bachelor degree essays are discussed. The ever-growing body of nursing research and specialized and complex health care practices make great demands on nursing education in terms of preparing students to be both skilled practitioners and users of research. Teaching to help students understand evidence-based practice is a challenge for nursing education. Action research was used to generate knowledge of and practical solutions to problems in everyday locations. Six models were developed: concept analysis, contributing to evidence-based nursing by means of quantitative research, contributing to evidence-based nursing by means of qualitative research, discourse analysis, analysis of narratives, and literature review. Action research was found to be a relevant procedure for changing ways of working with literature-based, bachelor degree essays. The models that were developed increased students' confidence in writing essays and preparedness for the nursing role.

  19. Self-reported attitudes versus actual practice of oxygen therapy by ICU physicians and nurses

    NARCIS (Netherlands)

    Helmerhorst, Hendrik J. F.; Schultz, Marcus J.; van der Voort, Peter H. J.; Bosman, Robert J.; Juffermans, Nicole P.; de Jonge, Evert; van Westerloo, David J.

    2014-01-01

    Background: High inspiratory oxygen concentrations are frequently administered in ventilated patients in the intensive care unit (ICU) but may induce lung injury and systemic toxicity. We compared beliefs and actual clinical practice regarding oxygen therapy in critically ill patients. Methods: In

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

    African Journals Online (AJOL)

    Background. Care of the critically ill patient has become increasingly challenging, with a rising incidence of resistant pathogens resulting in the ineffectiveness of many antibiotics. Severe infection is associated with prolonged intensive care unit (ICU) length of stay, and increased morbidity, mortality, and healthcare costs.

  1. Ideologies and Research in Nursing Care. Nursing Education. Swedish Research on Higher Education.

    Science.gov (United States)

    Wallen, Goran

    Trends in nursing research in Sweden are first discussed in relation to nursing education. Beyond the university, two "roots" of nursing research are investigated: (1) The first studies included analysis of the working conditions of nursing care; and (2) Later research topics covered nurse-patient relations and patients' needs. The…

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

    Science.gov (United States)

    Holmberg, Christopher; Caro, Jino; Sobis, Iwona

    2017-04-10

    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.

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

    Science.gov (United States)

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

    2016-01-01

    Abstract Background: Communication among doctors, nurses, and families contributes to high-quality end-of-life care, but is difficult to improve. Objective: Our objective was to identify aspects of communication appropriate for interventions to improve quality of dying in the intensive care unit (ICU). Methods: 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). Results: 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. Conclusions: 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

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

    Science.gov (United States)

    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

  5. Role clarity and role conflict among Swedish diabetes specialist nurses.

    Science.gov (United States)

    Boström, Eva; Hörnsten, Asa; Lundman, Berit; Stenlund, Hans; Isaksson, Ulf

    2013-10-01

    To explore diabetes specialist nurses (DSNs)' perceptions of their role in terms of clarity, conflict and other psychosocial work aspects. A cross-sectional study was conducted among DSNs in a county in northern Sweden. The DSNs answered the Nordic Questionnaire of Psychological and Social Factors at Work (QPS Nordic) about psychosocial aspects of their work. Statistical analysis compared DSNs with a reference group of different health professionals. Correlations between role clarity, role conflict, and other variables were analysed. The DSNs perceived more, and higher, job demands, including quantitative, decision-making and learning demands, but also more positive challenges at work compared with the reference group. Role clarity correlated with experiences of health promotion, perception of mastery, co-worker support, and empowering leadership, while role conflict correlated with quantitative and learning demands. The DSNs perceived high demands but also positive challenges in their work. Their role expectations correlated with several psychosocial work aspects. It is important that DSNs should be presented with positive challenges as meaningful incentives for further role development and enhanced mastery of their work. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  6. Perbandingan Abdominal Massage dengan Teknik Swedish Massage dan Teknik Effleurage terhadap Kejadian Konstipasi pada Pasien yang Terpasang Ventilasi Mekanik di ICU

    National Research Council Canada - National Science Library

    Arimbi Karunia Estri; Sari Fatimah; Ayu Prawesti

    2017-01-01

    ...). Teknik abdominal massage yang dapat digunakan untuk mencegah konstipasi adalah swedish massage dan effleurage, namun demikian belum ada penelitian lanjutan yang menunjukkan teknik yang paling efektif...

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

    Science.gov (United States)

    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 nurse and positive patient behaviors, (b) patient unaided augmentative and alternative communication (AAC) strategies and positive nurse behaviors, (c) individual patient unaided AAC strategies and individual nurse positive behaviors, (d) positive nurse behaviors and pain management, and (e) positive patient behaviors and sedation level. Findings provide evidence that nurse and patient behaviors effect communication and may be associated with nursing care quality. Copyright 2014, SLACK Incorporated.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Neonatal death and parents' grief. Experience, behaviour and attitudes of Swedish nurses.

    Science.gov (United States)

    Lundqvist, A; Nilstun, T

    1998-01-01

    The aim of the present study was to survey the experience, behaviour and attitudes of nurses in Swedish neonatal wards towards parents who refuse or are reluctant to see, touch or hold their dying or dead baby. A questionnaire was distributed to 173 nurses, of whom 144 responded. The questionnaire contained questions about the nurses' own experience of such situations, their behaviour, and their attitude towards influencing the parents. Seventy-four percent answered that they had experience of such situations, 59% that they often tried to persuade or in other ways influence the parents to change their mind, and 60% were of the opinion that the parents mourning-process is always facilitated when they touch or hold their dead baby. Most nurses (83%) were of the opinion that the conflict between beneficence and autonomy was difficult but not impossible to solve. A majority of the nurses were inclined to give priority to the principle of beneficence. But is this inclination ethically justified? A well-founded answer to this question requires more knowledge about the experiences of parents who have lived through such traumatic situations.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Nurse and Patient Interaction Behaviors Effects on Nursing Care Quality for Mechanically Ventilated, Older Adults in the ICU

    Science.gov (United States)

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

    2014-01-01

    The study purposes were to 1) describe interaction behaviors and factors that may impact communication and 2) explore associations between interaction behaviors and nursing care quality indicators between 38 mechanically ventilated patients (≥60 years) and their intensive care unit nurses (n=24). Behaviors were measured by rating videotaped 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 (pnurse and positive patient behaviors, 2) patient unaided augmentative and alternative communication (AAC) strategies and positive nurse behaviors, 3) individual patient unaided AAC strategies and individual nurse positive behaviors and 4) positive nurse behaviors and pain management, and 5) positive patient behaviors and sedation level. Findings provide evidence that nurse and patient behaviors impact communication and may be associated with nursing care quality. PMID:24496114

  12. Causal and emotional factors related to work stress in ICU nursing staff. The importance of accurate measurement.

    Science.gov (United States)

    Fornés Vives, J; Gallego Caminero, G; Barceló Oliver, M; Crespi Capó, M; Guttierrez Casado, A

    1994-03-01

    This study was designed to determine the degree of intervention of causal and emotional factors in work stress in intensive care unit (ICU) nursing staff. A questionnaire to assess stress causes (27) and associated emotions (33) was given to 123 people (85 registered nurses and 38 auxiliary nurses) aged 22-56, working in ICUs in different hospitals in Palma de Mallorca. Descriptive and factorial analyses were carried out. Respondents gave most stress causes a medium score (3.5-6.5 points), the highest values corresponding to staff shortage (mean = 6.71), bad management organisation (mean = 6.65) and little free time (mean = 6.5). These causes are grouped in seven factors which account for 65.51% of variance and are particularly related to organisational problems, training and personal relationships, work demands and physical and emotional overload. The most important emotions for this sample are: responsibility (mean = 6.61), impotence (mean = 6.23) and desire to excel (mean = 6.080). Such emotions are divided into seven factors which explain 65.31% of the variance and define states of personal satisfaction, depersonalisation, anxiety, low self-esteem, helplessness and arrogance. Surprisingly, the main factor with the value 5.08 and a variance of 15.42%, corresponds to positive or pleasant emotions. The results corroborate previous research findings on work stress, provide a simplified tool for assessing this and show the need to quantify the degree of such manifestations in the assessments.

  13. Development of an instrument to determine competencies of postgraduate ICU nurses in Cyprus.

    Science.gov (United States)

    Hadjibalassi, Maria; Papastavrou, Evridiki; Lambrinou, Ekaterini; Tsangari, Haritini; Athini, Evdokia; Georgiou, Evanthia; Nicolaou, Elisavet; Merkouris, Anastasios

    2012-01-01

    The study sought to explore the expected competencies for postgraduate intensive care unit nurses aiming to develop a future competency-based curriculum. The aim of this part of the study is to develop a new instrument to determine what competencies are expected of postgraduate critical care nurses. Despite existing competency frameworks that emerged from research in the area of critical care, globally and within countries there is diversity and an ongoing debate regarding level of critical care education, outcomes and competencies acquired. A combination of qualitative and quantitative approach was used. In first stage (qualitative), focus groups and interviews were used aiming to explore critical care nurses views concerning expected competencies of postgraduate critical care nurses. In second stage (quantitative), an 81 items Likert scale questionnaire, which was designed based on qualitative data and literature, was distributed among critical care nurses in Cyprus (n: 234, response rate 66%) aiming to receive feedback from clinical nurses and validate the instrument. Psychometric approaches such as internal consistency reliability using Cronbach's α and construct validity were used to validate the instrument. The final questionnaire includes 72 items and has a four-dimensional structure. The four dimensions are (1) leadership/management and professional development, (2) decision-making and management of emergencies, (3) provision of care and professional practice and (4) ethical practice. All factors were highly reliable, with Cronbach's α ranging from 0·895 to 0·974. A new instrument to determine what competencies are expected of postgraduate critical care nurses was generated from this study. A new framework of competencies is grounded on this study that addresses the holistic, individualized and ethically informed quality care of critically ill and may inform educational strategies. Critical care nurses competencies need to be determined for quality care

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

    Science.gov (United States)

    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.

  15. ICU Nurses' Knowledge, Attitude, and Practice Towards their Role in the Organ Donation Process from Brain-Dead Patients and Factors Influencing it in Iran.

    Science.gov (United States)

    Masoumian Hoseini, S T; Manzari, Z; Khaleghi, I

    2015-01-01

    Nowadays, ICU nurses play a significant role in the care of brain-dead patients and their families. Therefore, their knowledge, attitude and practice towards this issue are extremely important to the success of organ donation. To assess ICU nurses' knowledge, attitude and practice towards their role in the organ donation process from brain-dead patients and factors influencing it in Iran. In a cross-sectional analytical study, 90 ICU nurses working in Ghaem and Emam Reza Hospitals affiliated to Mashhad University of Medical Sciences were selected through a stratified random sampling. Data were collected from the participants by a questionnaire included demographic information, and factors influencing the nurses knowledge, attitude, and practice towards their roles in the organ donation process. 90 nurses participated in this study. 70% of the research subjects had spoken with their own families about organ donation; 20% had organ donation cards. The mean±SD score of nurses' knowledge was 49.13±9.6, attitude 21.49±14.32, and practice was 3.66±6.04. 80% of nurses had a mean knowledge about their roles in the organ donation process; 82% agreed with their roles in this process, and 97% showed weak practice in this regard. Nurses did not have adequate knowledge, attitude, and practice towards their role in organ donation process. It is suggested to include nursing courses on the organ donation process and organ transplantation as well as educational programs to acquaint nurses with their roles in the organ donation process.

  16. Nurses' experiences of caring encounters with older people living in Swedish nursing homes.

    Science.gov (United States)

    Westin, Lars; Danielson, Ella

    2006-03-01

    Aim.  The aim of the study was to describe and interpret the meaning of nurses' experiences of caring encounters with residents in nursing homes. Background.  Life for residents in nursing homes can be characterized as a process of decreased physical and psychological resources. Therefore, encounters with nurses are important activities for providing meaning and security for the residents. Research in this field has previously focused on communication, attitudes and job satisfaction, but gives limited knowledge about what the human encounters in this context mean for the nurses. Method.  A hermeneutic method was used in this study. Interviews were conducted with 14 nurses from two nursing homes about their experiences of caring encounters. The transcribed interview texts were interpreted as a whole. Results.  In the interpretation of the text concerning the meaning of nurses' experiences of encounters with resident's four themes and 11 subthemes emerged. The comprehensive interpretation mainly showed possible ways available being present, being significant and being aware of opportunities for the nurse to find meaning in the encounter with the resident, but impossible ways as being inadequately were also revealed. Conclusion.  This study shows the importance of caring encounters between nurses and residents in nursing homes. The good encounters provide various possible ways for nurses to find meaning and a sense of communion with residents. However, bad encounters, described as being inadequate, were found to inhibit nurses from finding meaning in their encounters with residents. Relevance to clinical practice.  Meeting the needs of older people in nursing homes requires special knowledge about the importance of the caring encounter. Therefore, nurses in this care context need supervision and continuous education in order to gain relevant knowledge about the meaning of caring encounters for themselves and residents.

  17. 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.

  18. Depression and use of antidepressants in Swedish nursing homes: a 12-month follow-up study.

    Science.gov (United States)

    Midlöv, Patrik; Andersson, Martin; Ostgren, Carl Johan; Mölstad, Sigvard

    2014-04-01

    The prescription of antidepressants in nursing homes has increased markedly since the introduction of SSRIs, while at the same time depressive symptoms often go unrecognized and untreated. The aim of this study was to examine whether depression among residents in nursing homes is treated adequately. A sample of 429 participants from 11 Swedish nursing homes was selected and was assessed with the Cornell Scale for Depression in Dementia (CSDD) and using medical records and drug prescription data. For 256 participants a follow-up assessment was performed after 12 months. The prevalence of depression, according to medical records, was 9.1%, and the prevalence of CSDD score of ≥8 was 7.5%. Depression persisted in more than 50% of cases at the 12-month follow-up. Antidepressants were prescribed to 33% of the participants without a depression diagnosis or with a CSDD score of depression diagnosis or with a CSDD score of nursing homes, paying special attention to the subjects which are on antidepressants.

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

    African Journals Online (AJOL)

    Data were analysed and categorised using content analysis. The study was conducted ... [1] Decreasing availability of antimicrobial therapy to treat complicated infections is .... the care of the patient … it's a massive responsibility.' (Non-nursing.

  20. Nurses' perceptions of standardised assessment and prevention of complications in an ICU.

    Science.gov (United States)

    Soh, Kim Lam; Davidson, Patricia M; Leslie, Gavin; DiGiacomo, Michelle; Soh, Kim Geok

    2013-03-01

    To describe nurses' perceptions of evidence-based recommendations to prevent complications in a Malaysian intensive care unit. Ventilator-associated pneumonia, catheter-related blood stream infection and pressure ulcer are three frequent adverse events in the intensive care unit. Implementing evidenced-based practice is critical in prevention of these complications. A qualitative focus group study. Focus groups were conducted with nurses in the intensive care unit of a regional hospital in Malaysia following evidence-based interventions. Focus group transcripts were analysed using the method of thematic analyses. Thirty-four nurses participated in eight focus groups. The main themes derived from the interviews: (1) nurses' knowledge impacts on the change process; (2) initial resistance, ambivalence and movement to acceptance; and (3) hierarchical organisational structure can hinder the change process. Enhancing nurses' knowledge and attitudes of evidence-based practice, providing them with tools to monitor their clinical practice, and empowering them to change practice are likely to be important in influencing clinical outcomes. Increasing the emphasis on evidence-based practice in nursing curricula and engaging in cultural change processes in the workplace are necessary to improve clinical outcomes. These findings provide valuable information for implementing clinical practice improvement interventions. © 2012 Blackwell Publishing Ltd.

  1. The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: results of a national survey.

    Science.gov (United States)

    Mealer, Meredith; Jones, Jacqueline; Newman, Julia; McFann, Kim K; Rothbaum, Barbara; Moss, Marc

    2012-03-01

    ICU nurses are repeatedly exposed to work related stresses resulting in the development of psychological disorders including posttraumatic stress disorder and burnout syndrome. Resilience is a learnable multidimensional characteristic enabling one to thrive in the face of adversity. In a national survey, we sought to determine whether resilience was associated with healthier psychological profiles in intensive care unit nurses. Surveys were mailed to 3500 randomly selected ICU nurses across the United States and included: demographic questions, the Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Maslach Burnout Inventory and the Connor-Davidson Resilience Scale. Overall, 1239 of the mailed surveys were returned for a response rate of 35%, and complete data was available on a total of 744 nurses. Twenty-two percent of the intensive care unit nurses were categorized as being highly resilient. The presence of high resilience in these nurses was significantly associated with a lower prevalence of posttraumatic stress disorder, symptoms of anxiety or depression, and burnout syndrome (burnout syndrome (pburnout syndrome in intensive care unit nurses. Future research is needed to better understand coping mechanisms employed by highly resilient nurses and how they maintain a healthier psychological profile. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. Experiencing a nurse identity: the meaning of identity to Swedish registered nurses 2 years after graduation.

    Science.gov (United States)

    Fagerberg, I; Kihlgren, M

    2001-04-01

    The professional identity and experiences of nurses have been focused upon in different studies This is a longitudinal study whose aim was to understand how nurses experience the meaning of their identity as nurses, when they are students and nurses 2 years after graduation. Data were collected through interviews once a year during education and two years after graduation, and were analysed using a phenomenological hermeneutic method, inspired by the philosophy of Paul Ricoeur. The analyses of the narratives resulted in four perspectives: 'Having the patient in focus', 'Being a team leader', 'Preceptorship' and 'Task orientation'. The nurses did not change perspectives but the perspective showed a transition over time. The nurses' not changing perspective over time is understood as being a life paradigm, remaining throughout the years.

  3. Goals of telephone nursing work--the managers' perspectives: a qualitative study on Swedish Healthcare Direct.

    Science.gov (United States)

    Kaminsky, Elenor; Carlsson, Marianne; Holmström, Inger K; Larsson, Jan; Fredriksson, Mio

    2014-04-24

    Swedish Healthcare Direct (SHD) receives 6 million calls yearly and aims at increased public sense of security and healthcare efficiency. Little is known about what SHD managers perceive as the primary goals of telephone nursing (TN) work and how the organisation matches goals of health promotion and equitable healthcare, so important in Swedish healthcare legislation. The aim of the study was to explore and describe what the SHD managers perceive as the goals of TN work and how the managers view health promotion and implementation of equitable healthcare with gender as example at SHD. The study was qualitative using an exploratory and descriptive design. All 23 managers employed at SHD were interviewed and data analysis used deductive directed content analysis. The findings reveal four themes describing the goals of TN work as recommended by the SHD managers. These are: 'create feelings of trust', 'achieve patient safety', 'assess, refer and give advice', and 'teach the caller'. Most of the managers stated that health promotion should not be included in the goals, whereas equitable healthcare was viewed as an important issue. Varying suggestions for implementing equitable healthcare were given. The interviewed managers mainly echoed the organisational goals of TN work. The managers' expressed goal of teaching lacked the caller learning components highlighted by telenurses in previous research. The fact that health promotion was not seen as important indicates a need for SHD to clarify its goals as the organisation is part of the Swedish healthcare system, where health promotion should always permeate work. Time used for health promotion and dialogues in a gender equitable manner at SHD is well invested as it will save time elsewhere in the health care system, thereby facing one of the challenges of European health systems.

  4. Integrative review of nurse-led follow-up after discharge from the ICU.

    Science.gov (United States)

    Jónasdóttir, Rannveig J; Klinke, Marianne E; Jónsdóttir, Helga

    2016-01-01

    To analyse and synthesise the structure, content, types of outcome variables and advantages of nurse-led follow-up of adult patients after discharge from intensive care units. Follow-up service after discharge from the intensive care unit has been suggested as a way of supporting recovery of patients. Nevertheless, varieties exist in the understanding and content of nurse-led follow-up. An integrative review of nurse-led follow-up inspired by the framework of Whittemore and Knafl. An integrative method merged with the recommendations of the PRISMA statement was used to structure the review and findings. Online databases PubMed, CINAHL, ScienceDirect and Scopus were searched from the years 2003-2014. The retrieved articles were independently assessed by two reviewers. Critical appraisal was conducted using check lists from Johanna Briggs Institute. Emerging patterns were validated by all the authors throughout the entire process of analysis. Seventeen papers were included. Three patterns of nurse-led follow-up were identified: (1) Ward visits--in the immediate time after discharge from intensive care unit, (2) Ward visits and appointment(s) to an intensive care unit follow-up clinic and (3) follow-up visit to an intensive care unit and phone call(s) after discharge. Content of short-term nurse-led follow-up (1) ranged from clinical assessment to supporting patients in articulating their subjective health concerns. Long-term nurse-led follow-up (2, 3) included appointments, phone call(s) or information on where advice could be sought. Types of outcome variables were primarily descriptive. There were strong implications for patients' satisfaction with nurse-led follow-up up to six months after discharge. Nurse-led follow-up might promote patients' health and enable use of adequate resources. The findings of this review could be used to design, and test, future interventions and their implementation. © 2015 John Wiley & Sons Ltd.

  5. Clinical nursing leaders' perceptions of nutrition quality indicators in Swedish stroke wards: a national survey.

    Science.gov (United States)

    Persenius, Mona; Hall-Lord, Marie-Louise; Wilde-Larsson, Bodil; Carlsson, Eva

    2015-09-01

    To describe nursing leaders' perceptions of nutrition quality in Swedish stroke wards. A high risk of undernutrition places great demand on nutritional care in stroke wards. Evidence-based guidelines exist, but healthcare professionals have reported low interest in nutritional care. The Donabedian framework of structure, process and outcome is recommended to monitor and improve nutrition quality. Using a descriptive cross-sectional design, a web-based questionnaire regarding nutritional care quality was delivered to eligible participants. Most clinical nursing leaders reported structure indicators, e.g. access to dieticians. Among process indicators, regular assessment of patients' swallowing was most frequently reported in comprehensive stroke wards compared with other stroke wards. Use of outcomes to monitor nutrition quality was not routine. Wards using standard care plans showed significantly better results. Using the structure, process and outcome framework to examine nutrition quality, quality-improvement needs became visible. To provide high-quality nutrition, all three structure, process and outcome components must be addressed. The use of care pathways, standard care plans, the Senior Alert registry, as well as systematic use of outcome measures could improve nutrition quality. To assist clinical nursing leaders in managing all aspects of quality, structure, process and outcome can be a valuable framework. © 2013 John Wiley & Sons Ltd.

  6. Patient safety subcultures among registered nurses and nurse assistants in Swedish hospital care: a qualitative study.

    Science.gov (United States)

    Danielsson, Marita; Nilsen, Per; Ohrn, Annica; Rutberg, Hans; Fock, Jenni; Carlfjord, Siw

    2014-01-01

    Patient safety culture emerges from the shared assumptions, values and norms of members of a health care organization, unit, team or other group with regard to practices that directly or indirectly influence patient safety. It has been argued that organizational culture is an amalgamation of many cultures, and that subcultures should be studied to develop a deeper understanding of an organization's culture. The aim of this study was to explore subcultures among registered nurses and nurse assistants in Sweden in terms of their assumptions, values and norms with regard to practices associated with patient safety. The study employed an exploratory design using a qualitative method, and was conducted at two hospitals in southeast Sweden. Seven focus group interviews and two individual interviews were conducted with registered nurses and seven focus group interviews and one individual interview were conducted with nurse assistants. Manifest content analysis was used for the analysis. Seven patient safety culture domains (i.e. categories of assumptions, values and norms) that included practices associated with patient safety were found: responsibility, competence, cooperation, communication, work environment, management and routines. The domains corresponded with three system levels: individual, interpersonal and organizational levels. The seven domains consisted of 16 subcategories that expressed different aspects of the registered nurses and assistants nurses' patient safety culture. Half of these subcategories were shared. Registered nurses and nurse assistants in Sweden differ considerably with regard to patient safety subcultures. The results imply that, in order to improve patient safety culture, efforts must be tailored to both registered nurses' and nurse assistants' patient safety-related assumptions, values and norms. Such efforts must also take into account different system levels. The results of the present study could be useful to facilitate discussions

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

    African Journals Online (AJOL)

    Background. Do not resuscitate (DNR) is the policy and practice of deliberately not attempting to resuscitate a person whose heart has stopped beating. Research on nursing care for patients designated with DNR orders has been conducted since the late 1980s; however, no study appears to have been carried out in the ...

  8. Swedish nurses' perception of nursing research and its implementation in clinical practice: a focus group study.

    Science.gov (United States)

    Bohman, Doris M; Ericsson, Terese; Borglin, Gunilla

    2013-09-01

    Nowadays, nursing research is seen as an integral part of professional nursing although implementing knowledge derived from nursing research into the practice setting is still problematic. Current research, conducted mainly with a descriptive quantitative design, highlights the struggle experienced by Registered Nurses (RNs) to use and implement research findings in clinical practice. Therefore, the aim of this naturalistic inquiry was to explore nurses' perception of nursing research and its implementation in a clinical context. A qualitative approach was chosen, and four focus group discussions were conducted. The groups comprised a total of 16 RNs (three men and 13 women) working in a secondary care setting. The transcribed texts were analysed, inspired by Burnard's description of content analysis. The texts were interpreted as representing three predominant themes: scholastic, individual and contextual influences highlighted as influential components impacting on the RNs' views on research and its implementation as well as on their readiness to accept and support it. However, the most influential aspect permeating our themes was their educational background--the type of qualification they held. In general, the RNs with a Bachelor of Science in Nursing viewed research and the implementation of knowledge in practice more favourably than those RNs with a diploma. Our findings, although based on a small qualitative study, are congruent with others, indicating that further research is warranted concerning the impact of education on RNs' views of nursing research and its implementation. Hence, it might well be that the RNs' educational point of departure needs to be stressed more than what so far have been anticipated. In the meanwhile, it is possible that a number of strategies could be tested to promote a more favourable view in these issues and where the nursing education has the possibility to influence this endeavour. © 2012 The Authors. Scandinavian Journal of

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  11. The impact of nUrsiNg DEliRium Preventive INnterventions in the Intensive Care Unit (UNDERPIN-ICU): A study protocol for a multi-centre, stepped wedge randomized controlled trial.

    Science.gov (United States)

    Wassenaar, Annelies; Rood, Paul; Schoonhoven, Lisette; Teerenstra, Steven; Zegers, Marieke; Pickkers, Peter; van den Boogaard, Mark

    2017-03-01

    Delirium is a common disorder in Intensive Care Unit (ICU) patients and is associated with serious short- and long-term consequences, including re-intubations, ICU readmissions, prolonged ICU and hospital stay, persistent cognitive problems, and higher mortality rates. Considering the high incidence of delirium and its consequences, prevention of delirium is imperative. This study focuses on a program of standardized nursing and physical therapy interventions to prevent delirium in the ICU, called UNDERPIN-ICU (nUrsiNg DEliRium Preventive INterventions in the ICU). To determine the effect of the UNDERPIN-ICU program on the number of delirium-coma-free days in 28days and several secondary outcomes, such as delirium incidence, the number of days of survival in 28 and 90days and delirium-related outcomes. A multicenter stepped wedge cluster randomized controlled trial. Eight to ten Dutch ICUs will implement the UNDERPIN-ICU program in a randomized order. Every two months the UNDERPIN-ICU program will be implemented in an additional ICU following a two months period of staff training. UNDERPIN-ICU consists of standardized protocols focusing on several modifiable risk factors for delirium, including cognitive impairment, sleep deprivation, immobility and visual and hearing impairment. ICU patients aged ≥18years (surgical, medical, or trauma) and at high risk for delirium, E-PRE-DELIRIC ≥35%, will be included, unless delirium was detected prior ICU admission, expected length of ICU stay is less then one day or when delirium assessment is not possible. For every intervention the balance between putative benefit and potential unwanted side effects needs to be considered. In non-ICU patients, it has been shown that a similar program resulted in a significant reduction of delirium incidence and duration. Recent small studies using multi component interventions to prevent delirium in ICU patients have also shown beneficial effect, without unwanted side effects. We

  12. Clinical decision-making described by Swedish prehospital emergency care nurse students - An exploratory study.

    Science.gov (United States)

    Nilsson, Tomas; Lindström, Veronica

    2016-07-01

    The purpose of this study was to explore the PECN students' clinical decision-making during a seven-week clinical rotation in the ambulance services. Developing expertise in prehospital emergency care practices requires both theoretical and empirical learning. A prehospital emergency care nurse (PECN) is a Registered Nurse (RN) with one year of additional training in emergency care. There has been little investigation of how PECN students describe their decision-making during a clinical rotation. A qualitative study design was used, and 12 logbooks written by the Swedish PECN students were analysed using content analysis. The students wrote about 997 patient encounters - ambulance assignments during their clinical rotation. Four themes emerged as crucial for the students' decision-making: knowing the patient, the context-situation awareness in the ambulance service, collaboration, and evaluation. Based on the themes, students made decisions on how to respond to patients' illnesses. The PECN students used several variables in their decision-making. The decision- making was an on-going process during the whole ambulance assignment. The university has the responsibility to guide the students during their transition from an RN to a PECN. The findings of the study can support the educators and clinical supervisors in developing the programme of study for becoming a PECN. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Finding a Middle Ground: Exploring the Impact of Patient- and Family-Centered Design on Nurse-Family Interactions in the Neuro ICU.

    Science.gov (United States)

    Rippin, Allyn S; Zimring, Craig; Samuels, Owen; Denham, Megan E

    2015-01-01

    This comparative study of two adult neuro critical care units examined the impact of patient- and family-centered design on nurse-family interactions in a unit designed to increase family involvement. A growing evidence base suggests that the built environment can facilitate the delivery of patient- and family-centered care (PFCC). However, few studies examine how the PFCC model impacts the delivery of care, specifically the role of design in nurse-family interactions in the adult intensive care unit (ICU) from the perspective of the bedside nurse. Two neuro ICUs with the same patient population and staff, but with different layouts, were compared. Structured observations were conducted to assess changes in the frequency, location, and content of interactions between the two units. Discussions with staff provided additional insights into nurse attitudes, perceptions, and experiences caring for families. Nurses reported challenges balancing the needs of many stakeholders in a complex clinical environment, regardless of unit layout. However, differences in communication patterns between the clinician- and family-centered units were observed. More interactions were observed in nurse workstations in the PFCC unit, with most initiated by family. While the new unit was seen as more conducive to the delivery of PFCC, some nurses reported a loss of workspace control. Patient- and family-centered design created new spatial and temporal opportunities for nurse-family interactions in the adult ICU, thus supporting PFCC goals. However, greater exposure to unplanned family encounters may increase nurse stress without adequate spatial and organizational support. © The Author(s) 2015.

  14. A gap between the intention of the Swedish law and interactions between nurses and children of patients in the field of palliative oncology - The perspective of nurses.

    Science.gov (United States)

    Karidar, Hakima; Åkesson, Helene; Glasdam, Stinne

    2016-06-01

    Children who have a parent with incurable cancer are in a vulnerable situation and the Swedish law tries to protect them. This article aims to explore the interactions between nurses and children of patients with incurable cancer from the nurses' perspective. Semi-structured interviews with nine nurses in palliative oncology in Southern Sweden. Latent content analysis was carried out, inspired by Lundmann and Graneheim. Parents are gatekeepers to the children's involvement and meetings with the healthcare professionals. Therefore the nurses were dependent on the parents for contact with their children. Additionally, nurses were subject to the structural frame of their working environment in terms of time, economy, resources and the medical logic ruling the priorities for nursing during their daily working day. The opportunities to pay attention to the children of patients were limited, despite good intentions, willingness and a favourable legal framework. Teenagers were regarded as a challenge, and per se they challenged the nurses' opportunities to gain control of the meetings and situations around the families. Often nurses did not see and acknowledge the children of the palliative patient. They knew that the children were there and that it was important that they were there, but they challenged the order in the working environment in relation to time-allocated tasks and working flow. In the working environment patients were prioritised over relatives. From the perspective of nurses, there is a gap between the intentions of the Swedish law and the interactions between nurses and children. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. A case report: Nursing interventions on a patient with anaphylactic shock in ICU.

    Science.gov (United States)

    Zariquiey-Esteva, G; Santa-Candela, P

    The care plan of a 42-year-old woman with anaphylactic shock, secondary to ingestion of amoxicillin/clavulanic acid, with upper airway involvement due to laryngeal angioedema, is presented. Previously she had had two episodes of angioedema of unknown origin. The incidence of this phenomenon is between 3.2 and 10 cases/100,000 people/year. An evaluation was made and three altered necessities stood out: breathing and circulation (she needed mechanical ventilation and noradrenalin perfusion), elimination (she required furosemide to keep an acceptable diuresis time), and hygiene and skin protection (she presented generalised hyperaemia, lip, lingual and oropharyngeal oedema). The hospital's Clinical Research Ethics Committee requested the patient's informed consent to access her clinical history. According to the altered necessities, seven diagnoses were prioritised according to NANDA taxonomy: risk of allergic response, risk of infection, risk of ineffective renal perfusion, decreased cardiac output, impaired spontaneous ventilation, risk of unstable blood glucose level, and risk of dysfunctional gastrointestinal motility. Scores of outcome criteria showed a favourable evolution after 24hours. The development of a standardised NANDA-NOC-NIC language in the clinical case presented allowed us to organise the nursing work, facilitating recording and normalising clinical practice. As a limitation of this case, we didn't have serial plasma levels of histamine and tryptase to assess the evolution of anaphylactic symptoms. Highlight the importance of health education in a patient with a history of angioedema. Copyright © 2016 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  16. A Swedish perspective on nursing and psychosocial research in paediatric oncology: A literature review.

    Science.gov (United States)

    Enskär, Karin; Björk, Maria; Knutsson, Susanne; Granlund, Mats; Darcy, Laura; Huus, Karina

    2015-06-01

    A dramatic improvement in outcomes of survival rates of childhood cancer has been seen. Caring science research is central in providing skills and knowledge to the health care sector, but few overviews of the content of published research have been carried out. The aim of this review was to investigate the content and methodology of published studies in paediatric oncology relevant to caring science, and also to compare possible differences in content and method of the published studies from the nursing and psychosocial perspectives. A systematic literature review was performed of 137 published articles on paediatric oncology relevant to caring science in Sweden. The results show that most of the studies were descriptive or comparative ones with a quantitative design. Most of them focused on parents (43%) or children (28%). Most of the studies investigated wellbeing (88%), using questionnaires (54%) or interviews (38%). Several different measurement instruments had been used. While the results were often clearly presented, the clinical implications were more diffuse. The most acknowledged research fund was the Swedish Childhood Foundation (75%). To reflect the children' perspectives in paediatric oncology require that future researchers take on the challenge of including children (even young ones) in research. The use of a limited number of agreed measurement instruments is desirable. The biggest challenge for the future is to make a shift from explorative to intervention studies. There is an urgent need to transform research results into clinical practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. The nurse-patient relationship in pre-hospital emergency care--from the perspective of Swedish specialist ambulance nursing students.

    Science.gov (United States)

    Berntsson, Tommy; Hildingh, Cathrine

    2013-10-01

    The development of the Swedish ambulance service has resulted in three different competence levels in Swedish ambulance teams: specialist ambulance nurses, registered nurses and emergency medical technicians. A nursing scientific model developed by Peplau (Peplau, H., 1991. Interpersonal Relations in Nursing. Springer Publishing Company, New York.) breaks down the nurse-patient relationship into a number of phases: an orientation, an identification, an exploitation and a resolution phase. This model has then been adapted to the pre-hospital emergency care by Suserud (Dahlberg, K., Segesten, K., Nyström, M., Suserud, B.-O., Fagerberg, I., 2003. Att förstå vårdvetenskap [To Understand Caring Science]. Studentlitteratur, Lund.). The purpose of this study was to explore, by direct content analysis, how the phases of the pre-hospital nurse-patient relationship described by Suserud (Dahlberg et al., 2003), emerge in 17 specialist ambulance nursing students descriptions of ambulance missions. The results show that the four phases of the pre-hospital nurse-patient relationship could be identified and each phase includes several different parts. Furthermore, the results show that the parts of each phase can vary depending on the patient's condition and the environmental circumstances of the ambulance mission. This improved understanding of the four phases of the pre-hospital nurse-patient relationship, and their parts, could be used by ambulance team members as a support during the pre-hospital caring process in ambulance missions. This new knowledge could also be used in education. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  20. 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

    2017-11-07

    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.

  1. Immigrants with dementia in Swedish residential care: an exploratory study of the experiences of their family members and Nursing staff.

    Science.gov (United States)

    Rosendahl, Sirpa Pietilä; Söderman, Mirkka; Mazaheri, Monir

    2016-01-16

    Worldwide, there is a growing population of older people who develop dementia in a country other than that of their origin. When their dementia has reached an advanced stage, residential care is most often needed. People with dementia in Sweden are often cared for in group homes. For immigrants, this may mean a linguistically challenging care environment for both healthcare staff and the patients' family members. The aim of this study was to explore and describe the experiences of family members and professional caregivers regarding the care provided to immigrants with dementia in group homes in Sweden. An exploratory, descriptive study with a qualitative approach was chosen. In-depth semi-structured interviews were conducted with nine professional caregivers and five family members of people with dementia with Finnish, Estonian, Hungarian and Ingrian backgrounds; all were chosen purposefully. All people with dementia had lost their Swedish language skills as their second language. The data was analysed using qualitative content analysis. Three main categories and seven subcategories were identified. The first main category: A new living situation comprised the subcategories: adjusting to new living arrangements and expectations regarding activities and traditional food at the group home, the second main category: Challenges in communication with the subcategories: limited communication between the immigrant with dementia and the Swedish-speaking nursing staff and the consequences of linguistic misunderstandings and nuanced communication in a common language and the third main category: The role of the family member at the group home with the subcategories: a link to the healthy life story of the family member with dementia and an expert and interpreter for the nursing staff. The family member played a crucial role in the lives of immigrants with dementia living in a group home by facilitating communication between the nursing staff and the PWD and also by making

  2. Swedish Projects

    National Research Council Canada - National Science Library

    Borgvall, Jonathan; Lif, Patrik

    2005-01-01

    .... The military research work presented here includes the three military administrations, FOI -- Swedish Defence Research Agency, FMV -- Swedish Defence Materiel Administration, and SNDC -- Swedish...

  3. ABCDEs of ICU: Early mobility.

    Science.gov (United States)

    Dang, Stephanie L

    2013-01-01

    The intensive care unit (ICU) provides a critical level of care to medically unstable patients. Patients need intensive monitoring and treatment that may require emergency interventions. The vulnerability and complexity of the ICU unintentionally creates an environment that limits and poorly defines the intervention of early mobility in the unstable critically ill patients. The short- and long-term effects of immobility and bed rest increase acute complications, the length of stay in the ICU and hospital, and mortality and morbidity rates. According to current research, instituting early mobility programs can improve patient outcomes. Current research has demonstrated the safety and feasibility of the initiation of early mobility programs in the critically ill. The benefits to patients enhance recovery of functional exercise capacity, weaning outcomes, self-perceived functional status, and muscle force and strength. Consequently, patient's length of stay in the ICU and in hospital decreases and improves health outcomes. The scope of practice for nurses and other health care providers should guide by evidenced-based research to reduce complications and enhance patient outcomes. Further research is necessary to establish and institute policies and protocols on early mobility programs in the ICU to direct patient care. The role of the clinical nurse specialist can contribute by conducting evidence-based research, educating health care providers and patients, and implementing protocols. The hope is to change the culture of the ICU for the better.

  4. 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.

  5. 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...

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

    NARCIS (Netherlands)

    Noome, M; Dijkstra, B.M.; Leeuwen, E. van; Vloet, L.C.M.

    2016-01-01

    Objectives: 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. Method: A

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

    NARCIS (Netherlands)

    Noome, M.; Dijkstra, B.M.; Leeuwen, E. van; Vloet, L.C.M.

    2016-01-01

    OBJECTIVES: 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. METHOD: A

  8. 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

  9. Vitamin D deficiency was common among nursing home residents and associated with dementia: a cross sectional study of 545 Swedish nursing home residents.

    Science.gov (United States)

    Arnljots, Rebeka; Thorn, Jörgen; Elm, Marie; Moore, Michael; Sundvall, Pär-Daniel

    2017-10-10

    Residents of nursing homes may have low 25-hydroxyvitamin D (25OHD) concentrations. Associations between vitamin D and cognitive performance, dementia and susceptibility to infections are not clearly established. The aim of this study was to investigate the prevalence of vitamin D deficiency and to identify associated factors among residents of nursing homes for elderly. In this cross-sectional study blood samples for analysis of 25OHD were collected from all participating residents of Swedish nursing homes for the elderly from January to March 2012. dementia too severe to collect a blood test, terminally ill or refusing participation. Serum 25OHD concentrations. Logistic regression to evaluate factors associated with vitamin D deficiency (25OHD vitamin D supplementation 17%, dementia 55%, lack of appetite ≥3 months 45% and any antibiotic treatment during the last 6 months 30%. Serum 25OHD concentrations: mean 34 nmol/L (SD 21, median 27, range 4-125), 82% (448/545) had 25OHD vitamin D deficiency (25OHD vitamin D supplementation 0.075 (0.031-0.18; p Vitamin D deficiency was common among nursing home residents and strongly associated with dementia. Regardless of causality or not, it is important to be alert for vitamin D deficiency in nursing homes residents with dementia. As expected vitamin D supplementation was associated with less vitamin D deficiency, however lack of appetite, staying outdoors and skin phototype were not significant predictors. Antibiotic treatments during the last 6 months were associated with vitamin D deficiency, potentially supporting the hypothesis that vitamin D deficiency is associated with infections.

  10. Enabling nursing students to become culturally competent--a documentary analysis of curricula in all Swedish nursing programs.

    Science.gov (United States)

    Momeni, Pardis; Jirwe, Maria; Emami, Azita

    2008-12-01

    Research has shown that majority of nurses feel that they lack relevant knowledge about immigrant's cultural backgrounds, and therefore, feel incompetent in providing these patients with good care. Last year alone, 4520 nursing students graduated from nursing schools throughout Sweden. Later on, they will meet and treat people from diverse cultural backgrounds and consequently, it is crucial that their educational training prepares them for their future work in a multiethnic society. The aim of this study was to investigate whether the nursing curricula in Sweden's nursing schools provide students with the necessary tools for becoming culturally competent. The present study was based on two main questions: (i) Do the present educational plans and courses provide nursing students with the opportunity to become culturally competent? (ii) How do the contents of the educational plans match the contents of the course plans? The study was conducted using a quantitative documentary analysis, where the authors analysed the curricula of 26 nursing schools in Sweden and then compared them to the theoretical frame of reference 'The Process of Cultural Competence in the Delivery of Healthcare Services', a model written by Campinha-Bacote. The results showed that 69% (18/26) had included the concept of culture in their educational plans, whereas 77% (20/26) had included this in their courses. In all, 15% (78) from a total of 504 curricula had included the concept of culture in some way or another. However, the analysis found that only three schools provided students with specific training on the topic. Conclusively, the results showed that nursing students were not prepared for their work in a multiethnic society and nursing education in Sweden has failed to implement existing research into the nursing curricula.

  11. Prevalence and predictive importance of anemia in Swedish nursing home residents - a longitudinal study.

    Science.gov (United States)

    Westerlind, Björn; Östgren, Carl Johan; Mölstad, Sigvard; Midlöv, Patrik

    2016-12-02

    Anemia is common in elderly people and especially in nursing home residents. Few studies have been performed on the consequences of anemia in a nursing home population. This study explored the prevalence of anemia in nursing homes in Sweden, including risk factors and mortality associated with anemia or hemoglobin (Hb) decline. Three hundred ninety patients from 12 nursing homes were included during 2008-2011. Information about medication, blood samples, questionnaire responses and information about physical and social activities was recorded. The baseline characteristics of the patients were compared for subjects with and without anemia. Vital status was ascertained during the following 7 years from baseline to compare the survival. Hb levels 100 ng/L) and severely reduced eGFR ( 9 g/L) was compared with the highest (improvement > 6 g/L) the mortality was higher in the lowest quartile (p = 0.03). Anemia is common in nursing home residents in Sweden, especially among men for whom it is related to higher mortality. A rapid Hb drop is associated with higher mortality. Regardless of earlier Hb values, monitoring Hb regularly in a nursing home population seems important for catching rapid Hb decline correlated with higher mortality.

  12. Swedish District Nurses’ Attitudes to Implement Information and Communication Technology in Home Nursing

    Science.gov (United States)

    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. PMID:19319223

  13. Community nurses' experiences of ethical dilemmas in palliative care: a Swedish study.

    Science.gov (United States)

    Karlsson, Margareta; Roxberg, Asa; da Silva, António Barbosa; Berggren, Ingela

    2010-05-01

    The aim of this study was to highlight community nurses' experiences of ethical dilemmas in palliative care. There are many studies on palliative care but research on how community nurses experience ethical dilemmas in palliative home care is lacking. The ethical dilemmas to which these nurses are exposed seriously challenge their ethical competence. Seven community nurses described their experiences of ethical dilemmas in palliative home care. The data was analysed by means of qualitative content analysis. The core themes that emerged were: powerlessness, frustration, and concern in relation to ethical dilemmas in palliative care. The nurses were motivated and felt responsibility for their patients' end of life, and their relatives, and took their duties seriously. They wanted to satisfy all parties; the patient, the relatives and other palliative care professionals. The study confirms the need for knowledge about how community nurses experience dilemmas in ethical decision-making. They have the freedom to act and the willingness to make decisions, but they lack competence and knowledge about how their colleagues' experience and deal with such issues.

  14. Sobrecarga de trabalho da Enfermagem e incidentes e eventos adversos em pacientes internados em UTI/Nursing workload and occurrence of incidents and adverse events in ICU patients/Sobrecarga de trabajo de Enfermería y los incidentes y eventos adversos en pacientes hospitalizados en la UCI

    National Research Council Canada - National Science Library

    Marcia Cristina Zago Novaretti; Edzangela de Vasconcelos Santos; Ligia Maria Quitério; Renata Mahfuz Daud-Gallotti

    2014-01-01

      This prospective cohort study aimed to identify the influence of nursing work overload on the occurrence of incidents without injury and adverse events in 399 patients hospitalized in Intensive Care Units (ICU...

  15. Knowledge and Utilization of ICU Admission Criteria and Guidelines ...

    African Journals Online (AJOL)

    The ICU team concentrated on prompt diagnosis, treatment and insisted on discharge once patient's condition stabilized and was out of danger. ... that although nurses have a high level of both knowledge and utilization of ICU admission criteria and guidelines, almost all of them have not trained in critical care nursing.

  16. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices.

    Science.gov (United States)

    van Sluisveld, Nelleke; Bakhshi-Raiez, Ferishta; de Keizer, Nicolette; Holman, Rebecca; Wester, Gert; Wollersheim, Hub; van der Hoeven, Johannes G; Zegers, Marieke

    2017-04-17

    Variation in intensive care unit (ICU) readmissions and in-hospital mortality after ICU discharge may indicate potential for improvement and could be explained by ICU discharge practices. Our objective was threefold: (1) describe variation in rates of ICU readmissions within 48 h and post-ICU in-hospital mortality, (2) describe ICU discharge practices in Dutch hospitals, and (3) study the association between rates of ICU readmissions within 48 h and post-ICU in-hospital mortality and ICU discharge practices. We analysed data on 42,040 admissions to 82 (91.1%) Dutch ICUs in 2011 from the Dutch National Intensive Care Evaluation (NICE) registry to describe variation in standardized ICU readmission and post-ICU mortality rates using funnel-plots. We send a questionnaire to all Dutch ICUs. 75 ICUs responded and their questionnaire data could be linked to 38,498 admissions in the NICE registry. Generalized estimation equations analyses were used to study the association between ICU readmissions and post-ICU mortality rates and the identified discharge practices, i.e. (1) ICU discharge criteria; (2) bed managers; (3) early discharge planning; (4) step-down facilities; (5) medication reconciliation; (6) verbal and written handover; (7) monitoring of post-ICU patients; and (8) consulting ICU nurses. In all analyses, the outcomes were corrected for patient-related confounding factors. The standardized rate of ICU readmissions varied between 0.14 and 2.67 and 20.8% of the hospitals fell outside the 95% control limits and 3.6% outside the 99.8% control limits. The standardized rate of post-ICU mortality varied between 0.07 and 2.07 and 17.1% of the hospitals fell outside the 95% control limits and 4.9% outside the 99.8% control limits. We could not demonstrate an association between the eight ICU discharge practices and rates of ICU readmissions or post-ICU in-hospital mortality. Implementing a higher number of ICU discharge practices was also not associated with better

  17. Ending One's Life in a Nursing Home: A Note on Swedish Findings.

    Science.gov (United States)

    Samuelsson, Gillis; Sundstrom, Gerdt

    1988-01-01

    Statistics on place of death, validated against longitudinal evidence on entrance into nursing homes, shows the "final" rate of institutionalization to have risen in Sweden between 1938 and 1975. Issues concerning who is institutionalized and why appear more important than precise measurement of rates of institutionalization. (Author/NB)

  18. 'There's something in their eyes' - Child Health Services nurses' experiences of identifying signs of postpartum depression in non-Swedish-speaking immigrant mothers.

    Science.gov (United States)

    Skoog, Malin; Hallström, Inger; Berggren, Vanja

    2017-01-25

    Due to the current world situation, Sweden has one of the highest asylum applications within the European Union. Immigrant mothers, specifically those who have immigrated during the last ten years and do not speak the language of the new country, are found to be at particular risk of being effected by postpartum depression. In this study, we elucidate Swedish Child Health Services nurses' experiences of identifying signs of postpartum depression in non-Swedish-speaking immigrant mothers. Latent content analysis was used when analysing data material from 13 research interviews. Being able to interpret a non-Swedish-speaking immigrant mother's mood required establishing and constant deepening of a transcultural caring relationship, the use of cultural knowledge to perceive signs of postpartum depression from observations and interactions and to rely on intuition. There are both challenges and key factors for success in interpreting the mood of non-Swedish-speaking immigrant mothers. This study provides information to healthcare professionals about challenges with adapting the screening with the Edinburgh Postnatal Depression Scale to immigrant mothers not speaking the language of residence. Tacit knowledge and cultural competence among healthcare personnel are invaluable assets when interpreting mental health in this vulnerable group of mothers. © 2017 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.

  19. Occurrence of delirium is severely underestimated in the ICU during daily care

    NARCIS (Netherlands)

    Spronk, Peter E.; Riekerk, Bea; Hofhuis, José; Rommes, Johannes H.

    2009-01-01

    Delirium is associated with prolonged intensive care unit (ICU) stay and higher mortality. Therefore, the recognition of delirium is important. We investigated whether intensivists and ICU nurses could clinically identify the presence of delirium in ICU patients during daily care. All ICU patients

  20. Extent and application of ICU diaries in Germany in 2014

    DEFF Research Database (Denmark)

    Nydahl, Peter; Knueck, Dirk; Egerod, Ingrid

    2015-01-01

    , 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...... 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...

  1. Working together: critical care nurses experiences of temporary staffing within Swedish health care: A qualitative study.

    Science.gov (United States)

    Berg Jansson, Anna; Engström, Åsa

    2017-08-01

    The aim of this study is to describe critical care nurses (CCN's) experiences of working with or as temporary agency staff. This explorative qualitative study is based on interviews with five agency CCNs and five regular CCNs, a total of ten interviews, focusing on the interviewees' experiences of daily work and temporary agency staffing. The interviews were analysed manually and thematically following an inductive approach. Four themes that illustrate both similarities and differences between regular and temporary agency CCNs emerged: "working close to patients versus being responsible for everything", "teamwork versus independence", "both groups needed" and "opportunities and challenges". The study findings illustrate the complexity of the working situation for agency and regular staff in terms of the organisation and management of the temporary agency nurses and the opportunities and challenges faced by both groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Patients' experience of a nurse-led lifestyle clinic at a Swedish health centre.

    Science.gov (United States)

    Nymberg, Peter; Drevenhorn, Eva

    2016-06-01

    In Sweden, 56% of the population aged 16-84 have an unhealthy lifestyle. The primary health care (PHC) has been instructed to offer citizens health promotion and disease-preventive actions. Very few studies have been conducted about how individuals experience interventions from the PHC intended to help them to change lifestyle. The purpose of the study was to explore patients' experiences of visiting a nurse-led lifestyle clinic. Patients (n = 137), who participated in a screening test at a lifestyle clinic, were invited to focus group interviews. Of these, 14 patients agreed to participate. The data were analysed using content analysis. The patients felt that the visit to the lifestyle clinic gave insight into their habits and diminished their fear of not being healthy. Primary health care was seen as a safe provider in this matter. Disappointment was occasioned by the unfulfilled expectations of blood tests, lack of follow-up visit and inconsistencies of approach during the visit to the lifestyle clinic. Personal chemistry was perceived to be crucial for how the encounter with the public health nurse evolved. Lifestyle clinics can give patients opportunity to change lifestyle and also to confirm the good habits. It may also be important to have follow-up visits to give the patients' support when changing lifestyle. Nurses counselling patients about lifestyle changes need to have recurrent training in Motivational Interviewing. © 2015 Nordic College of Caring Science.

  3. Professional development: Iranian and Swedish nurses' experiences of caring for dying people.

    Science.gov (United States)

    Iranmanesh, Sedigheh; Ghazanfari, Zahra; Sävenstedt, Stefan; Häggström, Terttu

    2011-01-01

    Our world is rapidly becoming a global community. This creates a need for us to further understand the universal phenomena of death and professional care for dying persons. A transcultural study was undertaken using a phenomenological approach to illuminate the meaning of nurses' experiences of professional development in the contexts of Iran and Sweden. Eight registered nurses working in oncology units in Tehran, Iran, and eight working in the context of a hospital and private homes in northern Sweden were interviewed. The interviews were analyzed using the principles of phenomenological hermeneutics inspired by Paul Ricoeur. A naive reading guided a structural analysis, which yielded four main themes: coping with existential, organizational, and cultural contexts; sharing knowledge, experiences, and responsibilities; using embodied knowledge; and developing personal competence. The interpreted comprehensive understanding revealed that the meaning of professional development is that it actualizes other-oriented values and self-oriented values. Caring professionally for dying people was a learning process that could help nurses to develop their personal and professional lives when they were supported by teamwork, reflective practice, and counselling.

  4. 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.

  5. 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...... and verbally when handing over patients from one setting to another. A deeper understanding of nurses' communicative interaction and of nurses' perception of their interaction is crucial to facilitate clinical interventions focusing to improve patient safety. DESIGN: An explorative, qualitative design using...... 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...

  6. Prevalence of antibiotic-resistant bacteria in residents of nursing homes in a Swedish municipality: healthcare staff knowledge of and adherence to principles of basic infection prevention.

    Science.gov (United States)

    Andersson, Helene; Lindholm, Christina; Iversen, Aina; Giske, Christian G; Örtqvist, Åke; Kalin, Mats; Fossum, Bjöörn

    2012-09-01

    The aims of this study were to investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in residents living in Swedish nursing homes, and if carriage of resistant bacteria was related to antibiotic treatment, other risk factors, and/or staff's adherence to guidelines for infection control. Five hundred and sixty residents from 9 nursing homes on a total of 67 wards participated in the study and had microbiological cultures taken. Faecal samples were obtained from 495 residents (88.3%). ESBL-positive residents were followed for 2 y with repeated sampling. Two hundred and ninety-six [corrected] staff members were interviewed and observed regarding familiarity with and adherence to infection control guidelines. No resident was positive for MRSA or VRE. Fifteen of the residents were found to be ESBL-positive. Residents living on wards where ESBL-positive residents were identified had been treated more frequently with antibiotics (42%), compared to those on wards where no residents with ESBL were found (28%; p = 0.02). ESBL-positive Escherichia coli isolates from residents living in adjacent rooms were found to be closely genetically related when analysed by pulsed-field gel electrophoresis, indicating transmission between residents. Staff adherence to infection control guidelines sometimes revealed shortcomings, but no significant differences regarding compliance to the guidelines could be found. Carriage of resistant bacteria was uncommon and only ESBL-producing Enterobacteriaceae were identified in Swedish nursing homes. Usage of antibiotics was higher on wards where ESBL-positive residents were detected and there was an indication of transmission of ESBL between residents.

  7. Privacy of Patients Admitted to the ICU : Systematic Literature Review

    OpenAIRE

    Nabunya, Christine; Chesop, Beatrice

    2015-01-01

    Aim: The aim of this systematic literature review is to evaluate how nurses can uphold/ safeguard the privacy of patients admitted in the ICU. The objectives of this study are; to help nurses understand the need and effectiveness of patients’ privacy in the ICU as well as to understand the concept of privacy and its benefits to patients admitted in the ICUs. This study research is part of the EVICURES people’s project in anticipation of the building of a new ICU for the Seinäjoki Central Hosp...

  8. Evacuation of the ICU

    Science.gov (United States)

    Niven, Alexander S.; Beninati, William; Fang, Ray; Einav, Sharon; Rubinson, Lewis; Kissoon, Niranjan; Devereaux, Asha V.; Christian, Michael D.; Grissom, Colin K.; Christian, Michael D.; Devereaux, Asha V.; Dichter, Jeffrey R.; Kissoon, Niranjan; Rubinson, Lewis; Amundson, Dennis; Anderson, Michael R.; Balk, Robert; Barfield, Wanda D.; Bartz, Martha; Benditt, Josh; Beninati, William; Berkowitz, Kenneth A.; Daugherty Biddison, Lee; Braner, Dana; Branson, Richard D; Burkle, Frederick M.; Cairns, Bruce A.; Carr, Brendan G.; Courtney, Brooke; DeDecker, Lisa D.; De Jong, Marla J.; Dominguez-Cherit, Guillermo; Dries, David; Einav, Sharon; Erstad, Brian L.; Etienne, Mill; Fagbuyi, Daniel B.; Fang, Ray; Feldman, Henry; Garzon, Hernando; Geiling, James; Gomersall, Charles D.; Grissom, Colin K.; Hanfling, Dan; Hick, John L.; Hodge, James G.; Hupert, Nathaniel; Ingbar, David; Kanter, Robert K.; King, Mary A.; Kuhnley, Robert N.; Lawler, James; Leung, Sharon; Levy, Deborah A.; Lim, Matthew L.; Livinski, Alicia; Luyckx, Valerie; Marcozzi, David; Medina, Justine; Miramontes, David A.; Mutter, Ryan; Niven, Alexander S.; Penn, Matthew S.; Pepe, Paul E.; Powell, Tia; Prezant, David; Reed, Mary Jane; Rich, Preston; Rodriquez, Dario; Roxland, Beth E.; Sarani, Babak; Shah, Umair A.; Skippen, Peter; Sprung, Charles L.; Subbarao, Italo; Talmor, Daniel; Toner, Eric S.; Tosh, Pritish K.; Upperman, Jeffrey S.; Uyeki, Timothy M.; Weireter, Leonard J.; West, T. Eoin; Wilgis, John; Ornelas, Joe; McBride, Deborah; Reid, David; Baez, Amado; Baldisseri, Marie; Blumenstock, James S.; Cooper, Art; Ellender, Tim; Helminiak, Clare; Jimenez, Edgar; Krug, Steve; Lamana, Joe; Masur, Henry; Mathivha, L. Rudo; Osterholm, Michael T.; Reynolds, H. Neal; Sandrock, Christian; Sprecher, Armand; Tillyard, Andrew; White, Douglas; Wise, Robert; Yeskey, Kevin

    2014-01-01

    BACKGROUND: Despite the high risk for patient harm during unanticipated ICU evacuations, critical care providers receive little to no training on how to perform safe and effective ICU evacuations. We reviewed the pertinent published literature and offer suggestions for the critical care provider regarding ICU evacuation. The suggestions in this article are important for all who are involved in pandemics or disasters with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS: The Evacuation and Mobilization topic panel used the American College of Chest Physicians (CHEST) Guidelines Oversight Committee’s methodology to develop seven key questions for which specific literature searches were conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS: Based on current best evidence, we provide 13 suggestions outlining a systematic approach to prepare for and execute an effective ICU evacuation during a disaster. Interhospital and intrahospital collaboration and functional ICU communication are critical for success. Pre-event planning and preparation are required for a no-notice evacuation. A Critical Care Team Leader must be designated within the Hospital Incident Command System. A three-stage ICU Evacuation Timeline, including (1) no immediate threat, (2) evacuation threat, and (3) evacuation implementation, should be used. Detailed suggestions on ICU evacuation, including regional planning, evacuation drills, patient transport preparation and equipment, patient prioritization and distribution for evacuation, patient information and tracking, and federal and international evacuation assistance systems, are also provided. CONCLUSIONS: Successful ICU evacuation during a disaster requires

  9. Exploring Nurses', Preschool Teachers' and Parents' Perspectives on Information Sharing Using SDQ in a Swedish Setting - A Qualitative Study Using Grounded Theory.

    Science.gov (United States)

    Fält, Elisabet; Sarkadi, Anna; Fabian, Helena

    2017-01-01

    Evidence-based methods to identify behavioural problems among children are not regularly used within the Swedish Child healthcare. A new procedure was therefore introduced to assess children through parent- and preschool teacher reports using the Strengths and Difficulties Questionnaire (SDQ). This study aims to explore nurses', preschool teachers' and parents' perspectives of this new information sharing model. Using the grounded theory methodology, semi-structured interviews with nurses (n = 10) at child health clinics, preschool teachers (n = 13) and parents (n = 11) of 3-, 4- and 5-year-old children were collected and analysed between March 2014 and June 2014. The analysis was conducted using constant comparative method. The participants were sampled purposively within a larger trial in Sweden. Results indicate that all stakeholders shared a desire to have a complete picture of the child's health. The perceptions that explain why the stakeholders were in favour of the new procedure-the 'causal conditions' in a grounded theory model-included: (1) Nurses thought that visits after 18-months were unsatisfactory, (2) Preschool teachers wanted to identify children with difficulties and (3) Parents viewed preschool teachers as being qualified to assess children. However, all stakeholders had doubts as to whether there was a reliable way to assess children's behaviour. Although nurses found the SDQ to be useful for their clinical evaluation, they noticed that not all parents chose to participate. Both teachers and parents acknowledged benefits of information sharing. However, the former had concerns about parental reactions to their assessments and the latter about how personal information was handled. The theoretical model developed describes that the causal conditions and current context of child healthcare in many respects endorse the introduction of information sharing. However, successful implementation requires considerable work to address barriers: the tension

  10. Staff Acceptance of Tele-ICU Coverage

    Science.gov (United States)

    Chan, Paul S.; Cram, Peter

    2011-01-01

    Background: Remote coverage of ICUs is increasing, but staff acceptance of this new technology is incompletely characterized. We conducted a systematic review to summarize existing research on acceptance of tele-ICU coverage among ICU staff. Methods: We searched for published articles pertaining to critical care telemedicine systems (aka, tele-ICU) between January 1950 and March 2010 using PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Library and abstracts and presentations delivered at national conferences. Studies were included if they provided original qualitative or quantitative data on staff perceptions of tele-ICU coverage. Studies were imported into content analysis software and coded by tele-ICU configuration, methodology, participants, and findings (eg, positive and negative staff evaluations). Results: Review of 3,086 citations yielded 23 eligible studies. Findings were grouped into four categories of staff evaluation: overall acceptance level of tele-ICU coverage (measured in 70% of studies), impact on patient care (measured in 96%), impact on staff (measured in 100%), and organizational impact (measured in 48%). Overall acceptance was high, despite initial ambivalence. Favorable impact on patient care was perceived by > 82% of participants. Staff impact referenced enhanced collaboration, autonomy, and training, although scrutiny, malfunctions, and contradictory advice were cited as potential barriers. Staff perceived the organizational impact to vary. An important limitation of available studies was a lack of rigorous methodology and validated survey instruments in many studies. Conclusions: Initial reports suggest high levels of staff acceptance of tele-ICU coverage, but more rigorous methodologic study is required. PMID:21051386

  11. Barriers Identified by Swedish School Nurses in Giving Information about Testicular Cancer and Testicular Self-Examination to Adolescent Males

    Science.gov (United States)

    Rudberg, Lennart; Nilsson, Sten; Wikblad, Karin; Carlsson, Marianne

    2005-01-01

    The purpose of this study was to investigate to what extent school nurses in Sweden inform adolescent men about testicular cancer (TC) and testicular self-examination (TSE). A questionnaire was completed by 129 school nurses from 29 randomly selected municipalities. All respondents were women, with a mean age of 42 years. The results showed that…

  12. ICU-Acquired Weakness.

    Science.gov (United States)

    Jolley, Sarah E; Bunnell, Aaron E; Hough, Catherine L

    2016-11-01

    Survivorship after critical illness is an increasingly important health-care concern as ICU use continues to increase while ICU mortality is decreasing. Survivors of critical illness experience marked disability and impairments in physical and cognitive function that persist for years after their initial ICU stay. Newfound impairment is associated with increased health-care costs and use, reductions in health-related quality of life, and prolonged unemployment. Weakness, critical illness neuropathy and/or myopathy, and muscle atrophy are common in patients who are critically ill, with up to 80% of patients admitted to the ICU developing some form of neuromuscular dysfunction. ICU-acquired weakness (ICUAW) is associated with longer durations of mechanical ventilation and hospitalization, along with greater functional impairment for survivors. Although there is increasing recognition of ICUAW as a clinical entity, significant knowledge gaps exist concerning identifying patients at high risk for its development and understanding its role in long-term outcomes after critical illness. This review addresses the epidemiologic and pathophysiologic aspects of ICUAW; highlights the diagnostic challenges associated with its diagnosis in patients who are critically ill; and proposes, to our knowledge, a novel strategy for identifying ICUAW. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  13. A qualitative study of factors that influence active family involvement with patient care in the ICU: Survey of critical care nurses.

    Science.gov (United States)

    Hetland, Breanna; McAndrew, Natalie; Perazzo, Joseph; Hickman, Ronald

    2017-11-20

    Family caregiver involvement may improve patient and family outcomes in the intensive care unit. This study describes critical care nurses' approaches to involving family caregivers in direct patient care. This is a qualitative content analysis of text captured through an electronic survey. A convenience sample of 374 critical care nurses in the United States who were subscribers to one of the American Association of Critical Care Nurses social media sites or electronic newsletters. Critical care nurses' responses to five open-ended questions about their approaches to family involvement in direct patient care. Nurse, patient, and family caregiver factors intersected in the context of the professional practice environment and the available resources for family care. Two main themes were identified: "Involving family caregivers in patient care in the intensive care unit requires careful ssessment" and "There are barriers and facilitators to caregiver involvement in patient care in the intensive care unit." Patient care demands, the professional practice environment and a lack of resources for families hindered nursing family caregiver involvement. Greater attention to these barriers as they relate to family caregiver involvement and clinical outcomes should be a priority in future research. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. The impact of nUrsiNg DEliRium Preventive INnterventions in the Intensive Care Unit (UNDERPIN-ICU): A study protocol for a multi-centre, stepped wedge randomized controlled trial

    NARCIS (Netherlands)

    Wassenaar, A.; Rood, P.J.T.; Schoonhoven, L.; Teerenstra, S.; Zegers, M.; Pickkers, P.; Boogaard, M.H.W.A. van den

    2017-01-01

    BACKGROUND: Delirium is a common disorder in Intensive Care Unit (ICU) patients and is associated with serious short- and long-term consequences, including re-intubations, ICU readmissions, prolonged ICU and hospital stay, persistent cognitive problems, and higher mortality rates. Considering the

  15. Relatives' and staff's experience of patients dying in ICU.

    Science.gov (United States)

    Donnelly, S M; Psirides, A

    2015-12-01

    Intensive care units (ICUs) exist to support patients through acute illness that threatens their life. Although ICUs aim to save life, they are also a place where a significant proportion of patients die with international mortality rates ranging from 15% to 24%. To explore the experience of relatives and staff of patients dying in ICU using qualitative approach. Consecutive patients were identified who were dying in the ICU. The researcher met the families prior to the patient's death. The ICU nurse and doctor most involved were interviewed within 48 h of the death. The families were interviewed 2 weeks later. Interviewees described their experience of the patient's dying and death. Recruitment until data saturation and thematic analysis occurred concurrently. Ten families, nurses and doctors were interviewed in relation to 10 patients. In caring for the patients who are dying in the ICU and their families, nurses practice to their satisfaction with creativity and autonomy, although concerned about continuity of care at handover. Families appreciate kindness and regular sensitive communication. Families would like more contact with the ICU doctors. Limiting access to the patient according to ICU protocol is distressing for relatives. Doctors struggle with decision making, determining prognosis and witnessing the grief of relatives. Some doctors wish to have a greater part in care of the dying patient. Distress among nurses reported in the ICU literature and attributed to disenfranchisement by doctors was not evident. In contrast, some doctors struggle to practice what they value. Adherence to ICU protocols needs flexibility when a patient is dying. © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

    Directory of Open Access Journals (Sweden)

    MK Fakhri

    2015-05-01

    Conclusion: assessment practices a key role in moderating the effects of stress in the workplace has been the experience, Therefore, identifying individuals who are perceived negative job stress In order to change their negative assessment of the situation causing stress in the workplace can reduce burnout and improve the quality of nursing care.

  17. Swedish nursing students' experience of aspects important for their learning process and their ability to handle the complexity of the nursing degree program.

    Science.gov (United States)

    Andersson, Petra Lilja; Edberg, Anna-Karin

    2012-05-01

    The aim of the study was to explore nursing students' experiences of aspects important for their learning process and their ability to handle the complexity of the nursing degree program. The study was longitudinal and qualitative based on interviews with nursing students, six women and two men aged 20-36, during their three years of education. In all, seven patterns were found embracing aspects of importance for the students' learning: Having a clear goal, being able to re-evaluate one's ideas, being acknowledged, when the abstract becomes tangible, using one's own experiences as a tool for learning, hovering between closeness and distance regarding one's future profession and handling theory and practice in relation to one another. The results show the importance of providing clinical courses, strongly connected to the theoretical parts of the program and to use reflection and experience-based learning in the nursing program. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Individual and organisational factors influencing registered nurses' attitudes towards patient advocacy in Swedish community health care of elders.

    Science.gov (United States)

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

    2014-09-01

    The aim of this study was to describe and explore individual and organisational factors potentially influencing registered nurses' (RNs) attitudes towards patient advocacy. In a quantitative cross-sectional study, data were collected from 226 RNs in community health care of elders. A questionnaire was used to measure a number of factors including attitudes towards patient advocacy, nursing competence, personality traits, individual preferences regarding the quality of health care and working climate. A multiple regression analysis was performed. The results showed that individual factors of nursing competence and individual preferences of the quality of health care, as well as organisational factors of the working climate, explained 26.2% of the variance in the RNs' attitudes towards patient advocacy. Although the mentioned individual factors may be intertwined, the conclusion is that both individual and organisational factors influenced RNs' attitudes towards patient advocacy. The results do not verify that nursing experience, workplace experience, educational level or personality traits influence the RNs' attitudes towards patient advocacy. The proportion of explained variance indicates that additional factors also influence attitudes towards patient advocacy, and more research is needed to shed further light on these factors. © 2013 Nordic College of Caring Science.

  19. Nosocomial bloodstream infections in ICU and non-ICU patients.

    Science.gov (United States)

    Suljagić, Vesna; Cobeljić, Miloje; Janković, Slavenka; Mirović, Veljko; Marković-Denić, Ljiljana; Romić, Predrag; Mikić, Dragan

    2005-08-01

    Nosocomial bloodstream infections (BSI) create a serious health problem in hospitals all over the world. The objectives of our study were to explore putative disease markers and potential risk factors with nosocomial BSI in patients in intensive care units (ICU) and non-ICU patients and to determine risk factors associated with increased 28-day mortality rate in patients with nosocomial BSI acquired in combined medical-surgical ICU. However, the major purposes of this report were to identify epidemiologic differences between nosocomial BSI acquired in ICU and non-ICU, as well as analyses outcomes for patients with nosocomial BSI acquired in ICU. A 1-year prospective cohort study was performed to determine the incidence of nosocomial BSI in hospitalized patients. Patient characteristics, risk factors related to health care, and source of infection of patients with BSI acquired in non-ICU were compared with those patient with BSI acquired in ICU. Also, nested case-control study of patients to nosocomial BSI acquired in ICU was performed to evaluate outcome. Patients were identified by active surveillance and positive blood culture during the study period. The incidence of nosocomial BSI was 2.2 per 1000 admission in non-ICU patients and 17.4 per 1000 admission in ICU patients. The 28-day crude mortality rate was 69% in ICU patients. A multivariate model showed that nasogastric tube (RR, 25.1; 95% CI: 3.845-163.85; P=.001), mechanical ventilation (RR, 13.04; 95% CI: 1.974-96.136; P=.008), and H2 blockers (RR, 12.16; 95% CI: 1.748-84.623; P=.012) were more prevalent among patients with BSI acquired in ICU, and aggressive procedures (RR, 8.65; 95% CI: 1.70-44.00; P=.009) were more prevalent among patients with BSI acquired in non-ICU patients. Risk factors independently associated with increased 28-day mortality rate in ICU patients were mechanical ventilation (OR, 8.63; 95% CI: 1.5-49.8; P=.016) and SAPS II >40 (OR, 6.0; 95% CI: 1.0-35.7; P=.049). The most common

  20. Nursing Activities Score (NAS como instrumento para medir carga de trabalho de enfermagem em UTI adulto Nursing Activities Score - NAS como instrumento para medir la carga de trabajo de enfermería en UCI adulto Evaluation of the Nursing Activities Score (NAS as a nursing workload measurement tool in an adult ICU

    Directory of Open Access Journals (Sweden)

    Regina Maria Yatsue Conishi

    2007-09-01

    ó interesante instrumento de clasificación de pacientes y en la carga de trabajo de enfermeras en UCI.This is an exploratory, descriptive, prospective field study with a quantitative approach carried out at a general/adult Intensive Care Unit in the city of São Paulo. Objectives: to evaluate the NAS - Nursing Activities Score - as a tool for measuring nursing workload, its use in measuring shifts, and its correspondence to the number of effective nursing personnel. Thirty-three patients, with mean age of 70 years (+/-16.5, were classified. Most were males (66.7%. Length of stay in the ICU was 17 days (+/- 20.4; SAPSII was 41.7 (+/-17.9, with mean probability of death of 33.5% (+/- 26.8; 63.6% were transferred to Intermediate Care Units and 18.2% died during ICU stay. Three hundred and ninety six NAS measures (shifts were performed (134-morning, 132-afternoon, 130-evening, with averages of 55.4 (+/-12.3 and 147 in 24-hour NAS and mean of 69.6 (+/- 18.2. NAS performed better in 24-hour application than in shifts, and proved to be an interesting tool for patient and nursing workload classification in intensive care.

  1. Processo de trabalho em saúde e enfermagem em UTI neonatal Proceso de trabajo en salud y enfermería en UTI neonatal Working process in health and nursing at a neonatal ICU

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Munhoz Gaíva

    2004-06-01

    its central nucleus, since this professional detains the work rationality. Situations of complementarity and interdependence were observed in the team's work, with moments of negotiation among nursing agents and physicians. The technological work organization at the neonatal ICU still shows in its daily life the images of a routine and technical work, marked by the preterm weak body appropriation, which characterizes the biologist and cure model of care.

  2. Change in depressive symptoms over higher education and professional establishment - a longitudinal investigation in a national cohort of Swedish nursing students.

    Science.gov (United States)

    Christensson, Anna; Runeson, Bo; Dickman, Paul W; Vaez, Marjan

    2010-06-15

    There are indications of a high prevalence of psychological distress among students in higher education and also that distress increases over the course of study. However, not all studies on student distress controlled for sociodemographic differences and few followed development of distress over an extended period through professional establishment. We investigated if there is an independent effect of time in education and the first two years in the profession on depressive symptoms and mapped change over the period in a national cohort of students. Data came from LANE, a nation-wide longitudinal panel survey of Swedish nursing students (N = 1700) who responded to annual questionnaires over five years from 2002 to 2007. Depressive symptoms were measured by the Major Depression Inventory and change over time analysed in a linear mixed effects model for repeated measures. There was a significant change in level of depressive symptoms over time: an increase from the first to later years in education and a decrease to levels similar to baseline after graduation and a year in the profession. The change in symptoms remained significant after adjustment for sociodemographic factors (p education and professional establishment on depressive symptoms. We think heightened distress over education abates as the graduate accommodates to the profession. Nevertheless, within education, the differences in depressive symptoms associated to demographic factors can help identify student groups more vulnerable to distress. Also, as individual differences in distress seem to persist over time, perhaps students highly distressed in the beginning of education can be helped by awareness among educators of the elevated levels of distress in late education.

  3. Reducing Hospital ICU Noise: A Behavior-Based Approach

    OpenAIRE

    Avinash Konkani; Barbara Oakley; Barbara Penprase

    2014-01-01

    Noise in Intensive Care Units (ICUs) is gaining increasing attention as a significant source of stress and fatigue for nursing staff. Extensive research indicates that hospital noise also has negative impact on patients. The objective of this study was to analyze noise variations as experienced by both nursing staff and patients, to gain a better understanding of noise levels and frequencies observed in ICU settings over extended (week-long) durations, and to implement a low cost behavior mod...

  4. The effects of health information technology change over time: a study of Tele-ICU functions.

    Science.gov (United States)

    Anders, S H; Woods, D D; Schweikhart, S; Ebright, P; Patterson, E

    2012-01-01

    Longitudinal studies exploring the evolution of health information technology functions provide valuable information about how technology systems are integrated and exploited in situ. This study reports changes in the distribution of functions for a specific health information technology, the tele-ICU, over time. The studied tele-ICU provided care to six remote ICUs within a local geographic region in the same state and had nursing staff around the clock. The intervention logs of tele-ICU nurses were collected during two discrete times and coded into nine emergent functional categories, who initiated the intervention and, if required, subsequent escalation. All coded functional categories were investigated for significant changes over time in the nursing logged interventions. A total of 1927 interventions were coded into the nine emergent functional categories. Seven of the nine categories (78%) were significantly different between 2005 and 2007. The functions of the tele-ICU system continue to change and develop over time. These findings suggest that the tele-ICU increased support when ICU nurses were off the unit, inter-hospital coordinating and adherence to best practices, while simultaneously decreasing real-time support for ICU nurses. This research suggests that sustaining safety features in a new technology over time have post-conditions after implementation.

  5. Endotracheal intubation in the ICU.

    Science.gov (United States)

    Lapinsky, Stephen E

    2015-06-17

    Endotracheal intubation in the ICU is a high-risk procedure, resulting in significant morbidity and mortality. Up to 40% of cases are associated with marked hypoxemia or hypotension. The ICU patient is physiologically very different from the usual patient who undergoes intubation in the operating room, and different intubation techniques should be considered. The common operating room practice of sedation and neuromuscular blockade to facilitate intubation may carry significant risk in the ICU patient with a marked oxygenation abnormality, particularly when performed by the non-expert. Preoxygenation is largely ineffective in these patients and oxygen desaturation occurs rapidly on induction of anesthesia, limiting the time available to secure the airway. The ICU environment is less favorable for complex airway management than the operating room, given the frequent lack of availability of additional equipment or additional expert staff. ICU intubations are frequently carried out by trainees, with a lesser degree of airway experience. Even in the presence of a non-concerning airway assessment, these patients are optimally managed as a difficult airway, utilizing an awake approach. Endotracheal intubation may be achieved by awake direct laryngoscopy in the sick ICU patient whose level of consciousness may be reduced by sepsis, hypercapnia or hypoxemia. As the patient's spontaneous respiratory efforts are not depressed by the administration of drugs, additional time is available to obtain equipment and expertise in the event of failure to secure the airway. ICU intubation complications should be tracked as part of the ICU quality improvement process.

  6. Estratégias de enfrentamento utilizadas pela equipe de enfermagem de um CTI adulto perante situações de estresse Coping strategies used by the nursing staff of an adult ICU in stress situations

    Directory of Open Access Journals (Sweden)

    Emanuelle Graziottin Colossi

    2011-09-01

    Full Text Available Introdução: Para os profissionais da saúde lidar com situações de estresse, como por exemplo, a eminência da morte dos pacientes, parece ser uma das maiores dificuldades vividas em sue ambiente de trabalho. Frente a este contexto, cada pessoa lança mão de estratégias próprias para o enfrentamento de situações estressantes (coping, as quais são determinadas pelo ambiente e por características de personalidade. Objetivo: Identificar as estratégias de enfrentamento (coping dos profissionais de enfermagem de um CTI adulto diante de situações estressantes inerentes a sua profissão. Materiais e Métodos: Trata-se de um estudo descritivo transversal, no qual foi aplicado o Inventário COPE, em trinta e oito técnicos de enfermagem e/ou enfermeiros. Os dados do inventário foram analisados em termos descritivos. Resultados: As estratégias de enfrentamento mais utilizadas foram as relacionadas à capacidade pró-ativa do sujeito (reinterpretação positiva, coping ativo e busca por suporte social e as menos utilizadas foram as relacionadas às emoções (foco nas emoções e humor. Conclusão: Na amostra estudada, os profissionais buscam estratégias que antecedam as dificuldades inerentes a sua prática diária, isolando os aspectos mais irrelevantes dos estressores e focalizando a atenção no resultado de suas ações, o que permite uma melhor percepção de seu trabalho e o sentimento de realização profissional.Introduction: For health professionals, to deal with stressful situations, such as the imminence of death of their patients, seems to be one of the greatest difficulties experienced in the workplace. In these situations, each person makes use of their own strategies in order to cope with stressful situations, which are determined by the environment and the personality traits. Objective: To identify the coping strategies used by nursing professionals of an adult ICU while facing stressful situations inherent to their

  7. In ICU state anxiety is not associated with posttraumatic stress symptoms over six months after ICU discharge: A prospective study.

    Science.gov (United States)

    Castillo, Maria I; Cooke, Marie L; Macfarlane, Bonnie; Aitken, Leanne M

    2016-08-01

    Posttraumatic stress symptoms are common after intensive care treatment. The influence of anxiety during critical illness on the development of posttraumatic stress symptoms needs to be investigated. To determine the association between anxiety during critical illness (state and trait components) and posttraumatic stress symptoms over six months after ICU discharge. Prospective study including 141 patients admitted ≥24h to a closed mixed adult ICU in a tertiary hospital. State anxiety was assessed with the Faces Anxiety Scale during ICU stay. Trait anxiety was measured with the State-Trait Anxiety Inventory Form Y-2. Posttraumatic stress symptoms were measured at three and six months after ICU discharge using the Post-Traumatic Stress Symptoms 10-Question Inventory. Clinical and demographical data were also collected. Mixed effect regression models were used to determine if state and trait anxiety were factors significantly associated with posttraumatic stress symptoms over time. Moderate to severe levels of state anxiety in ICU were reported by 81 (57%) participants. Levels of trait anxiety (median 36 IQR: 29-47) were similar to the Australian population. High levels of posttraumatic stress symptoms occurred at three (n=19, 19%) and six months (n=15, 17%). Factors independently associated with posttraumatic stress symptoms were trait anxiety (2.2; 95% CI, 0.3-4.1; p=0.02), symptoms of anxiety after ICU discharge (0.6; 95% CI, 0.2-1.1; p=0.005), younger age (-1.4; 95% CI, -2.6 to -0.2; p=0.02) and evidence of mental health treatment prior to the ICU admission (5.2; 95% CI, 1.5-8.9; p=0.006). Posttraumatic stress symptoms occurred in a significant proportion of ICU survivors and were significantly associated with higher levels of trait anxiety, younger age, mental health treatment prior to the ICU admission and more symptoms of anxiety after ICU discharge. Early assessment and interventions directed to reduce state and trait anxiety in ICU survivors may be of

  8. ICU-recovery in Scandinavia

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Risom, Signe S; Thomsen, Thordis

    2013-01-01

    The aim of our study was to describe and compare models of intensive care follow-up in Denmark, Norway and Sweden to help inform clinicians regarding the establishment and continuation of ICU aftercare programmes.......The aim of our study was to describe and compare models of intensive care follow-up in Denmark, Norway and Sweden to help inform clinicians regarding the establishment and continuation of ICU aftercare programmes....

  9. Limitations and practicalities of CAM-ICU implementation, a delirium scoring system, in a Dutch intensive care unit.

    Science.gov (United States)

    Riekerk, Bea; Pen, Evert Jan; Hofhuis, José G M; Rommes, Johannes H; Schultz, Marcus J; Spronk, Peter E

    2009-10-01

    Delirium is a frequently missed diagnosis in the intensive care unit (ICU). Implementation of the Confusion Assessment Method for the ICU (CAM-ICU) may improve recognition of delirium. However, the ICU team may be reluctant to adopt daily assessment by a screening tool. This report focusses on the obstacles and barriers encountered with respect to organisational context and prevailing opinions and attitudes when implementing the CAM-ICU in daily practice in a Dutch ICU. A structured implementation process was set up comprising four phases: (1) assessing the current situation to understand behaviour towards delirium; (2) the identification of barriers to the implementation of the CAM-ICU; (3) preparation of the ICU team for a change in attitude; and (4) evaluation of the effects of implementation. Phase 1 demonstrated that there was no delirium protocol available; it was left to the attending physicians when and how to diagnose delirium in each individual patient. In addition, nurses acted on delirium in a non-structured way; nurses thought implementation of the CAM-ICU would be very time-consuming and would not add to their ability in recognising delirium. In Phase 2, several barriers to implementation were addressed. Firstly, all nurses had to be convinced that delirium is an important problem and, secondly, logistics had to be put in place, for example, picture cards at every bedside, communication between daily nurses and a delirium working group had to be improved. In Phase 3, 10 nurses were educated to perform the CAM-ICU through several training sessions which included videos to illustrate different delirium states; these trained nurses educated all other nurses. A check box in the daily records was introduced to denote whether the CAM-ICU had been performed. In Phase 4, after a training period and 2 months of actual routine bedside CAM-ICU performance, evaluation demonstrated that frequency of assessments on un-sedated patients had increased from 38% to 95

  10. Mortality after hospital discharge in ICU patients

    NARCIS (Netherlands)

    Brinkman, Sylvia; de Jonge, Evert; Abu-Hanna, Ameen; Arbous, M. Sesmu; de Lange, Dylan W.; de Keizer, Nicolette F.

    2013-01-01

    To assess the mortality risk of ICU patients after hospital discharge and compare it to mortality of the general Dutch population. Cohort study of ICU admissions from a national ICU registry linked to administrative records from an insurance claims database. Eighty-one Dutch ICUs. ICU patients (n =

  11. Staff acceptance of tele-ICU coverage: a systematic review.

    Science.gov (United States)

    Young, Lance Brendan; Chan, Paul S; Cram, Peter

    2011-02-01

    Remote coverage of ICUs is increasing, but staff acceptance of this new technology is incompletely characterized. We conducted a systematic review to summarize existing research on acceptance of tele-ICU coverage among ICU staff. We searched for published articles pertaining to critical care telemedicine systems (aka, tele-ICU) between January 1950 and March 2010 using PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Library and abstracts and presentations delivered at national conferences. Studies were included if they provided original qualitative or quantitative data on staff perceptions of tele-ICU coverage. Studies were imported into content analysis software and coded by tele-ICU configuration, methodology, participants, and findings (eg, positive and negative staff evaluations). Review of 3,086 citations yielded 23 eligible studies. Findings were grouped into four categories of staff evaluation: overall acceptance level of tele-ICU coverage (measured in 70% of studies), impact on patient care (measured in 96%), impact on staff (measured in 100%), and organizational impact (measured in 48%). Overall acceptance was high, despite initial ambivalence. Favorable impact on patient care was perceived by > 82% of participants. Staff impact referenced enhanced collaboration, autonomy, and training, although scrutiny, malfunctions, and contradictory advice were cited as potential barriers. Staff perceived the organizational impact to vary. An important limitation of available studies was a lack of rigorous methodology and validated survey instruments in many studies. Initial reports suggest high levels of staff acceptance of tele-ICU coverage, but more rigorous methodologic study is required.

  12. ICU-based rehabilitation and its appropriate metrics.

    Science.gov (United States)

    Gosselink, Rik; Needham, Dale; Hermans, Greet

    2012-10-01

    Survival of critically ill patients is frequently associated with significant functional impairment and reduced health-related quality of life. Early rehabilitation of ICU patients has recently been identified as an important focus for interdisciplinary ICU teams. However, the amount of rehabilitation performed in ICUs is often inadequate. The scope of the review is to discuss recent developments in application of assessment tools and rehabilitation in critically ill patients within an interdisciplinary approach. ICU-based rehabilitation has become an important evidence-based component in the management of patients with critical illness. The assessment and evidence-based treatment of these patients should include a focus on prevention and treatment of deconditioning (muscle weakness, joint stiffness, impaired functional performance) and weaning failure (respiratory muscle weakness) to identify targets for rehabilitation. A variety of modalities for assessment and early ICU rehabilitation are supported by emerging clinical research and must be implemented according to the stage of critical illness, comorbidities, and consciousness and cooperation of the patient. Daily evaluation of every critically ill patient should include evaluation of the need for bedrest and immobility, and assessment of the potential for early rehabilitation interventions. Early ICU rehabilitation is an interdisciplinary team responsibility, involving physical therapists, occupational therapists, nurses and medical staff.

  13. Cytomegalovirus reactivation in ICU patients.

    Science.gov (United States)

    Papazian, Laurent; Hraiech, Sami; Lehingue, Samuel; Roch, Antoine; Chiche, Laurent; Wiramus, Sandrine; Forel, Jean-Marie

    2016-01-01

    Approximately 20 years have passed since we reported our results of histologically proven cytomegalovirus (CMV) pneumonia in non-immunocompromised ICU patients. Even if there are more recent reports suggesting that CMV may worsen the outcomes for ICU patients, there is no definite answer to this question: is CMV a potential pathogen for ICU patients or is it simply a bystander? We will describe the pathophysiology of active CMV infection and the most recent insights concerning the epidemiological aspects of these reactivations. Cytomegalovirus can be pathogenic by a direct organ insult (such as for the lung), by decreasing host defences against other microorganisms and/or by enhancing the body's inflammatory response (as in acute respiratory distress syndrome). The incidence of active CMV infection is dependent on the diagnostic method used. Using the most sophisticated available biological tools, the incidence can reach 15-20% of ICU patients (20-40% in ICU patients with positive CMV serology). In adequately powered cohorts of patients, active CMV infection appears to be associated with worse outcomes for mechanically ventilated ICU patients. There is no absolute direct proof of a negative impact of active CMV infection on the health outcomes of mechanically ventilated patients. Prospective randomized trials are lacking. Future trials should examine the potential benefits for health outcomes of using antiviral treatments. Such treatments could be prophylactic, pre-emptive or used only when there is an end-organ disease. Cytomegalovirus infection may affect health outcomes for ICU patients. Additional prospective trials are necessary to confirm this hypothesis.

  14. [The teaching-learning process in ICU: a phenomenological study].

    Science.gov (United States)

    Guedes, Glauteice Freitas; Ohara, Conceição Vieira da Silva; Silva, Gilberto Tadeu Reis da

    2008-01-01

    This study aimed to understanding the meaning attributed by teaching staff throughout the traineeship from nursing under graduation course in intensive care on the teaching and learning process. It's a study of phenomenological qualitative approach. The data were obtained through the following guiding question: 'How do you live the teaching-learning process at the ICU traineeship?'. From the subjects' descriptions, four open categories came up: 'An awakening to ICU', 'A searching for how to teaching Nursing in Intensive Care', 'A connection between the teaching staff and the students' and 'A meaningful experience'. This study showed that this living experience, which is shared, permits an approaching and the meeting of the teaching staff with the students in this setting, facilitating the teaching-learning process.

  15. Reducing Hospital ICU Noise: A Behavior-Based Approach

    Directory of Open Access Journals (Sweden)

    Avinash Konkani

    2014-01-01

    Full Text Available Noise in Intensive Care Units (ICUs is gaining increasing attention as a significant source of stress and fatigue for nursing staff. Extensive research indicates that hospital noise also has negative impact on patients. The objective of this study was to analyze noise variations as experienced by both nursing staff and patients, to gain a better understanding of noise levels and frequencies observed in ICU settings over extended (week-long durations, and to implement a low cost behavior modification program to reduce noise. The results of our study indicate that behavioral modification alone is not adequate to control excessive noise. There is a need for further research involving the supportive involvement by clinicians, ICU staff, along with effective medical device alarm management, and continuous process improvement methods.

  16. Temperature variability during delirium in ICU patients: an observational study.

    Directory of Open Access Journals (Sweden)

    Arendina W van der Kooi

    Full Text Available INTRODUCTION: Delirium is an acute disturbance of consciousness and cognition. It is a common disorder in the intensive care unit (ICU and associated with impaired long-term outcome. Despite its frequency and impact, delirium is poorly recognized by ICU-physicians and -nurses using delirium screening tools. A completely new approach to detect delirium is to use monitoring of physiological alterations. Temperature variability, a measure for temperature regulation, could be an interesting component to monitor delirium, but whether temperature regulation is different during ICU delirium has not yet been investigated. The aim of this study was to investigate whether ICU delirium is related to temperature variability. Furthermore, we investigated whether ICU delirium is related to absolute body temperature. METHODS: We included patients who experienced both delirium and delirium free days during ICU stay, based on the Confusion Assessment method for the ICU conducted by a research- physician or -nurse, in combination with inspection of medical records. We excluded patients with conditions affecting thermal regulation or therapies affecting body temperature. Daily temperature variability was determined by computing the mean absolute second derivative of the temperature signal. Temperature variability (primary outcome and absolute body temperature (secondary outcome were compared between delirium- and non-delirium days with a linear mixed model and adjusted for daily mean Richmond Agitation and Sedation Scale scores and daily maximum Sequential Organ Failure Assessment scores. RESULTS: Temperature variability was increased during delirium-days compared to days without delirium (β(unadjusted=0.007, 95% confidence interval (CI=0.004 to 0.011, p<0.001. Adjustment for confounders did not alter this result (β(adjusted=0.005, 95% CI=0.002 to 0.008, p<0.001. Delirium was not associated with absolute body temperature (β(unadjusted=-0.03, 95% CI=-0.17 to 0

  17. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices

    OpenAIRE

    Sluisveld, N. van; F. Bakhshi-Raiez; de Keizer, N; Holman, R.; Westert, G.P.; Wollersheim, H.C.; van der Hoeven, J. G.; Zegers, M.

    2017-01-01

    Background Variation in intensive care unit (ICU) readmissions and in-hospital mortality after ICU discharge may indicate potential for improvement and could be explained by ICU discharge practices. Our objective was threefold: (1) describe variation in rates of ICU readmissions within 48?h and post-ICU in-hospital mortality, (2) describe ICU discharge practices in Dutch hospitals, and (3) study the association between rates of ICU readmissions within 48?h and post-ICU in-hospital mortality a...

  18. Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study.

    Science.gov (United States)

    van Sluisveld, Nelleke; Oerlemans, Anke; Westert, Gert; van der Hoeven, Johannes Gerardus; Wollersheim, Hub; Zegers, Marieke

    2017-04-04

    Evidence indicates that suboptimal clinical handover from the intensive care unit (ICU) to general wards leads to unnecessary ICU readmissions and increased mortality. We aimed to gain insight into barriers and facilitators to implement and use ICU discharge practices. A mixed methods approach was conducted, using 1) 23 individual and four focus group interviews, with post-ICU patients, ICU managers, and nurses and physicians working in the ICU or general ward of ten Dutch hospitals, and 2) a questionnaire survey, which contained 27 statements derived from the interviews, and was completed by 166 ICU physicians (21.8%) from 64 Dutch hospitals (71.1% of the total of 90 Dutch hospitals). The interviews resulted in 66 barriers and facilitators related to: the intervention (e.g., feasibility); the professional (e.g., attitude towards checklists); social factors (e.g., presence or absence of a culture of feedback); and the organisation (e.g., financial resources). A facilitator considered important by ICU physicians was a checklist to structure discharge communication (92.2%). Barriers deemed important were lack of a culture of feedback (55.4%), an absence of discharge criteria (23.5%), and an overestimation of the capabilities of general wards to care for complex patients by ICU physicians (74.7%). Based on the barriers and facilitators found in this study, improving handover communication, formulating specific discharge criteria, stimulating a culture of feedback, and preventing overestimation of the general ward are important to effectively improve the ICU discharge process.

  19. 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

    2012-12-01

    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). 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. We measured percent correct detection of abnormal patient variables, nurses' perceived workload (NASA-TLX), and display usability ratings. 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, pdisplay design methodology. Information displays developed using user-centered design should accommodate the full diversity of the intended user population across use sites. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  20. Nurses' Use and Perception of an Information and Communication Technology System for Improving Coordination During Hospital Discharges: A Survey in Swedish Primary Healthcare.

    Science.gov (United States)

    Christiansen, Line; Fagerström, Cecilia; Nilsson, Lina

    2017-07-01

    To facilitate communications between care levels and improve coordination during hospital discharges, there is great potential in using information and communication technology systems, because they can significantly help to deter unnecessary readmissions. However, there is still a lack of knowledge about how often nurses use information and communication technology and the indicators related to its use. The aims of this study were to describe the indicators related to nurses' use of an information and communication technology system for collaboration between care levels and to estimate whether the level of use can be related to nurses' perceptions of the information and communication technology system's contribution to improve coordination during hospital discharges. A quantitative survey of 37 nurses from 11 primary healthcare centers was performed in a county in southern Sweden. The data were analyzed using descriptive and comparative analyses. The results showed that perceptions concerning the information and communication technology system's usability and time consumption differed between nurses who used the system and those who did not. Simultaneously, the nurses were rather unaware of the ability of the information and communication technology system to improve coordination during patient discharges.

  1. American Association of Critical-Care Nurses

    Science.gov (United States)

    ... in the ICU Explore Explore New Nurses Experienced Nurses Educators/Managers Advanced Practice Membership As a new member of AACN who is also new to critical care, you belong to a group of committed professionals ...

  2. 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

  3. The Swedish Model

    DEFF Research Database (Denmark)

    Kokko, Ari

    2012-01-01

    The main characteristics of ‘the Swedish model’ are arguably related to the country's knowledge-intensive industry and its advanced welfare state. The purpose of this chapter is to discuss the historical development of these two features of the Swedish economy. The first part looks at industrial...

  4. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices

    NARCIS (Netherlands)

    van Sluisveld, Nelleke; Bakhshi-Raiez, Ferishta; de Keizer, Nicolette; Holman, Rebecca; Wester, Gert; Wollersheim, Hub; van der Hoeven, Johannes G.; Zegers, Marieke

    2017-01-01

    Variation in intensive care unit (ICU) readmissions and in-hospital mortality after ICU discharge may indicate potential for improvement and could be explained by ICU discharge practices. Our objective was threefold: (1) describe variation in rates of ICU readmissions within 48 h and post-ICU

  5. Swedish District Nurses' experiences on the use of information and communication technology for supporting people with serious chronic illness living at home--a case study.

    Science.gov (United States)

    Nilsson, Carina; Skär, Lisa; Söderberg, Siv

    2010-06-01

    The aim of this case study was to describe two District Nurses' (DN) experiences of using information and communication technology (ICT) to communicate with chronically ill people in their homes. An electronic messaging program via computers and mobile phones with an Internet connection was used, enabling DNs and the ill people to exchange messages to and from anywhere. The program comprised different virtual rooms, and communication was via text messages. The DNs in this study used the program two to four times each week from November 2003 to March 2004. Semi-structured interviews were performed before, during and after the implementation of the new technology and were analysed using thematic content analysis. The results showed that the DNs felt that the technology increased accessibility to nursing care through a more direct communication with the ill person meaning that a more trusting relationship could be created. The DNs also experienced that the use of ICT saved working time. This study indicates that the use of ICT for communication allowed the DN to better support a chronically ill person at home leading to improved home nursing care. This method of communication cannot replace physical presence, but can be seen as a complement to nursing care at home.

  6. A measure of organizational effectiveness in nursing management in relation to transactional and transformational leadership: a study in a Swedish county hospital.

    Science.gov (United States)

    Prenkert, F; Ehnfors, M

    1997-09-01

    This paper presents an empirical study of the influences of transactional (TA) and transformational (TF) leadership on organizational effectiveness (OE), measured as the degree of goal attainment and the quality of nursing care (NQ). The study subjects were all head-nurses and assistant head-nurses at a medium-sized hospital in Sweden (n = 23). The methods used were questionnaires and interviews. The multi-leadership questionnaire earlier developed by Bass was modified and named the Leadership Nursing-Effectiveness Questionnaire (LNEQ), comprising 84 items using Likert-type scales. The study showed low mean scores on OE (2.19) and TA (1.05) but high mean scores on NQ (3.17) and TF (3.84). The results suggest that the degree of TA and TF leadership had a low and insignificant connection with OE in this hospital organization. The study did not support the statement that organizational units exposed to a higher degree of TA and TF leadership at the same time show a high degree of OE, as has been shown in studies in other cultural contexts and organizations.

  7. Is the competence of Swedish Registered Nurses working in municipal care of older people merely a question of age and postgraduate education?

    Science.gov (United States)

    Karlstedt, Michaela; Wadensten, Barbro; Fagerberg, Ingegerd; Pöder, Ulrika

    2015-06-01

    Previous studies suggest that not only education but also personal aspects such as experience of working as a registered nurse (RN) and age can influence competence. The objective was to explore the educational and self-rated competence of RNs and their duties within the care of older people. A cross-sectional descriptive design was used. All RNs in two counties in Sweden were asked to complete a written questionnaire: a study specific questionnaire with educational and work related questions using the Nurse Competence Scale. The response rate was 61% (n 344). Higher self-rated satisfaction with own professional competence was related to older age, more years after nursing education and possessing at least one postgraduate education in specialist nursing. Educational needs were related to younger age and fewer years since nursing graduation. Education within elder care, including education about drugs was rated the most urgently needed area of education. The most frequently reported tasks were found in the domain helping role, whereas ensuring quality was less present in their daily work. Educational level, age and years of experience had an impact on RNs' self-perceived competence, which is in accordance with previous descriptions of the concept competence. It seems imperative that RNs working in care of the old and with the demands placed on them are given the opportunity to take a postgraduate specialist education in order to gain a competence level in their desired area of work. It is also important that RNs working in care of the old get tailored education in line with the requirements the organisation places on them. © 2014 Nordic College of Caring Science.

  8. Renal replacement therapy in ICU

    Directory of Open Access Journals (Sweden)

    C Deepa

    2012-01-01

    Full Text Available Diagnosing and managing critically ill patients with renal dysfunction is a part of the daily routine of an intensivist. Acute kidney insufficiency substantially contributes to the morbidity and mortality of critically ill patients. Renal replacement therapy (RRT not only does play a significant role in the treatment of patients with renal failure, acute as well as chronic, but also has spread its domains to the treatment of many other disease conditions such as myaesthenia gravis, septic shock and acute on chronic liver failure. This article briefly outlines the role of renal replacement therapy in ICU.

  9. Educação continuada da equipe de enfermagem nas UTIs do município de São Paulo Educación continua del equipo de enfermería en Unidades de Tratamiento Intensivo del municipio de São Paulo Continuing education of ICU nursing staff in São Paulo city

    Directory of Open Access Journals (Sweden)

    Maria Sumie Koizumi

    1998-07-01

    écnicas y rutinas y la atualizacción de patologias. Las actividades de educación continua son desarrolladas, predominantemente, por los enfermeros de las UTIs. 50,2% de los enfermeros respondieran haber frecuentado cursos de especialización o aprimoramiento en Enfermería Médico-Quirúrgica o en otras áreas. Frente a lo detectado y considerando el desarrollo del enfermero de UTI como el de un especialista, se presentan algunas sugestiones para el mejoramiento de las actividades de la educación continua en estas Unidades.This study is part of a project about ICU's characteristics in São Paulo city. This article describes the continuing education programs for nursing staff. 43 ICUs were analysed and the questionnaire answered by the ICU nurse cordinator was used to collect data. Results showed that 34 (79,1% of the ICUs have initial program for training each nursing staff category and 18 (41,9% had regular continuing education program focusing primarily on nursing procedures and routines and the update in pathologies. Continuing education programs are developed primarily by ICU's nurses. 50,2% of the nurses answered that they attended specialisation/ extension courses too, in Medical Surgical Nursing or in other areas or in both areas. Due to this result and the development of the ICU's nurses as specialists, some suggestions are presented to improve the continuing education program in these Units.

  10. Swedish Government Minister at CERN

    CERN Multimedia

    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...

  11. Development and evaluation of an interprofessional communication intervention to improve family outcomes in the ICU.

    Science.gov (United States)

    Curtis, J Randall; Ciechanowski, Paul S; Downey, Lois; Gold, Julia; Nielsen, Elizabeth L; Shannon, Sarah E; Treece, Patsy D; Young, Jessica P; Engelberg, Ruth A

    2012-11-01

    The intensive care unit (ICU), where death is common and even survivors of an ICU stay face the risk of long-term morbidity and re-admissions to the ICU, represents an important setting for improving communication about palliative and end-of-life care. Communication about the goals of care in this setting should be a high priority since studies suggest that the current quality of ICU communication is often poor and is associated with psychological distress among family members of critically ill patients. This paper describes the development and evaluation of an intervention designed to improve the quality of care in the ICU by improving communication among the ICU team and with family members of critically ill patients. We developed a multi-faceted, interprofessional intervention based on self-efficacy theory. The intervention involves a "communication facilitator" - a nurse or social worker - trained to facilitate communication among the interprofessional ICU team and with the critically ill patient's family. The facilitators are trained using three specific content areas: a) evidence-based approaches to improving clinician-family communication in the ICU, b) attachment theory allowing clinicians to adapt communication to meet individual family member's communication needs, and c) mediation to facilitate identification and resolution of conflict including clinician-family, clinician-clinician, and intra-family conflict. The outcomes assessed in this randomized trial focus on psychological distress among family members including anxiety, depression, and post-traumatic stress disorder at 3 and 6 months after the ICU stay. This manuscript also reports some of the lessons that we have learned early in this study. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Economics of ICU organization and management.

    Science.gov (United States)

    Wunsch, Hannah; Gershengorn, Hayley; Scales, Damon C

    2012-01-01

    The intensive care unit (ICU) is a complex system and the economic implications of altering care patterns in the ICU can be difficult to unravel. Few studies have specifically examined the economics of implementing organizational and management changes or acknowledged the many competing economic interests of patient, hospital,payer, and society. With continuously increasing healthcare costs,there is a great need for more studies focused on the optimal organization of the ICU. These studies should not focus solely on reductions in ICU length of stay but should strive to measure the true costs of care within a given healthcare system.

  13. Infection control in the ICU.

    Science.gov (United States)

    Eggimann, P; Pittet, D

    2001-12-01

    Nosocomial infections (NIs) now concern 5 to 15% of hospitalized patients and can lead to complications in 25 to 33% of those patients admitted to ICUs. The most common causes are pneumonia related to mechanical ventilation, intra-abdominal infections following trauma or surgery, and bacteremia derived from intravascular devices. This overview is targeted at ICU physicians to convince them that the principles of infection control in the ICU are based on simple concepts and that the application of preventive strategies should not be viewed as an administrative or constraining control of their activity but, rather, as basic measures that are easy to implement at the bedside. A detailed knowledge of the epidemiology, based on adequate surveillance methodologies, is necessary to understand the pathophysiology and the rationale of preventive strategies that have been demonstrated to be effective. The principles of general preventive measures such as the implementation of standard and isolation precautions, and the control of antibiotic use are reviewed. Specific practical measures, targeted at the practical prevention and control of ventilator-associated pneumonia, sinusitis, and bloodstream, urinary tract, and surgical site infections are detailed. Recent data strongly confirm that these strategies may only be effective over prolonged periods if they can be integrated into the behavior of all staff members who are involved in patient care. Accordingly, infection control measures are to be viewed as a priority and have to be integrated fully into the continuous process of improvement of the quality of care.

  14. Carga de trabajo en tres grupos de pacientes de UCI Española según el Nursing Activities Score Carga de trabalho em três grupos de pacientes em uma UTI espanhola segundo Nursing Activites Score Assessment of nursing workload in three groups of patients in a Spanish ICU using the Nursing Activities Score Scale

    Directory of Open Access Journals (Sweden)

    Francisco Javier Carmona-Monge

    2013-04-01

    Full Text Available Se objetivó valorizar la carga de trabajo al ingreso y al alta en tres grupos de pacientes (síndrome coronario agudo, insuficiencia respiratoria aguda y sepsis en terapia intensiva. Estudio descriptivo, prospectivo, de 27 meses, incluyéndose 563 pacientes, valorando carga de trabajo según Nursing Activities Score. Existieron diferencias significativas en la carga de trabajo al ingreso y en el alta entre los grupos de pacientes, siendo superior en ambos momentos la de pacientes con insuficiencia respiratoria aguda y sepsis frente a pacientes coronarios. Durante los siete primeros días de estancia se mantuvo esta diferencia, desapareciendo a partir del octavo día, equilibrándose la carga de trabajo para los tres grupos. Para conseguir una adecuada dotación de personal es fundamental contar con instrumentos para medir las necesidades de cuidados y conocer la carga de trabajo de los distintos grupos de enfermos que ingresan con mayor frecuencia en las unidades de terapia intensiva.O objetivo deste estudo foi avaliar a carga de trabalho na admissão e alta dos pacientes de três grupos (síndrome coronária aguda, insuficiência respiratória aguda e sepsis em cuidados intensivos. Trata-se de estudo prospectivo, descritivo, que decorreu durante 27 meses, incluindo 563 pacientes. Para a avaliação da carga de trabalho utilizou-se a escala Nursing Activities Score. A partir dos resultados do estudo parecem existir diferenças significativas na carga de trabalho no dia da admissão e alta entre os grupos de pacientes, sendo a carga maior em ambos os tempos a dos pacientes com insuficiência respiratória aguda e sepsis. Durante os primeiros sete dias de internamento essa diferença manteve-se, desaparecendo no oitavo dia, o que equilibrou a carga de trabalho para os três grupos. Conclui-se que para se conseguir os recursos adequados é essencial dispor de instrumentos para medir as necessidades de cuidados e conhecer a carga de trabalho dos

  15. P. aeruginosa colonization at ICU admission as a risk factor for developing P. aeruginosa ICU pneumonia

    NARCIS (Netherlands)

    Paling, FP; Wolkewitz, Martin; Depuydt, Pieter; de Bus, Liesbet; Sifakis, Frangiscos; Bonten, Marc J M; Kluytmans, Jan A J W

    2017-01-01

    OBJECTIVE: To determine the incidence of P. aeruginosa (PA) ICU pneumonia and its independent association with PA colonization at ICU admission. METHODS: This was a post-hoc analysis of a prospectively collected cohort study. Adult ICU patients with a length of stay of ≥48 h were included and

  16. Swedish nursing students' experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education.

    Science.gov (United States)

    Blomberg, Karin; Bisholt, Birgitta; Kullén Engström, Agneta; Ohlsson, Ulla; Sundler Johansson, Annelie; Gustafsson, Margareta

    2014-08-01

    To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education. Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference. A cross-sectional study with evaluative design. Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included. Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis. The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation. It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support. © 2014 John Wiley & Sons Ltd.

  17. Nurses' perceptions of leadership in an adult intensive care unit: a phenomenology study.

    Science.gov (United States)

    Linton, Jenelle; Farrell, Maureen J

    2009-04-01

    The purpose of this research was to explore ICU nurses' perceptions of nursing leadership in the adult intensive care unit (ICU). The nursing profession needs leaders at all levels; ward, administration and executive and in an era in which there is a shortage of ICU nurses, nursing leadership is important, as positive leadership skills correlate with enhanced recruitment and retention of these specialist nurses. Six ICU nurses with at least 5 years experience in ICU nursing were recruited from a metropolitan hospital in Australia. Qualitative phenomenological methodology was used to depict the lived experiences of nurses' leadership in the adult ICU. Data were collected through individual semi-structured interviews using open-ended questions and analysed using Giorgi's [Giorgi A. Toward phenomenologically based research in psychology. J Phenomenol Psychol 1970;1:75-98] descriptive method for data analysis. Five themes emerged and these were all inter-related: leading by example, communication, ability to think outside the management square, knowing your staff and stepping up in times of crisis. These findings highlight the importance of nursing leadership in the adult ICU and the need to ensure that all current and future nursing ICU leaders are adequately prepared and educated for this role. This information may also be used to assist in the development of leadership skills in ICU nurses.

  18. Humanização nas relações com a família: um desafio para a enfermagem em UTI Pediátrica - DOI: 10.4025/actascihealthsci.v26i1.1666 Humanization in the relationship with the family: a challenge to the Nursing in Pediatric ICU - DOI: 10.4025/actascihealthsci.v26i1.1666

    Directory of Open Access Journals (Sweden)

    Benedita Maria Rêgo Deusdará Rodrigues

    2004-04-01

    Full Text Available Cuidar em pediatria significa envolver a criança e a pessoa significativa para ela. O estudo enfoca as vivências da equipe de enfermagem com a família de crianças internadas em UTI pediátrica, tendo como objetivo apreender o típico da ação da equipe de enfermagem em relação aos familiares de crianças internadas em UTI pediátrica. Utilizouse a fenomenologia sociológica de Alfred Schutz por nos possibilitar, na relação face a face e na perspectiva dos motivos, buscar o típico dessa ação. O cenário foi uma UTI Pediátrica de um hospital municipal do Rio de Janeiro, cujos sujeitos foram os profissionais da equipe de enfermagem. Os resultados apontaram duas categorias: interação com a família e participação da família. Concluímos que os profissionais não se sentem preparados para dividirem com os familiares de crianças internadas em UTI pediátrica os mesmos espaços, percebendo a importância da participação da família como um cliente em potencial.In Pediatrics, to look after means to involve a child and a significant person to her. The study focuses on experiences of the nursing staff with the family of children who are hospitalized in Pediatric ICU. The aim of this study is to learn the typical action of the nursing staff towards the families of the children hospitalized in the Pediatric ICU. Alfred Schutz’s sociological phenomenology was used, in a face-to-face relationship and in the perspective of the 'motives' to seek the typical of this action. The setting was a Pediatric ICU of a municipal hospital in Rio de Janeiro. The subjects were the professionals of its nursing staff. Results showed two categories: family interaction and family participation. We concluded that the professionals are not prepared to share the same room with the families of hospitalized children in Pediatric ICU. But, they are aware of the importance of the family participation as a potential client.

  19. Intensive care unit nurse managers' views regarding nurse staffing in their units in South Africa.

    Science.gov (United States)

    Matlakala, Mokgadi C; Botha, Annali D H

    2016-02-01

    To explore the views of the intensive care unit (ICU) nurse managers regarding nurse staffing in the large ICUs. A qualitative design was used to explore the views of the ICU managers. Four individual interviews were conducted with ICU managers. The interviews were audio recorded; transcribed verbatim and content data analysis was undertaken. The settings were ICUs of four private hospitals in the Tshwane metropolitan area in Gauteng Province, South Africa. Two themes that emerged from the data were shortage of competent and trained nurses and problems with agency nurses. Shortage of competent and trained nurses was associated with the global shortage of nurses; and led to increased patient-to-nurse ratios and the use of other categories of nurses, other than professional nurses. The problems with agency nurses were lack of ICU experience and lack of commitment to their professional work. These brought about risks in the provision of quality nursing care. Adequate numbers of competent and committed nurses is essential for efficient patient care and favourable outcomes in the ICUs. The findings demonstrate the importance of provision of ICU trained nurses for patient care, rather than nurse staffing simply to balance the numbers. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. P. aeruginosa colonization at ICU admission as a risk factor for developing P. aeruginosa ICU pneumonia

    Directory of Open Access Journals (Sweden)

    Fleur P. Paling

    2017-04-01

    Full Text Available Abstract Objective To determine the incidence of P. aeruginosa (PA ICU pneumonia and its independent association with PA colonization at ICU admission. Methods This was a post-hoc analysis of a prospectively collected cohort study. Adult ICU patients with a length of stay of ≥48 h were included and assessed for microbiologically confirmed PA ICU pneumonia. Multivariate survival analysis was performed, including the covariates age, gender, PA colonization at ICU admission, ICU admission specialty and mechanical ventilation at ICU admission, while taking into account the effect of competing risks. Results We included 5093 patients, 2447 (48% were tested for colonization; of those 226 (9.2% were PA colonized at ICU admission. The incidence of PA ICU pneumonia was 1.34% (n = 68. PA colonization was an independent risk factor (subdistribution hazard ratio [SHR] 8.8; 95% confidence interval [CI] 4.9–15.7, as was mechanical ventilation (SHR 5.3, 95% CI 2.7–10.6. Conclusion In this study the incidence of P. aeruginosa ICU pneumonia was 1.34%. Hazard ratios for PA colonized patients compared to non-colonized to develop PA ICU pneumonia were 8.8. The high risk associated with P. aeruginosa colonization for subsequent infection may offer a target for future interventions.

  1. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices

    NARCIS (Netherlands)

    Sluisveld, N. van; Bakhshi-Raiez, F.; Keizer, N. de; Holman, R.; Westert, G.P.; Wollersheim, H.C.; Hoeven, J.G. van der; Zegers, M.

    2017-01-01

    BACKGROUND: Variation in intensive care unit (ICU) readmissions and in-hospital mortality after ICU discharge may indicate potential for improvement and could be explained by ICU discharge practices. Our objective was threefold: (1) describe variation in rates of ICU readmissions within 48 h and

  2. The health-illness care process and the logic of the nurse's work in the ICU El proceso de salud-enfermedad-cuidado y la lógica en el trabajo del enfermero en UCI O processo saúde-doença-cuidado e a lógica do trabalho do enfermeiro na UTI

    Directory of Open Access Journals (Sweden)

    Leandro Barbosa de Pinho

    2007-04-01

    Full Text Available The present study aims to learn the health production logic in the ICU based on the discourse defended by nurses and on the professional practice that is recognized by the relatives accompanying the hospitalized patients. This is a qualitative and dialectic investigation performed with seven nurses and five relatives in an ICU for adults of a teaching hospital in Santa Catarina. The theoretical-philosophical referential was based on Marxist and Gramscians readings. The results show that the logic of the health production in the ICU is inserted in a dialectic rhythm of autonomy, dependence and co-responsibility for the care. We understand that this reality can demonstrate the need to rethink the knowledge and practices to promote the constant re-formularization and transformation of the assistant context of intensive care.Este estudio pretende conocer la lógica de producción en salud en la UCI basado en lo que es expresado - defendido por el enfermero dentro de su práctica profesional, la cual es reconocida por los familiares que acompañan a los pacientes internados. Se trata de una investigación cualitativa con orientación dialéctica, realizada con 7 enfermeros y 5 familiares de una UCI de adultos dentro de un hospital universitario de Santa Catarina. El referencial teórico-filosófico escogido se basó en lecturas marxistas y gramscianas. Los resultados demuestran que la lógica de producción en salud en UCI se encuentra incluida dentro de una red compleja, la cual se da dentro de un ritmo dialéctico basado en autonomía, dependencia y co-responsabilidad para con el cuidado. Comprendemos que la realidad refleja la necesidad de repensar sobre el saber y las prácticas profesionales promoviendo la constante reformulación y transformación de los cuidados intensivos dentro del contexto asistencial.O presente estudo pretende conhecer a lógica da produção de saúde na UTI com base no discurso defendido pelo enfermeiro e na pr

  3. [Ethical dilemmas in ICU: contributions of Max Scheler's Theory of Values].

    Science.gov (United States)

    Medeiros, Marlise Barros de; Pereira, Eliane Ramos; Silva, Rose Mary Costa Rosa Andrade; Silva, Marcos Andrade

    2012-01-01

    The study aimed to reflect, based on the theoretical framework of Max Scheler, about the ethical dilemmas experienced by nurses in the ICU, and about the values that guide their actions and decisions,. This is qualitative research, and ten ICU nurses have been interviewed at a university hospital. It was identified the experience of ethical dilemmas related to the terminality related to the limits of intervention and use of material resources, as well as the issue of blood transfusion in case of religious restrictions. The values identified were: respect, dignity of the patient, scientific knowledge, humility, passion for the profession and love of God. The theory of values is an important tool for nursing because it allows the approach of an ethics of humanizing praxis, especially in situations of ethical dilemmas.

  4. Nurses' knowledge about and attitudes toward organ donation in ...

    African Journals Online (AJOL)

    The objectives of this study were to explore nurses' knowledge of the organ donation process and to explore personal beliefs and attitudes around ..... Ndebele. 4 (1.5). RN = registered nurse; ICU = intensive care unit; EN = enrolled nurse; NA = nurse assistant; SN = student nurse; CW = care worker; ND = not determined.

  5. Impact of ICU-acquired weakness on post-ICU physical functioning: a follow-up study

    OpenAIRE

    Wieske, Luuk; Daniela S Dettling-Ihnenfeldt; Verhamme, Camiel; Nollet, Frans; Ivo N van Schaik; Schultz, Marcus J.; Horn, Janneke; van der Schaaf, Marike

    2015-01-01

    Introduction ICU-acquired weakness is thought to mediate physical impairments in survivors of critical illness, but few studies have investigated this thoroughly. The purpose was to investigate differences in post-ICU mortality and physical functioning between patients with and without ICU-acquired weakness at 6 months after ICU discharge. Method ICU patients, mechanically ventilated ?2 days, were included in a single-center prospective observational cohort study. ICU-acquired weakness was di...

  6. The Swedish Academy Dictionary Project

    African Journals Online (AJOL)

    rbr

    (bo.wendt@svenskaakademien.se), Dictionary Staff of the Swedish Academy,. Lund, Sweden. Abstract: The Swedish Academy Dictionary is one of the world's largest dictionary projects. Work on it was started in 1884 and it will be completed by 2017. The dictionary describes the writ- ten standard language of Swedish from ...

  7. Early goal-directed nutrition in ICU patients (EAT-ICU)

    DEFF Research Database (Denmark)

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

    2016-01-01

    %). 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...... will provide important data on the effects of early goal-directed protein-energy nutrition based on measured requirements in these patients. FUNDING: The EAT-ICU trial is funded by Copenhagen University Hospital, Rigshospitalet and Fresenius Kabi A/S and supported by The European Society for Clinical Nutrition......-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...

  8. [Family-Centered Care in the ICU].

    Science.gov (United States)

    Hartog, Christiane S; Bodechtel, Ulf

    2018-01-01

    Family-centered care in the ICU is a quality criterion of modern intensive care. Relatives are not just visitors, caregivers and involved stakeholders, but also partners for the medical team, especially when eliciting patient preferences and during shared decisionmaking. The move towards family-centered care signifies that traditional roles are changing; family-centered care is becoming a critical component of optimizing patient outcomes in the ICU. © Georg Thieme Verlag KG Stuttgart · New York.

  9. The National Early Warning Score: Translation, testing and prediction in a Swedish setting.

    Science.gov (United States)

    Spångfors, Martin; Arvidsson, Lisa; Karlsson, Victoria; Samuelson, Karin

    2016-12-01

    The National Early Warning Score - NEWS is a "track and trigger" scale designed to assess in-hospital patients' vital signs and detect clinical deterioration. In this study the NEWS was translated into Swedish and its association with the need of intensive care was investigated. A total of 868 patient charts, recorded by the medical emergency team at a university hospital, containing the parameters needed to calculate the NEWS were audited. The NEWS was translated into Swedish and tested for inter-rater reliability with a perfect agreement (weighted κ=1.0) among the raters. The median score for patients admitted to the ICU were higher than for those who were not (10 vs. 8, pscores for the parameters oxygen saturation and level of consciousness in the NEWS may predict admission to the ICU. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Erlang loss bounds for OT-ICU systems

    NARCIS (Netherlands)

    van Dijk, N.M.; Kortbeek, Nikky

    2009-01-01

    In hospitals, patients can be rejected at both the operating theater (OT) and the intensive care unit (ICU) due to limited ICU capacity. The corresponding ICU rejection probability is an important service factor for hospitals. Rejection of an ICU request may lead to health deterioration for

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

    Science.gov (United States)

    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

  12. 神经外科重症监护室老年患者气管切开后肺部感染原因与护理%Analysis of Pulmonary Infection and Nursing Points in Elder Patients After Tracheotomy in Neurosurgical ICU

    Institute of Scientific and Technical Information of China (English)

    王宏; 王建平; 刘学民

    2017-01-01

    目的 分析神经外科重症监护室(intensive care unit,ICU)内老年患者气管切开后肺部感染原因,总结其护理要点.方法 回顾性分析2015年1月至2016年6月安徽省淮北市人民医院收治的颅脑损伤及自发性脑出血行气管切开术后发生肺部感染的老年患者45例的临床资料,分析其气管切开后肺部感染原因及菌谱,并提出护理对策要点.结果 45例患者中,32例接受机械通气治疗,除有6例患者在院外行气管切开术,其余患者在入院治疗期间均行气管切开术.导致肺部感染的前3位致病菌分别为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌.结论 在神经外科ICU中,老年患者气管切开后,肺部感染多为阴性菌感染,并且多重耐药、泛耐药甚至耐碳青霉烯菌株也不少见,应优先采取有效护理对策,减少院内感染机会;一旦发生感染,应尽早获得痰培养及药敏结果,指导临床用药.%Objective To summarize and analyze the reasons of pulmonary infection in elder patients after tracheotomy in neurosurgical intensive care unit (ICU).Methods Clinical data of totally 45elder patients after traeheotomy with craniocerebral injury and spontaneous intracerebral hemorrhage from January 2015 to June 2016 were analyzed retrospectively.The reasons of pulmonary infection and the spectrum of bacteria were analyzed and the nursing points were summarized.Results There were 45 patients included,32 of whom were treated with mechanical ventilation.Except 6 patients with pre-hospital tracheotomy.The first three pathogens were Acinetobacterbaumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa.Conclusion In neurosurgical ICU,pulmonary infections of elder patients mostly were negative bacterial infections,and multi-drug resistance,pan-resistant and even carbapenem-resistant strains are not uncommon.It should give priority to take effective care measures to reduce nosocomial infection opportunities;once infection

  13. Identifying Nurse Education Needs with Documentation Audits

    African Journals Online (AJOL)

    Background. In July 2014, the Intensive Care Unit (ICU) at the University Teaching Hospital of Butare (CHUB) implement- ed a new daily nursing flow sheet. The use of a detailed flow sheet assessment had never been implemented as a care modality in the ICU at CHUB. In October 2014, a documentation audit tool was ...

  14. 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

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

    Science.gov (United States)

    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.

  16. Developing a mobility protocol for early mobilization of patients in a surgical/trauma ICU.

    Science.gov (United States)

    Zomorodi, Meg; Topley, Darla; McAnaw, Maire

    2012-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. As representações sociais dos trabalhadores de enfermagem não enfermeiros (técnicos e auxiliares de enfermagem sobre o trabalho em Unidade de Terapia Intensiva em um hospital-escola Las representaciones sociales del personal no enfermero (técnicos y auxiliares de enfermería sobre el trabajo en un Centro de Terapia Intensiva en un hospital ecuela Social representations of ICU auxiliary nursing personnel from a teaching hospital about their practice

    Directory of Open Access Journals (Sweden)

    Helena Eri Shimizu

    2002-06-01

    Full Text Available Este estudo tem como objetivos conhecer as representações sociais dos trabalhadores de enfermagem não enfermeiros acerca do trabalho na UTI, os modos de expressão do sofrimento e prazer e as formas de enfrentamento do sofrimento ligados a esse trabalho. Adota como referencial teórico-metodológico a Teoria das Representações Sociais. Os dados são obtidos por meio de entrevistas semi-estruturadas e analisados com a técnica de análise de conteúdo, especificamente, a análise de enunciação. As representações evidenciam que, para suportarem a dor, o sofrimento e a morte do paciente, utilizam-se de diversos mecanismos individuais de defesa, classicamente descritos pela Psicopatologia e pela Psicanálise.El objetivo de este estudio es conocer las representaciones sociales del personal no enfermero sobre el trabajo en el Centro de Terapia Intensiva, los modos de expresión del sufrimiento y el placer y las formas de el sufrimiento relacionados a esse trabajo. Adopta como referencia teórica-meodológica la Teoria de las Representaciones Sociales. Los datos fueron obtenidos mediante entrevistas semiestructuradas y analizados com la técnica del análisis de contenido, más exactamente, el análisis de enunciación. Las representaciones demuestran que, para soportar el dolor, el sufrimiento y la muerte del paciente, los técnicos y auxiliares de enfermeria se valen de diversos mecanismos individuales de defensa, clásicamente descritos por la psicopatología y psicoanálisis.The study identifies and analyses social representations of Intensive Care Unit (ICU nursing staff about their work and how they express feelings of sorrow and pleasure associated to their job. The theoretical and methodological reference used by this study was the Theory of Social Representations. Interviews were carried out with auxiliary nursing personnel (licensed practical nurse and nurse technician. The data were analyzed by analysis-of-content technique, in

  19. Reshaping ICU ward round practices using video-reflexive ethnography.

    Science.gov (United States)

    Carroll, Katherine; Iedema, Rick; Kerridge, Ross

    2008-03-01

    In this article, we outline a study method with which structural changes to clinical communication were achieved within a local intensive care unit (ICU). The study method involved in-depth, round-the-clock observation, interviewing, and video filming of how intensivists conducted their practices, as well as showing selected footage to the clinicians for feedback. This feedback component iteratively engaged clinicians in problem-solving their own communication difficulties. The article focuses on one such feedback meeting and describes changes to the morning ward round and planning meeting that this feedback process catalyzed: greater time efficiency, a greater presence of intensivists in the ICU, more satisfied nursing staff, and a handover sheet to improve the structure of clinical information exchanges. We argue that in embodying not a descriptive but an interventionist approach to health service provision, this video-ethnographic method has great significance for enhancing clinicians' and researchers' understanding of the rising complexity of in-hospital practices, and for enabling them to intervene in these practices.

  20. Frequency of nosocomial pneumonia in ICU Qazvin Razi hospital (2013

    Directory of Open Access Journals (Sweden)

    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.

  1. S. aureus colonization at ICU admission as a risk factor for developing S. aureus ICU pneumonia

    NARCIS (Netherlands)

    Paling, Fleur P|info:eu-repo/dai/nl/413968669; Wolkewitz, Martin; Bode, Lonneke G M; Klein Klouwenberg, Peter M C|info:eu-repo/dai/nl/33706864X; Ong, David S Y; Depuydt, Pieter; de Bus, Liesbet; Sifakis, Frangiscos; Bonten, Marc J M|info:eu-repo/dai/nl/123144337; Kluijtmans, Jan|info:eu-repo/dai/nl/323262139

    OBJECTIVE: To quantify the incidence of intensive care unit (ICU) acquired pneumonia caused by Staphylococcus aureus (S. aureus) and its association with S. aureus colonization at ICU admission. METHODS: This was a post-hoc analysis of two cohort studies in critically ill patients. The primary

  2. 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...

  3. 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...

  4. 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.

  5. Caring for the dying patient in the ICU--the past, the present and the future.

    Science.gov (United States)

    Fridh, Isabell

    2014-12-01

    The aim of this paper is to present the state of the science concerning issues in end-of-life (EOL) care which have an impact on intensive care nurses possibilities to provide nursing care for dying patients and their families. The perspective of families is also illuminated and finally ethical challenges in the present and for the future are discussed. The literature review revealed that the problem areas nurses report concerning EOL care have been the same over three decades. Most problems are related to inter-disciplinary collaboration and communication with the medical profession about the transition from cure to comfort care. Nurses need enhanced communication skills in their role as the patient's advocate. Education in EOL care and a supportive environment are prerequisites for providing EOL care. Losing a loved one in the ICU is a stressful experience for close relatives and nursing care has a profound impact on families' memories of the EOL care given to their loved ones. It is therefore important that ICU nurses are aware of families' needs when a loved one is dying and that follow-up services are appreciated by bereaved family members. Ethical challenges are related to changed sedation practices, organ donation, globalisation and cultural sensitivity. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    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, P<0.05), nurse-physician communication (r=0.25, P<0.05), and age (r=0.21, P<0.05). The predicting factors for turnover 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.

  7. Salmonella in Swedish cattle

    OpenAIRE

    Ågren, Estelle

    2017-01-01

    In Sweden, all herds detected with salmonella are put under restrictions and measures aiming at eradication are required. The purpose of these studies was to provide a basis for decisions on how surveillance and control of salmonella in Swedish cattle can be made more cost-efficient. Results from a bulk milk screening were used to investigate seroprevalence of salmonella and to study associations between salmonella status and geographical location, local animal density, number of test pos...

  8. Swedish electricity market 1996

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-11-01

    The organization of the Swedish electricity market has been in a state of continual change since the electricity market reform was started in the early 1990s. The conditions for the development of the electricity market have changed since the new Electricity Act came into force on 1 January 1996. The purpose of the reform is to introduce greater competition on the electricity market and provide the consumers with greater freedom of choice and, by open trade in electricity, to create the conditions for more efficient pricing. Being the central energy authority, the Swedish National Board for Industrial and Technical Development, NUTEK, was entrusted by the Government with the task of following developments on the Swedish electricity market. The Network Authority, which has the supervisory function for the new electricity market, were entrusted by the Government with the task of following developments on the Swedish electricity market and regularly compiling and reporting current market information. The new electricity market has now been operative for ten months. The Network Authority has submitted to the Government a detailed report entitled `Developments on the electricity market`, dealing with the experience gained from the electricity market reform. The purpose of the publication is to provide the players on the electricity market - the decision makers, the media and the general public - with comprehensive and easily accessible information on the market conditions. The publication includes summaries of information on electricity production and use in recent years, the structure of the electricity market from the perspective of a player, electricity trade in Sweden and in northern Europe, electricity prices in Sweden and other countries, and the impact of the electricity sector on the environment

  9. Swedish Family Policy.

    Science.gov (United States)

    Herrstrom, Staffan

    1986-01-01

    Family policy remains one of the leading issues of Swedish domestic politics. All parties are agreed that families with children must be given a better deal in the wake of the economic crisis. But how is this to be done and how quickly can it be achieved? Is the expansion of day nursery facilities to be speeded up, or are parents to be given a…

  10. 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...... are indices of acute renal failure (ARF). Septic ICU patients develop multi-organ failure and ARF is often an important complication. In order to attempt to substitute artificially for the failing renal function, septic ARF patients often undergo hemodialytic procedures until kidney damage resolves....... 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...

  11. Nonrespiratory sleep disorders found in ICU patients.

    Science.gov (United States)

    Brown, Lee K; Arora, Madhu

    2008-07-01

    Intensive care subjects the critically ill patient to a multitude of stressors caused by the severity of illness and the use of invasive treatment modalities and medications. The ICU environment contributes significant stress of its own related to noise, light, 24-hour patient care, and other factors that disturb sleep. Consequently, various sleep pathologies may emerge or worsen in the ICU patient. Some sleep disorder symptomatology may be confused with serious neurologic complications of critical illness and lead to inappropriate testing or treatment, particularly in the patient who has narcolepsy. Given the high prevalence of sleep disorders in the general population, it is essential that the ICU practitioner attain an adequate knowledge of sleep and its disorders.

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. Clinical application of arrhythmia analyzer in ICU.

    Science.gov (United States)

    Oyama, T; Ishihara, H; Tanioka, F; Matsuki, A; Aida, N; Ishii, H

    1987-01-01

    A microcomputer system (NEC Sanei Ins. Company Ltd.) has been developed for the continuous monitoring and storage and retrieval of data from serial ECG tracings in each ICU patient. Eight hundred and forty patients were monitored using the system. Diagnosis of ventricular arrhythmias and ST-segment change was highly accurate. However, the false positive diagnosis was sometimes generated by artifact. Diagnosis of supraventricular arrhythmias or rhythmic abnormalities were less accurate compared with that of ventricular arrhythmias. Application of microcomputer system in the space limited ICU is of benefit to identify and evaluate ECG gracings in time saving way. However, further version-up is needed to promote the accuracy of the diagnosis.

  15. 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...

  16. Implementation of a delirium assessment tool in the ICU can influence haloperidol use.

    Science.gov (United States)

    van den Boogaard, Mark; Pickkers, Peter; van der Hoeven, Hans; Roodbol, Gabriel; van Achterberg, Theo; Schoonhoven, Lisette

    2009-01-01

    In critically ill patients, delirium is a serious and frequent disorder that is associated with a prolonged intensive care and hospital stay and an increased morbidity and mortality. Without the use of a delirium screening instrument, delirium is often missed by ICU nurses and physicians. The effects of implementation of a screening method on haloperidol use is not known. The purpose of this study was to evaluate the implementation of the confusion assessment method-ICU (CAM-ICU) and the effect of its use on frequency and duration of haloperidol use. We used a tailored implementation strategy focused on potential barriers. We measured CAM-ICU compliance, interrater reliability, and delirium knowledge, and compared the haloperidol use, as a proxy for delirium incidence, before and after the implementation of the CAM-ICU. Compliance and delirium knowledge increased from 77% to 92% and from 6.2 to 7.4, respectively (both, P < 0.0001). The interrater reliability increased from 0.78 to 0.89. More patients were treated with haloperidol (9.9% to 14.8%, P < 0.001), however with a lower dose (18 to 6 mg, P = 0.01) and for a shorter time period (5 [IQR:2-9] to 3 [IQR:1-5] days, P = 0.02). With a tailored implementation strategy, a delirium assessment tool was successfully introduced in the ICU with the main goals achieved within four months. Early detection of delirium in critically ill patients increases the number of patients that receive treatment with haloperidol, however with a lower dose and for a shorter time period.

  17. The validity and reliability of the Arabic version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU): A prospective cohort study.

    Science.gov (United States)

    Selim, Abeer; Kandeel, Nahed; Elokl, Mohamed; Khater, Mohamed Shawky; Saleh, Ashraf Nabil; Bustami, Rami; Ely, E Wesley

    2017-12-28

    Accurate diagnosis for Arabic speaking critically ill patients suffering from delirium is limited by the need for a valid/reliable translation of a standardized delirium instrument such as the Confusion Assessment Method for the ICU (CAM-ICU). To determine the validity and reliability of the Arabic version of the CAM-ICU. A prospective cohort study design was used to conduct the current study. Data collection took place in Geriatric, Emergency and Surgical intensive care units. Fifty-eight adult patients met the inclusion criteria and participated in the study. Among the participants 22(38%) patients were on mechanical ventilation. After translating the CAM-ICU into Arabic language, the Arabic CAM-ICU was administered by two well-trained critical care nurses and compared with reference standard assessments by delirium experts using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM -IV-TR), along with assessment of severity of illness using Sequential Organ Failure Assessment (SOFA). Concurrent validity was assessed by calculating sensitivity, specificity and positive and negative predictive value (PPV and NPV) for the two Arabic CAM-ICU raters, where calculations were based on considering the DSM-IV-TR criterion as the reference standard. The convergent validity of the Arabic CAM-ICU was explored by comparing the Arabic CAM-ICU ratings and the total score of SOFA (severity of illness) and MMSE (cognitive impairment). A total of 58 ICU patients were included, of whom 27 (47%) were diagnosed with delirium during their ICU stay via DSM-IV criteria. Interrater reliability for the Arabic CAM-ICU, overall and for mechanically ventilated patients assessed using Cohen's kappa (κ) were 0.82 and 1, respectively, p < 0.001. The sensitivities (95% CI) for the two critical care nurses when using the Arabic CAM-ICU compared with the reference standard were 81% (60%-93%) and 85% (65%-95%), respectively, whereas specificity (95% CI

  18. [Burnout syndrome among nurses and nurses' aides in an intensive care unit and admission wards].

    Science.gov (United States)

    Santana Cabrera, Luciano; Hernández Medina, Elena; Eugenio Robaina, Pilar; Sánchez-Palacios, Manuel; Pérez Sánchez, Ruymán; Falcón Moreno, Raúl

    2009-01-01

    To compare the degree of severity of burnout syndrome among the healthcare personnel of an intensive care unit (ICU) and admission wards. We performed a cross-sectional, descriptive study with nurses and nurses' aides in the ICU and admission wards of the Hospital Universitario Insular de Gran Canaria (Spain). An anonymous survey was performed through the 22-item Maslach Burnout Inventory, which measures the three dimensions of burnout syndrome: emotional exhaustion, depersonalization and personal accomplishment. We interviewed 92 nurses (61% from the ICU and 39% from admission wards) and 80 nurses' aides (51% from the ICU and 49% from admission wards). In all groups, a moderate degree of emotional exhaustion was found, which was more severe in nurses' aides working on admission wards than in those working in the ICU (22.26, SD=7.47 vs 26.51, SD=7.12, p=0.011). High levels of depersonalization and emotional exhaustion were found in all groups, with no significant difference among staff working in the ICU or admission wards. No significant differences were found in the perception of burnout between staff in the ICU or in admission wards. The degree of emotional exhaustion was moderate, while degrees of depersonalization and lack of personal accomplishment were high.

  19. Nurses' leadership styles in the icu: association with personal and professional profile and workload Estilos de liderazgo de enfermeros en una unidad de terapia intensiva: asociación con el perfil personal, profesional y con la carga de trabajo Estilos de liderança de enfermeiros em unidade de terapia intensiva: associação com perfil pessoal, profissional e carga de trabalho

    Directory of Open Access Journals (Sweden)

    Alexandre Pazetto Balsanelli

    2009-02-01

    Full Text Available 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 (p0.05. The determine, persuade, and share leadership styles prevailed. However, whenever the nursing workload peaked, the determine and persuade styles were used (pEste estudio tuvo como objetivos verificar a relación que existe entre los estilos de liderazgo de los enfermeros con el perfil personal, profesional y carga de trabajo de enfermería. La muestra fue constituida por siete enfermeros y siete técnicos de enfermería que formaron parejas. Durante tres meses los enfermeros fueron cuestionados sobre cual sería el estilo de liderazgo adoptado cuando el técnico de enfermería, bajo su evaluación, prestase cuidados a los pacientes admitidos en la Unidad de Terapia Intensiva. Los datos fueron analizados aplicándose estadística descriptiva, el método de comparaciones múltiples de Tukey y la prueba t de Student (0,05. Los estilos de liderazgo: determinar, persuadir y compartir fueron los predominantes, sin embargo, cuando la carga de trabajo de enfermería era mayor, se observaron los estilos determinar y persuadir (pEste estudo teve como objetivos verificar a relação dos estilos de liderança de enfermeiros com perfil pessoal e profissional e carga de trabalho de enfermagem. A amostra foi constituída por sete enfermeiros e sete técnicos de enfermagem que formaram duplas. Durante três meses os enfermeiros foram questionados sobre qual estilo de liderança seria adotado quando o técnico de

  20. Dysmagnesaemia and outcome in a trauma ICU

    African Journals Online (AJOL)

    Objective. To determine the prevalence of dysmagnesaemia among patients admitted to a trauma intensive care unit (ICU) and to investigate whether dysmagnesaemia at admission correlated with a worse outcome. Methods. In this retrospective case study of patients admitted to a regional level 1 trauma unit, from April ...

  1. Continuous Exhaled Breath Analysis on the Icu

    Science.gov (United States)

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

    2011-09-01

    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.

  2. Environmental Management at Swedish Universities

    Science.gov (United States)

    Arvidsson, Karin

    2004-01-01

    Since 1996, all Swedish public authorities, which includes most universities, have been made responsible for contributing to the sustainable development of the society. Swedish universities are thus required to submit annual environmental reports about their policies, structures and actions. This study provides a review of the activities that…

  3. Depressive symptoms and anxiety in intensive care unit (ICU) survivors after ICU discharge.

    Science.gov (United States)

    Choi, JiYeon; Tate, Judith A; Rogers, Mary Alana; Donahoe, Michael P; Hoffman, Leslie A

    2016-01-01

    The association between intensive care unit (ICU) survivors' psychological sequelae, individual care needs, and discharge disposition has not been evaluated. To describe depressive symptoms and anxiety in ICU survivors and explore these symptoms based on individual care needs and discharge disposition for 4 months post-ICU discharge. We analyzed data from 39 ICU survivors who self-reported measures of depressive symptoms (Center for Epidemiologic Studies-Depression 10 items [CESD-10]) and anxiety (Shortened Profile of Mood States-Anxiety subscale [POMS-A]). A majority of patients reported CESD-10 scores above the cut off (≥ 8) indicating risk for clinical depression. POMS-A scores were highest within 2 weeks post-ICU discharge and decreased subsequently. Data trends suggest worse depressive symptoms and anxiety when patients had moderate to high care needs and/or were unable to return home. ICU survivors who need caregiver assistance and extended institutional care reported trends of worse depressive symptoms and anxiety. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Early goal-directed nutrition in ICU patients (EAT-ICU)

    DEFF Research Database (Denmark)

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

    2016-01-01

    INTRODUCTION: Extensive weight loss has been docu-mented in intensive care unit (ICU) survivors, primarily as the result of muscle loss, leading to impaired physical function and reduced quality of life. The aim of the EAT-ICU trial is to test the effect of early goal-directed protein-energy nutr......INTRODUCTION: Extensive weight loss has been docu-mented in intensive care unit (ICU) survivors, primarily as the result of muscle loss, leading to impaired physical function and reduced quality of life. The aim of the EAT-ICU trial is to test the effect of early goal-directed protein......-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...

  5. 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

  6. 'Providing good and comfortable care by building a bond of trust': nurses views regarding their role in patients' perception of safety in the intensive care unit.

    Science.gov (United States)

    Wassenaar, Annelies; van den Boogaard, Mark; van der Hooft, Truus; Pickkers, Peter; Schoonhoven, Lisette

    2015-11-01

    To describe and understand intensive care unit (ICU) nurses' views regarding their role in ICU patients' perception of safety. Feeling safe is an important issue for ICU patients. Not feeling safe may result in adverse effects including traumatic experiences, having nightmares and feeling depressed. Nursing care plays a major role in patients' perception of safety. However, it is unknown whether ICU nurses are aware of this role. A grounded theory approach following Corbin and Strauss. A total of 13 participants were included in the study following maximum variation sampling, by selecting ICU nurses who differed in gender, age, work experience as registered ICU nurse, and were employed in different IC units. In-depth interviews were performed using open-ended questions guided by a topic list with broad question areas. Data collection and analysis were executed during an iterative process. The core category, building a bond of trust to provide good and comfortable care, arose from four main categories: explaining and informing ICU patients, using patients' family bond, ICU nurses' attitudes and expertise, and creating physical safety. The ICU nurses stated that they were not explicitly aware of ICU patients' perception of safety, but that they strived to provide good and comfortable care, through building a bond of trust with their patients. According to the nurses, a bond of trust is essential for patients to feel safe in the ICU. The importance of feeling safe in ICU patients should be addressed within the education and clinical practice of ICU nurses, to ensure that they become aware of ICU patients' perception of safety. © 2015 John Wiley & Sons Ltd.

  7. Sleep monitoring by actigraphy in short-stay ICU patients

    NARCIS (Netherlands)

    van der Kooi, A. W.; Tulen, J. H. M.; van Eijk, M. M. J.; de Weerd, A. W.; van Uitert, M. J. G.; van Munster, B. C.; Slooter, A. J. C.

    2013-01-01

    Sleep deprivation is common in intensive care unit (ICU) patients. The criterion standard for sleep monitoring, polysomnography, is impractical in ICU. Actigraphy (a wrist watch indicating amount of sleep) proved to be a good alternative in non-ICU patients, but not in prolonged mechanically

  8. Interactivity Centered Usability Evaluation (ICUE) for Course Management Systems

    Science.gov (United States)

    Yoon, Sangil

    2010-01-01

    ICUE (Interactivity Centered Usability Evaluation) is an enhanced usability testing protocol created by the researcher. ICUE augments the facilitator's role for usability testing, and offers strategies in developing and presenting usability tasks during a testing session. ICUE was designed to address weaknesses found in the usability evaluation of…

  9. Clements Kadalie, the ICU, and the Language of Freedom | Johnson ...

    African Journals Online (AJOL)

    The language of the Industrial and Commercial Workers Union (ICU) and its leader Clements Kadalie is examined. The article analyses afresh the ICU archive – the articles, manifestoes, speeches, memoirs and letters of Kadalie and his ICU comrades in the 1920s and 1930s. Two questions guide discussion. How did the ...

  10. [APACHE II and ATN-ISS in acute renal failure (ARF) in intensive care unit (ICU) and non-ICU].

    Science.gov (United States)

    Fernandes, Natáia Maria da Silva; Pinto, Patrícia dos Santos; Lacet, Thiago Bento de Paiva; Rodrigues, Dominique Fonseca; Bastos, Marcus Gomes; Stella, Sérgio Reinaldo; Cendoroglo Neto, Miguel

    2009-01-01

    Acute renal failure (ARF) remains highly prevalent with a high rate of morbidity and mortality. of this study was to compare use of the APACHE II scoring prognosis with that of the ATN-ISS to determine whether the APACHE II could be used for patients with ARF outside the ICU. For this purpose, 205 patients with ARF were accompanied in a prospective cohort. Demographic data, preexisting conditions, organ failure and characteristics of ARF were analyzed. The prognostic scores were performed with the assessment of a nephrologist. The mean age was 52 +/- 18 years, 50% were male, 69% were white, 45% were treated in ICU and 55% in other units. Mortality in the ICU group was 85% and in the non-ICU group 18%. Factors that correlated with higher mortality were more prevalent in the ICU group: age, male, hospitalization with ARF, organ failure, sepsis, septic IRA, oliguria and need of dialysis. Overall, the prognostic markers were the same for both the ICU and non-ICU groups. The discrimination with the APACHE II was similar in both, ICU and non-ICU groups and calibration was better in the non-ICU group. The ATN-ISS achieved good discrimination in both the ICU and non-ICU groups, but, regarding calibration, there was a discreet over estimating of mortality in the non-ICU group. The ATN-ISS showed a greater capacity for discrimination than the APACHE II in both the ICU and non-ICU groups. It was concluded that the APACHE II and ATN-ISS scores could be used for stratification of risk in patients with ARF treated outside of the ICU in Brazil.

  11. Impact of ICU-acquired weakness on post-ICU physical functioning: a follow-up study

    NARCIS (Netherlands)

    Wieske, Luuk; Dettling-Ihnenfeldt, Daniela S.; Verhamme, Camiel; Nollet, Frans; van Schaik, Ivo N.; Schultz, Marcus J.; Horn, Janneke; van der Schaaf, Marike

    2015-01-01

    ICU-acquired weakness is thought to mediate physical impairments in survivors of critical illness, but few studies have investigated this thoroughly. The purpose was to investigate differences in post-ICU mortality and physical functioning between patients with and without ICU-acquired weakness at 6

  12. [Pain and fear in the ICU].

    Science.gov (United States)

    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.

  13. 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.

  14. A path to precision in the ICU.

    Science.gov (United States)

    Maslove, David M; Lamontagne, Francois; Marshall, John C; Heyland, Daren K

    2017-04-03

    Precision medicine is increasingly touted as a groundbreaking new paradigm in biomedicine. In the ICU, the complexity and ambiguity of critical illness syndromes have been identified as fundamental justifications for the adoption of a precision approach to research and practice. Inherently protean diseases states such as sepsis and acute respiratory distress syndrome have manifestations that are physiologically and anatomically diffuse, and that fluctuate over short periods of time. This leads to considerable heterogeneity among patients, and conditions in which a "one size fits all" approach to therapy can lead to widely divergent results. Current ICU therapy can thus be seen as imprecise, with the potential to realize substantial gains from the adoption of precision medicine approaches. A number of challenges still face the development and adoption of precision critical care, a transition that may occur incrementally rather than wholesale. This article describes a few concrete approaches to addressing these challenges.First, novel clinical trial designs, including registry randomized controlled trials and platform trials, suggest ways in which conventional trials can be adapted to better accommodate the physiologic heterogeneity of critical illness. Second, beyond the "omics" technologies already synonymous with precision medicine, the data-rich environment of the ICU can generate complex physiologic signatures that could fuel precision-minded research and practice. Third, the role of computing infrastructure and modern informatics methods will be central to the pursuit of precision medicine in the ICU, necessitating close collaboration with data scientists. As work toward precision critical care continues, small proof-of-concept studies may prove useful in highlighting the potential of this approach.

  15. Patient, Family, and Physician Satisfaction With Planning for Direct Discharge to Home From Intensive Care Units: Direct From ICU Sent Home Study.

    Science.gov (United States)

    Lam, Joyce Nga Hei; Lau, Vincent I; Priestap, Fran A; Basmaji, John; Ball, Ian M

    2017-01-01

    In the new era of decreasing hospital bed availability, there is an increasing rate of direct discharge to home (DDH) from intensive care units (ICUs), despite sparse literature informing this practice. To evaluate patient, family, and ICU attending physician satisfaction with planning for DDH from the ICU and intensivists' current DDH practices and perceptions. Prospective cohort study, using convenience sampling, of adult patients undergoing DDH from an ICU between February 2016 and February 2017 using a modified FS-ICU 24 satisfaction survey completed by patients, family members, and attending physicians at the time of patient discharge to home from the ICU. Seventy-two percent of patients, 37% of family members, and 100% of ICU physicians recruited completed the survey. A majority of patients (89%) and families (78%) were satisfied or very satisfied with DDH. Only 6% of patients and 8% of families were dissatisfied to very dissatisfied with DDH. Conversely, ICU physician satisfaction varied, with only 5% being very comfortable with DDH and the majority (50%) only somewhat comfortable. Twenty percent of staff consultants were uncomfortable to very uncomfortable with the practice of DDH. Thirty-one percent of staff physician respondents felt that patient and family discomfort would be barriers to DDH. Compared to physicians and other allied health professionals, nurses were identified as the most helpful members of the health-care team in preparation for DDH by 98% of patients and 92% of family members. The DDH rates have increased for the past 12 years in our ICUs but declined during the study period (February 2016 to February 2017). Patients and family members are satisfied with the practice of DDH from ICU, although ICU physician satisfaction is more variable. Physician comfort may be improved by data informing which patients may be safely DDH from the ICU.

  16. Knowledge of intensive care nurses in selected care areas ...

    African Journals Online (AJOL)

    ICUs) in respect of pain management, glycaemic control and weaning from mechanical ventilation. Methods. An analytical, cross-sectional survey design was used. All ICU-trained and non-ICU-trained registered nurses (N=136) working in the ...

  17. Swedish nuclear waste efforts

    Energy Technology Data Exchange (ETDEWEB)

    Rydberg, J.

    1981-09-01

    After the introduction of a law prohibiting the start-up of any new nuclear power plant until the utility had shown that the waste produced by the plant could be taken care of in an absolutely safe way, the Swedish nuclear utilities in December 1976 embarked on the Nuclear Fuel Safety Project, which in November 1977 presented a first report, Handling of Spent Nuclear Fuel and Final Storage of Vitrified Waste (KBS-I), and in November 1978 a second report, Handling and Final Storage of Unreprocessed Spent Nuclear Fuel (KBS II). These summary reports were supported by 120 technical reports prepared by 450 experts. The project engaged 70 private and governmental institutions at a total cost of US $15 million. The KBS-I and KBS-II reports are summarized in this document, as are also continued waste research efforts carried out by KBS, SKBF, PRAV, ASEA and other Swedish organizations. The KBS reports describe all steps (except reprocessing) in handling chain from removal from a reactor of spent fuel elements until their radioactive waste products are finally disposed of, in canisters, in an underground granite depository. The KBS concept relies on engineered multibarrier systems in combination with final storage in thoroughly investigated stable geologic formations. This report also briefly describes other activities carried out by the nuclear industry, namely, the construction of a central storage facility for spent fuel elements (to be in operation by 1985), a repository for reactor waste (to be in operation by 1988), and an intermediate storage facility for vitrified high-level waste (to be in operation by 1990). The R and D activities are updated to September 1981.

  18. Original Research: Implementation of an Early Mobility Program in an ICU.

    Science.gov (United States)

    Fraser, Danielle; Spiva, LeeAnna; Forman, Wendy; Hallen, Caroline

    2015-12-01

    Research is needed to determine the feasibility of implementing a dedicated ICU mobility team in community hospital settings. The purpose of this study was to assess, in one such hospital, four nurse-sensitive quality-of-care outcomes (falls, ventilator-associated events, pressure ulcers, and catheter-associated urinary tract infections [CAUTIs]), as well as hospital costs, sedation and delirium measures, and functional outcomes by comparing ICU patients who received physical therapy from a dedicated mobility team with ICU patients who received routine care. We conducted a retrospective longitudinal study at a community acute care hospital; patients were randomly assigned to intervention or routine care groups. The mobility team screened patients Monday through Friday using a mobility algorithm to determine eligibility for participation in each early mobility session. Based on their strength, balance, hemodynamic stability, and ability to participate in early mobility activities, patients advanced through four progressively difficult phases of mobility. Data were collected and analyzed after patients were discharged from the hospital. The 66 patients who received the mobility intervention had significantly fewer falls, ventilator-associated events, pressure ulcers, and CAUTIs than the 66 patients in the routine care group. The mobility group also had lower hospital costs, fewer delirium days, lower sedation levels, and improved functional independence compared with the routine care group. Patients in the mobility group got out of bed on 2.5 more days than patients in the routine care group. There were also no adverse events in the mobility group. It is feasible for a community hospital to create and implement a dedicated ICU mobility team. Early mobilization of ICU patients contributed to fewer delirium days and improved patient outcomes, sedation levels, and functional status.

  19. To develop a regional ICU mortality prediction model during the first 24 h of ICU admission utilizing MODS and NEMS with six other independent variables from the Critical Care Information System (CCIS) Ontario, Canada.

    Science.gov (United States)

    Kao, Raymond; Priestap, Fran; Donner, Allan

    2016-01-01

    Intensive care unit (ICU) scoring systems or prediction models evolved to meet the desire of clinical and administrative leaders to assess the quality of care provided by their ICUs. The Critical Care Information System (CCIS) is province-wide data information for all Ontario, Canada level 3 and level 2 ICUs collected for this purpose. With the dataset, we developed a multivariable logistic regression ICU mortality prediction model during the first 24 h of ICU admission utilizing the explanatory variables including the two validated scores, Multiple Organs Dysfunctional Score (MODS) and Nine Equivalents Nursing Manpower Use Score (NEMS) followed by the variables age, sex, readmission to the ICU during the same hospital stay, admission diagnosis, source of admission, and the modified Charlson Co-morbidity Index (CCI) collected through the hospital health records. This study is a single-center retrospective cohort review of 8822 records from the Critical Care Trauma Centre (CCTC) and Medical-Surgical Intensive Care Unit (MSICU) of London Health Sciences Centre (LHSC), Ontario, Canada between 1 Jan 2009 to 30 Nov 2012. Multivariable logistic regression on training dataset (n = 4321) was used to develop the model and validate by bootstrapping method on the testing dataset (n = 4501). Discrimination, calibration, and overall model performance were also assessed. The predictors significantly associated with ICU mortality included: age (p  0.31). The overall optimism of the estimation between the training and testing data set ΔAUC = 0.003, indicating a stable prediction model. This study demonstrates that CCIS data available after the first 24 h of ICU admission at LHSC can be used to create a robust mortality prediction model with acceptable fit statistic and internal validity for valid benchmarking and monitoring ICU performance.

  20. Exploring unplanned ICU admissions: a systematic review.

    Science.gov (United States)

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

    2011-01-01

    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

  1. Assessment of Patient and Relatives Satisfaction in a Cardiac Surgery ICU Model

    Directory of Open Access Journals (Sweden)

    Kamran Shadvar

    2015-10-01

    Full Text Available Introduction: Evaluation of patients’ and their families’ satisfaction regarding the quality of care in the ICU is an important concern that can identify deficiencies of this field and help to improve satisfaction of both patients and their families. Considering the fact that problems related to cardiac surgery ICUs differ from other ICUs, recognition of these problems and the factors that lead to patient or family dissatisfaction can not only improve the quality and quantity of services provided in this section but also lead to increased satisfaction in these groups and promote scientific and practical knowledge related to sectors at regional levels. The aim of this study was to evaluate the satisfaction of patients and their families from the quantity and quality of services provided in the cardiac surgical ICU of Madani hospital, Tabriz, Iran. Materials and Methods: In this descriptive study, satisfaction of patients and their relatives from cardiac surgery ICU of Shahid Madani Hospital was evaluated using Modified MISS questionnaire for patients and CCMFNA questionnaires for their relatives during one year (1391-1390. The obtained data were statistically analyzed using descriptive statistics (frequency, percentage, mean ± SD and SPSS ver. 15. Results: Majority of patients expressed moderate to high satisfaction. The overall satisfaction of doctors was higher than nurses (27% vs. 22%. The lowest level of satisfaction related to the possibility of meeting relatives (14.3%. Most relatives were spouses of patients who contributed to the highest rate of satisfaction; however, the location and meets expectations were less satisfactory. Conclusion: Improving waiting room quality, increasing duration of family meetings and increasing nursing attention are the factors that could be associated with further satisfaction.   Keywords: ICU; Patient satisfaction; Family satisfaction

  2. The desirability of an Intensive Care Unit (ICU) clinician-led bereavement screening and support program for family members of ICU Decedents (ICU Bereave).

    Science.gov (United States)

    Downar, James; Barua, Reeta; Sinuff, Tasnim

    2014-04-01

    Many bereaved family members (FMs) of intensive care unit decedents experience symptoms of complicated grief (CG) or social distress, but there is no standard screening or follow-up for these individuals. We determined the desirability and need for an intensive care unit-based bereavement screening and support program for these FMs. We surveyed bereaved FMs to measure symptoms of CG, prolonged grief disorder, and social difficulties and the desire for support; and staff physicians and nurses at 2 teaching hospitals in Toronto, Canada, to determine comfort and interest in providing routine bereavement support. We could not contact 69% of FMs largely because of inaccuracies in the patient record. Of the 64 who were contacted, 32 (50%) agreed to be surveyed a mean (SD) of 7.4 (2.2) months after the loss of their relative. Among eligible staff, 57 (61%) of 94 completed the questionnaire. Nine (28%) FMs met subthreshold criteria for CG or prolonged grief disorder, and 7 (22%) met criteria for social distress. Only 10 (31%) had received professional support for emotional symptoms, and 2 (6%) received professional assistance for their social difficulties. Fifty-eight percent supported routine screening, and 68% wanted to receive (or receive more) support. Fifty-five percent of FMs expressed a strong willingness to meet with the medical team to review events surrounding the death of the patient, which was the type of support that the health care staff were most comfortable providing. Most staff (85%) reported providing emotional support at the time of death, but few provided any support afterwards. Fifty-six (98%) of 57 would be willing to support or participate in a formal bereavement screening and support program. Respondents cited the need for training and dedicated time to carry out such a program. An ICU-based bereavement screening and support program for FMs of ICU decedents is both needed and desirable, although there are important needs and barriers. Future studies

  3. Strategic analysis of Swedish agriculture

    OpenAIRE

    Fogelfors, Håkan; Wivstad, Maria; Eckersten, Henrik; Holstein, Fredrik; Johansson, Susanne; Verwijst, Theo

    2009-01-01

    This strategic analysis of Swedish agriculture – production systems and agricultural landscapes in a time of change – focuses on climate change, future availability of natural resources and economic regulation in a global food market. The background to the project was that the Faculty of Natural Resources and Agriculture of the Swedish University of Agricultural Sciences identified an urgent need to explore the implications and opportunities of coming changes for agricultural production syste...

  4. 'Providing good and comfortable care by building a bond of trust': nurses views regarding their role in patients' perception of safety in the Intensive Care Unit

    NARCIS (Netherlands)

    Wassenaar, A.; Boogaard, M.H.W.A. van den; Hooft, T. van der; Pickkers, P.; Schoonhoven, L.

    2015-01-01

    AIMS AND OBJECTIVES: To describe and understand intensive care unit (ICU) nurses' views regarding their role in ICU patients' perception of safety. BACKGROUND: Feeling safe is an important issue for ICU patients. Not feeling safe may result in adverse effects including traumatic experiences, having

  5. Nurses' Competency and Challenges in Enteral feeding in the ...

    African Journals Online (AJOL)

    needs, and the characteristics of the nurse and patient synergise, optimal patient outcomes can ... All 53 nurses working in the intensive care unit (ICU) and high dependency unit (HDU) were recruited to ..... attitudes among doctors and nurses in Scandinavia: A questionnaire based survey. Clinical Nutrition, 2006; 25, ...

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    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......INTRODUCTION: Extensive weight loss has been docu-mented in intensive care unit (ICU) survivors, primarily as the result of muscle loss, leading to impaired physical function and reduced quality of life. The aim of the EAT-ICU trial is to test the effect of early goal-directed protein...

  7. Carga de trabalho de enfermagem para quantificar proporção profissional de enfermagem/paciente em UTI cardiológica Carga de trabajo en enfermería para cuantificar la proporción profesional de enfermería/paciente en UCI cardiológica Nursing workload to verify nurse/patient ratio in a cardiology ICU

    Directory of Open Access Journals (Sweden)

    Adriana Janzantte Ducci

    2008-12-01

    study, aiming at comparing the nursing workload in a post-operatory heart surgery unit (UPOCC using NAS, TISS-28 and NEMS, and verifying both the observed and recommended nursing staff-to-patient ratio according to the workload indexes used. Data collection happened in a University Hospital, from October to November, 2004. The sample included 55 patients, resulting in 283 nursing workload measurements. The nursing workload measured by NAS (73.7% were statistically higher than TISS-28 (66.2% and NEMS (59.7%. The average of nursing staff-to-patient ratio estimated by NAS (1:1, TISS-28 (0.8:1 and NEMS (0.8:1 were lower than the observed ratio in the unit (1.2:1. We concluded that NAS measured a higher nursing workload and showed a nursing staff-to-patient ratio similar to the results found in the unit studied.

  8. The experiences of rural and remote families involved in an inter-hospital transfer to a tertiary ICU: a hermeneutic study.

    Science.gov (United States)

    Mackie, Benjamin; Kellett, Ursula; Mitchell, Marion; Tonge, Angela

    2014-11-01

    Inter-hospital transfers are necessary for critically ill patients to improve their chance of survival. Rural and remote families experience significant disruption to family life when critically ill patients are required to undergo a transfer to a tertiary hospital. What is not known is how ICU staff can assist these families who are involved in an inter-hospital transfer to a tertiary ICU. To gain an understanding of rural and remote critical care families' experiences during an inter-hospital transfer to a tertiary ICU. A hermeneutic phenomenological approach was adopted informed by the philosophical world views of Heidegger and Gadamer. Data collection occurred by in-depth conversational interviews from a purposeful sample of seven family members. Interview transcripts, field notes and diary entries formed the text which underwent hermeneutic analysis. Being confused, being engaged, being vulnerable and being resilient emerged as significant aspects of the rural and remote family members' experience during a transfer event. A better understanding of the experiences of rural and remote families during an inter-hospital transfer journey can inform the practice of ICU nurses. This study highlights the specific experiences of rural and remote families during an inter-hospital transfer journey to a tertiary ICU. It also informs nurses of the meaningful ways in which they can support these families with the uncertainty and chaos experienced as part of this journey. Copyright © 2014 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Factors Influencing Nurses’ Compliance with Universal Precautions

    Science.gov (United States)

    1990-05-01

    effects of greater accessibility of sinks on handwashing compliance. The frequency of handwashing in one medical and one surgical Intensive care unit...shifts. The medical ICU nurses washed their hands more frequently (76%) compared to the surgical ICU nurses (51 %), (D < .01). The frequency of handwashing ...protective gear and personnel apparel in the operating room. Areas of infraction included, but were not limited to, the surgical cap not being adequately

  10. Sedation in the ICU Less is more

    DEFF Research Database (Denmark)

    Strom, T.

    2012-01-01

    was days without mechanical ventilation, days in the ICU and total length of hospital stay. We conducted a post-hoc analysis of the data with kidney function expressed in urine output and RIFLE classification as the primary outcome. After hospital discharge all patients were invited to an interview....... An increased urine output was seen in the group receiving no sedation compared to the sedated control group (1.15 ml/kg/hour vs. 0.88 ml/kg/hour, P=0.03), also more patients from the sedated control group was classified with renal impairment (41 (76 %)) according to the RIFLE classification compared...

  11. Nurse-physician collaboration and associations with perceived autonomy in Cypriot critical care nurses.

    Science.gov (United States)

    Georgiou, Evanthia; Papathanassoglou, Elizabeth DE; Pavlakis, Andreas

    2017-01-01

    Increased nurse-physician collaboration is a factor in improved patient outcomes. Limited autonomy of nurses has been proposed as a barrier to collaboration. This study aims to explore nurse-physician collaboration and potential associations with nurses' autonomy and pertinent nurses' characteristics in adult intensive care units (ICUs) in Cyprus. Descriptive correlational study with sampling of the entire adult ICU nurses' population in Cyprus (five ICUs in four public hospitals, n = 163, response rate 88·58%). Nurse-physician collaboration was assessed by the Collaboration and Satisfaction About Care Decisions Scale (CSACD), and autonomy by the Varjus et al. scale. The average CSACD score was 36·36 ± 13·30 (range: 7-70), implying low levels of collaboration and satisfaction with care decisions. Male participants reported significantly lower CSACD scores (t = 2·056, p = 0·04). CSACD correlated positively with years of ICU nursing experience (r = 0·332, p autonomy score was 76·15 ± 16·84 (range: 18-108). Higher degree of perceived collaboration (CSACD scores) associated with higher autonomy scores (r = 0·508, p autonomy in ICU nurses in Cyprus. The results provide insight into the association between nurse-physician collaboration and nurses' autonomy and the correlating factors. © 2015 British Association of Critical Care Nurses.

  12. [Obesity and outcomes in the ICU: an observational study].

    Science.gov (United States)

    Bisurgi, G; Caroleo, S; Pezzi, M; Vero, R; Verre, M; Amantea, B

    2010-01-01

    We examined the relationships among Body Mass Index (BMI) with or without Metabolic Syndrome (MetS), ICU length of stay (ICU-LOS), duration of mechanical ventilation and mortality among ICU patients. This prospective observational study included all patients hospitalized in a 10-bed polyvalent ICU over a period of one year and seven months. We divided the studied population into 4 groups by BMI values: group A: between 18.5 and 24.9 (n=369); group B1: 25-39.9 without MetS (n=86); B2 group: 25-39.9 with MetS (n=72); group C: >40 (n=42). Major exclusion criteria were: age 25 with MetS was an independent predictive factor of: lower ICU-LOS, lower duration of mechanical ventilation, higher mortality rate. In our study, a BMI >25 with MetS was significantly associated with increased morbidity and mortality in ICU patients.

  13. Swedish encapsulation station review

    Energy Technology Data Exchange (ETDEWEB)

    Andersson, Sven Olof; Brunzell, P.; Heibel, R.; McCarthy, J.; Pennington, C.; Rusch, C.; Varley, G. [NAC International, Zuerich (Switzerland)

    1998-06-01

    In the Encapsulation Station (ES) Review performed by NAC International, a number of different areas have been studied. The main objectives with the review have been to: Perform an independent review of the cost estimates for the ES presented in SKB`s document `Plan 1996`. This has been made through comparisons between the ES and BNFL`s Waste Encapsulation Plant (WEP) at Sellafield as well as with the CLAB facility. Review the location of the ES (at the CLAB site or at the final repository) and its interaction with other parts of the Swedish system for spent fuel management. Review the logistics and plant capacity of the ES. Identify important safety aspects of the ES as a basis for future licensing activities. Based on NAC International`s experience of casks for transport and storage of spent fuel, review the basic design of the copper/steel canister and the transport cask. This review insides design, manufacturing, handling and licensing aspects. Perform an overall comparison between the ES project and the CLAB project with the objective to identify major project risks and discuss their mitigation 19 refs, 9 figs, 35 tabs

  14. Swedish vineyards: a utopia?

    Directory of Open Access Journals (Sweden)

    Mårtensson A

    2013-07-01

    Full Text Available Anna Mårtensson,1 Thord Karlsson,2 Jan-Gunnar Gustafsson31Department of Soil and Environment, 2Department of Economics, Swedish University of Agricultural Sciences, Uppsala, Sweden; 3Bio Evaluation AB, Uppsala, SwedenAbstract: As there is an increasing interest for setting up vineyards and wineries in Sweden, a cost analysis is becoming necessary. In this study, we assessed the potential for wine production in Sweden. The estimated annual costs varied from €15.1/per L for production of 1800 L wine per ha to €41.9 for 525 L per ha. For an annual production of 1800 L per ha potentially achieved in an established vineyard, the capital requirement is €730,000. It would take 6 years for the investment to be paid off if the wine was sold for €37.5 per L. The high production costs mean that the only viable option for success is to orientate production towards the exclusive upper segment.Keywords: cold climate conditions, wine production costs, wine quality

  15. Efficacy of the APACHE II score at ICU discharge in predicting post-ICU mortality and ICU readmission in critically ill surgical patients.

    Science.gov (United States)

    Lee, H; Lim, C W; Hong, H P; Ju, J W; Jeon, Y T; Hwang, J W; Park, H P

    2015-03-01

    In this study, we evaluated the efficacy of the discharge Acute Physiology and Chronic Health Evaluation (APACHE) II score in predicting post-intensive care unit (ICU) mortality and ICU readmission during the same hospitalisation in a surgical ICU. Of 1190 patients who were admitted to the ICU and stayed >48 hours between October 2007 and March 2010, 23 (1.9%) died and 86 (7.2%) were readmitted after initial ICU discharge, with 26 (3.0%) admitted within 48 hours. The area under the receiver operating characteristics curve of the discharge and admission APACHE II scores in predicting in-hospital mortality was 0.631 (95% confidence interval [CI] 0.603 to 0.658) and 0.669 (95% CI 0.642 to 0.696), respectively (P=0.510). The area under the receiver operating characteristics curve of discharge and admission APACHE II scores for predicting all forms of readmission was 0.606 (95% CI 0.578 to 0.634) and 0.574 (95% CI 0.545 to 0.602), respectively (P=0.316). The area under the receiver operating characteristics curve of discharge APACHE II score in predicting early ICU readmissions was, however, higher than that of admission APACHE II score (0.688 [95% CI 0.660 to 0.714] versus 0.505 [95% CI 0.476 to 0.534], P=0.001). The discharge APACHE II score (odds ratio [OR] 1.1, 95% CI 1.01 to 1.22, P=0.024), unplanned ICU readmission (OR 20.0, 95% CI 7.6 to 53.1, P=0.001), eosinopenia at ICU discharge (OR 6.0, 95% CI 1.34 to 26.9, P=0.019), and hospital length-of-stay before ICU admission (OR 1.02, 95% CI 1.01 to 1.03, P=0.021) were significant independent factors in predicting post-ICU mortality. This study suggests that the discharge APACHE II score may be useful in predicting post-ICU mortality and is superior to the admission APACHE II score in predicting early ICU readmission in surgical ICU patients.

  16. A Nationwide Census of ICU Capacity and Admissions in Mongolia

    OpenAIRE

    Mendsaikhan, Naranpurev; Begzjav, Tsolmon; Lundeg, Ganbold; Brunauer, Andreas; D?nser, Martin W.

    2016-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    Garrouste-Orgeas, Maité; Périer, Antoine; Mouricou, Philippe; Grégoire, Charles; Bruel, Cédric; Brochon, Sandie; Philippart, François; Max, Adeline; Misset, Benoit

    2014-01-01

    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. 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). 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. 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.

  19. Use of Improving Palliative Care in the ICU (Intensive Care Unit) Guidelines for a Palliative Care Initiative in an ICU

    Science.gov (United States)

    Mun, Eluned; Nakatsuka, Craig; Umbarger, Lillian; Ruta, Ruth; McCarty, Tracy; Machado, Cynthia; Ceria-Ulep, Clementina

    2017-01-01

    Objective: For improved utilization of the existing palliative care team in the intensive care unit (ICU), a process was needed to identify patients who might need a palliative care consultation in a timelier manner. Methods: A systematic method to create a new program that would be compatible with our specific ICU environment and patient population was developed. A literature review revealed a fairly extensive array of reports and numerous clinical practice guidelines, which were assessed for information and strategies that would be appropriate for our unit. Results: The recommendations provided by the Center to Advance Palliative Care from its Improving Palliative Care in the ICU project were used to successfully implement a new palliative care initiative in our ICU. Conclusion: The guidelines provided by the Improving Palliative Care in the ICU project were an important tool to direct the development of a new palliative care ICU initiative. PMID:28241905

  20. 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.

  1. A gap between Need and Reality: Neonatal Nursing Staff Requirements on a German Intensive Care Unit

    OpenAIRE

    Patry, Christian; Schindler, Monika; Reinhard, Julia; Hien, Steffen; Demirakca, Süha; Böhler, Thomas; Schaible, Thomas

    2014-01-01

    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 da...

  2. Health and safety strategy in Swedish agriculture.

    Science.gov (United States)

    Lundqvist, Peter; Svennefelt, Catharina Alwall

    2012-01-01

    In Sweden there is a joint focus on injury prevention in agriculture and this is coordinated through the Swedish Committee on Working Environment (LAMK). LAMK is a network working for a good, healthy and safe working environment in Swedish agriculture from the view of the enterprise with the humans in focus. It is a committee consisting of representatives of authorities, institutions, companies, research & education institutions and organisations referring to the green sector. Examples of on-going initiatives & partners are presented which are included in this mission against injuries in agriculture. It involves the Swedish Work Environment Authority,, the Federation of Swedish Farmers (LRF), the Swedish Institute of Agricultural and Environmental Engineering, Swedish University of Agricultural Sciences (SLU, the Federation of Swedish Forestry and Agricultural Employers (SLA) and the Swedish Municipal Worker's Union.

  3. 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.

  4. Is the Swedish FRAX model appropriate for Swedish immigrants?

    Science.gov (United States)

    Johansson, H; Odén, A; Lorentzon, M; McCloskey, E; Kanis, J A; Harvey, N C; Karlsson, M K; Mellström, D

    2015-11-01

    The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population born in Sweden. Thus, the use of a FRAX® model in immigrants overestimates the risk of fracture, and the use of country of origin-specific models may be more appropriate. Age-specific fracture and mortality rates vary between countries so that FRAX tools are country-specific. In the case of immigrants, it is not known whether the model for the original or the new country is most appropriate. The aim of this study was to compare the incidence of hip fractures in foreign-born and Swedish-born individuals residing in Sweden. We studied the incidence of hip fracture in all men and women aged 50 years or more in Sweden between 1987 and 2002. The population comprised 2.8 million Swedish-born and 270,000 foreign-born individuals. Incident hip fractures occurred in 239,842 Swedish-born and 12,563 foreign-born individuals. The hip fracture incidence rose with age for both groups and was higher for women than men amongst both Swedish-born and foreign-born individuals. The hip fracture incidence for the Swedish-born cohort was approximately twice that of immigrants. For example, at the age of 70 years, the annual hip fracture incidence (per 100,000) was 450 (95 % CI 446-454) for a Swedish-born woman and 239 (95 % CI 223-257) for a foreign-born woman at the time of immigration. The hip fracture incidence rose slowly with time from immigration (0.6 % per annum, 95 % CI 0.5-0.8 %) but remained significantly lower than for Swedish-born individuals even after 40 years of residence. The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population native to Sweden. Although there was a small rise in age- and sex-specific incidence after immigration, the incidence remained markedly lower than that observed in Swedish-born individuals. Thus, the use of a FRAX model for Sweden will overestimate the risk of fracture for foreign-born individuals living

  5. Bonjour tristesse in Swedish suburbia

    DEFF Research Database (Denmark)

    Andersson, Jonas E

    2013-01-01

    the country. Global news media paralleled the Swedish situation with previous incidents in Paris in 2007, Athens in 2008 and London in 2011. Foreign offices, among others the American, British, Danish, and Norwegian ones, advised their citizens not to travel to Sweden: the Swedish welfare model...... and a high unemployment rate. The young generation experienced a Bonjour Tristesse! existence going in and out of unemployment. An existing dismay with architecture and physical planning of suburbia surfaced: The plausible responsibility of the body of architects was debated, since many esteemed profiles...... of the Swedish functionalist architecture had been involved in its realisation. One representative of the profession stated the need for upgrading the existing architecture to new user needs, while another one emphasised that the real group of inhabitants in suburbia is often not the group of users envisioned...

  6. Obstetric Thromboprophylaxis: The Swedish Guidelines

    Directory of Open Access Journals (Sweden)

    Pelle G. Lindqvist

    2011-01-01

    Full Text Available Obstetric thromboprophylaxis is difficult. Since 10 years Swedish obstetricians have used a combined risk estimation model and recommendations concerning to whom, at what dose, when, and for how long thromboprophylaxis is to be administrated based on a weighted risk score. In this paper we describe the background and validation of the Swedish guidelines for obstetric thromboprophylaxis in women with moderate-high risk of VTE, that is, at similar or higher risk as the antepartum risk among women with history of thrombosis. The risk score is based on major risk factors (i.e., 5-fold increased risk of thromboembolism. We present data on the efficacy of the model, the cost-effectiveness, and the lifestyle advice that is given. We believe that the Swedish guidelines for obstetric thromboprophylaxis aid clinicians in providing women at increased risk of VTE with effective and appropriate thromboprophylaxis, thus avoiding both over- and under-treatment.

  7. Correlation between workplace and occupational burnout syndrome in nurses.

    Science.gov (United States)

    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.

  8. Influence of opioid choice on mechanical ventilation duration and ICU length of stay.

    Science.gov (United States)

    Futier, E; Chanques, G; Cayot Constantin, S; Vernis, L; Barres, A; Guerin, R; Chartier, C; Perbet, S; Petit, A; Jabaudon, M; Bazin, J E; Constantin, J M

    2012-01-01

    The aim of this study was to assess the impact on mechanical ventilation and ICU outcomes of substituting remifentanil for sufentanil, in an analgesia-based sedation protocol. A database of data prospectively collected was retrospectively analyzed. The study was carried out in a 16-bed tertiary-care ICU. The study included 1544 mechanically ventilated patients admitted from January 2001 to December 2006. Patients were compared between two consecutive phases. Analgesia-based sedation guidelines were the same, except for the opiate used. The patient-to-nurse ratio (2.5) and ventilator weaning practices remained unchanged. 794 patients were included during the sufentanil phase, and 750 during the remifentanil phase. Remifentanil was associated with significantly less time spent on mechanical ventilation (10 days[3-21] vs. 14 days[3-27], P<0.01) and in the ICU (16 days[3-22] vs. 19 days[4-26], P<0.01). The difference was significant for patients ventilated no longer than four days (P=0.0035) but not for patients ventilated more than four days (P=0.058). Sedation target on the Ramsay scale was reached more often with remifentanil. The use and amount of hypnotic agents in addition to the opiate were significantly lower with remifentanil. The cost of analgesia-based sedation was similar in the sufentanil and the remifentanil group. Our study suggests that using a short-acting opiate with short context-sensitive half-life in an analgesia-based sedation protocol may significantly decrease the duration of mechanical ventilation and the ICU length of stay even though not significantly in long term sedation, while improving the achievement of sedation goals despite a lower requirement for adjunctive hypnotic agents, with no additional costs.

  9. From Vocational Training to Academic Education: The Situation of the Schools of Nursing in Sweden.

    Science.gov (United States)

    Andersson, Ewa Pilhammar

    1999-01-01

    The success of the change from vocational training to academic education for nurses in Sweden depends on faculty competence. Observations at three Swedish nursing schools and interviews with 59 nurse educators identified strategies educators used to maintain teaching competence: being "real" nurses, being prepared in different subjects,…

  10. 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.

  11. Multidisciplinary team training to enhance family communication in the ICU.

    Science.gov (United States)

    Shaw, David J; Davidson, Judy E; Smilde, Renée I; Sondoozi, Tarane; Agan, Donna

    2014-02-01

    Current guidelines from the U.S. Society for Critical Care Medicine state that training in "good communication skills...should become a standard component of medical education and ... available for all ICU caregivers". We sought to train multidisciplinary teams of ICU caregivers in communicating with the families of critically ill patients to improve staff confidence in communicating with families, as well as family satisfaction with their experiences in the ICU. Pre- and postintervention design. Community hospital medical and surgical ICUs. All patients admitted to ICU during the two time periods. Ninety-eight caregivers in multidisciplinary teams of five to eight individuals trained in a standardized approach to communicating with families of ICU patients using the Setup, Perception, Invitation, Knowledge, Emotions, Strategy (or Subsequent) (SPIKES) protocol followed by participation in a simulated family conference. Staff confidence in communicating with family members of critically ill patients was measured immediately before and 6-8 weeks after training sessions using a validated tool. Family satisfaction using seven items measuring effectiveness of communication from the Family Satisfaction in the ICU (24) tool in surveys received from family members of 121 patients admitted to the ICU before and 121 patients admitted to the ICU after trainings was completed. Using 46 matched pre- and postsurveys, staff confidence in communicating with family members of critically ill patients increased significantly (p communication showed significant (p communication. This intervention is easily reproduced.

  12. Altered Circadian Rhythmicity in Patients in the ICU

    NARCIS (Netherlands)

    Gazendam, Joost A. C.; Van Dongen, Hans P. A.; Grant, Devon A.; Freedman, Neil S.; Zwaveling, Jan H.; Schwab, Richard J.

    Background: Patients in the ICU are thought to have abnormal circadian rhythms, but quantitative data are lacking. Methods: To investigate circadian rhythms in the ICU, we studied core body temperatures over a 48-h period in 21 patients (59 11 years of age; eight men and 13 women). Results: The

  13. Sleep disturbances in critically ill patients in ICU

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Ording, H; Jennum, P

    2012-01-01

    Sleep disturbances in the intensive care unit (ICU) seem to lead to development of delirium, prolonged ICU stay, and increased mortality. That is why sufficient sleep is important for good outcome and recovery in critically ill patients. A variety of small studies reveal pathological sleep patterns...

  14. Test-Site Evaluation of ICU/PLANIT.

    Science.gov (United States)

    Frederick, Terry J.

    Test-site evaluation of the Instructor's Computer Utility/Programing Language of Interactive Teaching (ICU/PLANIT) was conducted. Goals included: 1) analysis of the operation of ICU/PLANIT; 2) development of two PLANIT. Modifications were made in a distrubuted version, cost analyses were in man hours and quantities of machine resources consumed,…

  15. 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.

  16. Development of an instrument for a primary airway provider's performance with an ICU multidisciplinary team in pediatric respiratory failure using simulation.

    Science.gov (United States)

    Nishisaki, Akira; Donoghue, Aaron J; Colborn, Shawn; Watson, Christine; Meyer, Andrew; Niles, Dana; Bishnoi, Ram; Hales, Roberta; Hutchins, Larissa; Helfaer, Mark A; Brown, Calvin A; Walls, Ron M; Nadkarni, Vinay M; Boulet, John R

    2012-07-01

    To develop a scoring system that can assess the multidisciplinary management of respiratory failure in a pediatric ICU. In a single tertiary pediatric ICU we conducted a simulation-based evaluation in a patient care area auxiliary to the ICU. The subjects were pediatric and emergency medicine residents, nurses, and respiratory therapists who work in the pediatric ICU. A multidisciplinary focus group with experienced providers in pediatric ICU airway management and patient safety specialists was formed. A task-based scoring instrument was developed to evaluate a primary airway provider's performance through Healthcare Failure Mode and Effect Analysis. Reliability and validity of the instrument were evaluated using multidisciplinary simulation-based airway management training sessions. Each session was evaluated by 3 independent expert raters. A global assessment of the team performance and the previous experience in training were used to evaluate the validity of the instrument. The Just-in-Time Pediatric Airway Provider Performance Scale (JIT-PAPPS) version 3, with 34 task-based items (14 technical, 20 behavioral), was developed. Eighty-five teams led by resident airway providers were evaluated by 3 raters. The intraclass correlation coefficient for raters was 0.64. The JIT-PAPPS score correlated well with the global rating scale (r = 0.71, P primary airway provider's performance with a multidisciplinary pediatric ICU team on simulated pediatric respiratory failure was developed. Reliability and validity evaluation supports the developed scale.

  17. Factors influencing triage decisions in patients referred for ICU admission.

    Science.gov (United States)

    Orsini, Jose; Butala, Ashvin; Ahmad, Noeen; Llosa, Alfonso; Prajapati, Ramesh; Fishkin, Edward

    2013-10-01

    Few data is available on triage of critically ill patients. Because the demand for ICU beds often exceeds their availability, frequently intensivists need to triage these patients in order to equally and efficiently distribute the available resources based on the concept of potential benefit and reasonable chance of recovery. The objective of this study is to evaluate factors influencing triage decisions among patients referred for ICU admission and to assess its impact in outcome. A single-center, prospective, observational study of 165 consecutive triage evaluations was conducted in patients referred for ICU admission that were either accepted, or refused and treated on the medical or surgical wards as well as the step-down and telemetry units. Seventy-one patients (43.0%) were accepted for ICU admission. Mean Acute Physiology and Chronic Health Evaluation (APACHE)-II score was 15.3 (0 - 36) and 13.9 (0 - 30) for accepted and refused patients, respectively. Three patients (4.2%) had active advance directives on admission to ICU. Age, gender, and number of ICU beds available at the time of evaluation were not associated with triage decisions. Thirteen patients (18.3%) died in ICU, while the in-hospital mortality for refused patients was 12.8%. Refusal of admission to ICU is common, although patients in which ICU admission is granted have higher mortality. Presence of active advance directives seems to play an important role in the triage decision process. Further efforts are needed to define which patients are most likely to benefit from ICU admission. Triage protocols or guidelines to promote efficient critical care beds use are warranted.

  18. 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...

  19. Does an additional structured information program during the intensive care unit stay reduce anxiety in ICU patients?: a multicenter randomized controlled trial.

    Science.gov (United States)

    Fleischer, Steffen; Berg, Almuth; Behrens, Johann; Kuss, Oliver; Becker, Ralf; Horbach, Annegret; Neubert, Thomas R

    2014-01-01

    Communication and information in order to reduce anxiety in the intensive care unit (ICU) has been described as area needing improvement. Therefore, the aim of this trial was to evaluate whether a structured information program that intensifies information given in standard care process reduces anxiety in ICU patients. Multicenter, two-armed, non-blinded, parallel-group randomized controlled trial in hospitals in the cities of Marburg, Halle, and Stuttgart (Germany). The trial was performed in cardiac surgery, general surgery, and internal medicine ICUs. Two-hundred and eleven elective and non-elective ICU patients were enrolled in the study (intervention group, n = 104; control group, n = 107). The experimental intervention comprised a single episode of structured oral information that was given in addition to standard care and covered two main parts: (1) A more standardized part about predefined ICU specific aspects - mainly procedural, sensory and coping information, and (2) an individualized part about fears and questions of the patient. The control group received a non-specific episodic conversation of similar length additional to standard care. Both conversations took place at the beginning of the ICU stay and lasted 10-15 minutes. Study nurses administered both interventions. The primary outcome ICU-related anxiety (CINT-Score, 0-100 pts., higher scores indicate higher anxiety) was assessed after admission to a regular ward. The primary outcome could be measured in 82 intervention group participants and 90 control group participants resulting in mean values of 20.4 (SD 14.4) compared to 20.8 (SD 14.7) and a mean difference of -0.2 (CI 95% -4.5 to 4.1). A structured information intervention additional to standard care during ICU stay had no demonstrated additional benefit compared to an unspecific communication of similar duration. Reduction of anxiety in ICU patients will probably require more continuous approaches to information giving and

  20. Exposição corporal do cliente no atendimento das necessidades básicas em UTI: incidentes críticos relatados por enfermeiras Exposición corporal de pacientes en la atención a las necesidades básicas en UTI: los incidentes críticos relatados por enfermeros Physical exposure of clients in care for basic needs at an ICU: critical incidents reported by nurses

    Directory of Open Access Journals (Sweden)

    Jussara Simone Lenzi Pupulim

    2005-06-01

    ón de estas necesidades, que el equipo y los clientes manifiestan los mismos sentimientos, que los aspectos que garantizan la calidad de la atención son protección de la intimidad del cliente, respecto, confianza y orientación, y que desprotección de la intimidad del cliente perjudica la calidad de la atención.This study aimed to identify and analyze situations involving the physical exposure and invasion of clients' privacy, which are inherent to ICU care. The population consisted of 15 adult ICU nurses in Maringá-PR, Brazil. The Critical Incident Technique was used (CIT, resulting in 30 reports, 15 of which were positive and 15 negative. From these, 22 positive and 30 negative critical incidents were extracted. These were compiled in 6 categories. We chose to present and to discuss the category Basic needs. The health team's behavior constituted 5 categories and the clients' behavior 3. Consequences for health team and clients corresponded to 4 categories. The results revealed that the nursing team is better prepared to handle problems related to care for basic needs; that team and clients disclose the same feelings; that privacy protection, respect, confidence and guidance guarantee the quality of care and that not protecting clients' intimacy impaired care quality.

  1. Introducing an integrated intermediate care unit improves ICU utilization: a prospective intervention study

    OpenAIRE

    Solberg, Barbara CJ; Dirksen, Carmen D; Nieman, Fred HM; van Merode, Godefridus; Ramsay, Graham; Roekaerts, Paul; Poeze, Martijn

    2014-01-01

    Background Improvement of appropriate bed use and access to intensive care (ICU) beds is essential in optimizing utilization of ICU capacity. The introduction of an intermediate care unit (IMC) integrated in the ICU care may improve this utilization. Method In a before-after prospective intervention study in a university hospital mixed ICU, the impact of introducing a six-bed mixed IMC unit supervised and staffed by ICU physicians was investigated. Changes in ICU utilization (length of stay, ...

  2. The effect of a neurocritical care service without a dedicated neuro-ICU on quality of care in intracerebral hemorrhage.

    Science.gov (United States)

    Burns, Joseph D; Green, Deborah M; Lau, Helena; Winter, Michael; Koyfman, Feliks; DeFusco, Christina M; Holsapple, James W; Kase, Carlos S

    2013-06-01

    Introduction of neurocritical care services to dedicated neuro-ICUs is associated with improved quality of care. The impact of a neurocritical care service without a dedicated neuro-ICU has not been studied. We retrospectively identified all patients admitted to our institution with intracerebral hemorrhage (ICH) in two 12-month periods: immediately before the arrival of the first neurointensivist ("before") and after the neurocritical care service was established ("after"). There was no nursing team, ICU housestaff/physician extender team, or physical unit dedicated to the care of patients with critical neurologic illness during either period. Using an uncontrolled before-after design, we compared clinical outcomes and performance on quality metrics between groups. We included 74 patients with primary supratentorial ICH. Mortality, length of stay (LOS), proportion of patients with modified Rankin Score 0-3, and destination on discharge did not differ between groups when adjusted for confounders. Time to first two consecutive systolic blood pressure (SBP) measurements neuro-ICU at our institution was associated with a trend toward longer ICU LOS and improvement in some key metrics of quality of care for patients with ICH.

  3. Correlation between workplace and occupational burnout syndrome in nurses

    Directory of Open Access Journals (Sweden)

    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.

  4. A new conceptual framework for ICU performance appraisal and improvement.

    Science.gov (United States)

    Rotondi, Armando J; Sirio, Carl A; Angus, Derek C; Pinsky, Michael R

    2002-03-01

    This study examined the use of outcomes for the purposes of ICU evaluation and improvement. We reviewed the strengths and weaknesses of an outcomes-centered approach to intensive care unit (ICU) evaluation and present a more comprehensive conceptual framework for ICU evaluation and improvement. Data was collected from 2 sources: (1) a structured review of the literature, with relevant articles identified using Medline, and (2) 85 semistructured interviews of health care professionals (eg, physicians) and health care administrators (eg, chief executive officer). The interviewees came from 4 institutions: a 900-bed East Coast teaching medical center, a 600-bed East Coast teaching medical center, a 590-bed East Coast teaching medical center, and a 435-bed West Coast private community hospital. A nonrandomized, purposeful sample was used. A conceptual framework for ICU evaluation is presented that identifies and defines 3 different types of variables: performance (eg, appropriateness of care, effectiveness of care), outcome (eg, resource use, mortality), and process (eg, timeliness of treatment, work environment). The framework emphasizes performance variables and the relationships between performance, outcome, and process of care variables, as a logical focus for ICU evaluation and improvement. Performance variables offer distinct advantages over outcome variables for ICU evaluation. Their use, however, will require additional development of current evaluation tools and methods. They provide the ability to identify the value an ICU adds to patient care in a hospital or to an episode of illness, and to evaluate integrated systems for providing care. Copyright 2002, Elsevier Science (USA). All rights reserved.

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

    OpenAIRE

    Huihui Liu; Xiaohong Zhang; Rui Chang; Weining Wang

    2017-01-01

    Objective: The paper aims to explore the status of intensive care unit (ICU) nurses' self-esteem, job satisfaction, and subjective well-being and to investigate the relationship among the three elements. Methods: A cross-sectional survey of 224 nurses from five teaching hospitals in Tianjin, China, was conducted. Self-esteem scale, job satisfaction scale, and subjective well-being scale were used to explore the status of ICU nurses' self-esteem, job satisfaction, and subjective well-being....

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

    Science.gov (United States)

    Kauppi, Wivica; Proos, Matilda; Olausson, Sepideh

    2018-01-22

    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.

  7. Ocorrência e significado do toque entre profissionais de enfermagem e pacientes de uma UTI e Unidade Semi-intensiva cirúrgica Ocurrencia y significado del toque entre profesionales de enfermería y pacientes de una uci y unidad semiintensiva quirúrgica Occurence and meaning of the touch between nursing professionals and patients of an icu and semi intensive surgical unit

    Directory of Open Access Journals (Sweden)

    Marília Fogaça Gala

    2003-03-01

    Full Text Available Este trabalho tem como objetivos identificar a utilização, pelos profissionais de Enfermagem, do toque instrumental e/ou afetivo e suas características, na comunicação não-verbal com os pacientes da UTI e unidade semi-intensiva cirúrgica do HU-USP; e os sentimentos e percepções dos profissionais de Enfermagem e dos pacientes em relação aos toques experimentados. O estudo foi desenvolvido com 19 profissionais e 19 pacientes, no período de outubro a novembro de 2000, através de observação direta das interações e entrevista individual. Os sentimentos e percepções relatados foram categorizados e percebemos que a maioria dos toques é instrumental-afetivo.Este trabajo tiene como objectivo identificar la utilización, por los profesionales de Enfermería del toque instrumental y / o afectivo y sus características, en la comunicación no verbal con los pacientes de la UCI y unidad semiintensiva quirúrgica del HU-USP, y los sentimientos y percepciones de los profesionales de Enfermería y los pacientes en relación de los toques experimentados. Lo estudio fue desenvuelto con 19 profesionales y 19 pacientes, en el período de octubre a noviembre de 2000, por medio de observaciones directas de las interacciones y encuestas individuales. Los sentimientos y percepciones relatados fueram categorizados y percibimos que la mayor parte de los toques fueran instrumental - afectivo.This study aims to identify the use of the instrumental and/or emotional touch and its characteristics by nursing professionals in the nonverbal communication with the ICU and Semi Intensive Surgical Unit patients of a school hospital - University of São Paulo; and to identify the professionals and patients feelings and perceptions in relation to the touches experienced. The study was developed with 19 nursing professionals and 19 patients, from October to November 2000, through direct observation of the interaction and individual interview. The feelings and

  8. Designing and validity evaluation of Quality of Nursing Care Scale in Intensive Care Units.

    Science.gov (United States)

    Zeraati, Mashaalah; Alavi, Negin Masoudi

    2014-01-01

    Quality of nursing care measurement is essential in critical care units. The aim of this study was to develop a scale to measure the quality of nursing care in intensive care units (ICUs). The 68 items of nursing care standards in critical care settings were explored in a literature review. Then, 30 experts evaluated the items' content validity index (CVI) and content validity ratio (CVR). Items with a low CVI score (nursing care scale in ICU (Quality of Nursing Care Scale- ICU) that was developed in this research had acceptable CVI and CVR.

  9. Hospital-acquired pneumonia in ICU.

    Science.gov (United States)

    Leone, Marc; Bouadma, Lila; Bouhemad, Bélaïd; Brissaud, Olivier; Dauger, Stéphane; Gibot, Sébastien; Hraiech, Sami; Jung, Boris; Kipnis, Eric; Launey, Yoann; Luyt, Charles-Edouard; Margetis, Dimitri; Michel, Fabrice; Mokart, Djamel; Montravers, Philippe; Monsel, Antoine; Nseir, Saad; Pugin, Jérôme; Roquilly, Antoine; Velly, Lionel; Zahar, Jean-Ralph; Bruyère, Rémi; Chanques, Gérald

    2018-02-01

    The French Society of Anesthesia and Intensive Care Medicine and the French Society of Intensive Care edited guidelines focused on hospital-acquired pneumonia (HAP) in intensive care unit (ICU). The goal of 16 French-speaking experts was to produce a framework enabling an easier decision-making process for intensivists. The guidelines were related to 3 specific areas related to HAP (prevention, diagnosis and treatment) in 4 identified patient populations (COPD, neutropenia, postoperative and pediatric). The literature analysis and the formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research over the last 10 years was conducted based on publications indexed in PubMed™ and Cochrane™ databases. HAP should be prevented by a standardized multimodal approach and the use of selective digestive decontamination in units where multidrug-resistant bacteria prevalence was below 20%. Diagnosis relies on clinical assessment and microbiological findings. Monotherapy, in the absence of risk factors for multidrug-resistant bacteria, non-fermenting Gram negative bacilli and/or increased mortality (septic shock, organ failure), is strongly recommended. After microbiological documentation, it is recommended to reduce the spectrum and to prefer monotherapy for the antibiotic therapy of HAP, including for non-fermenting Gram-negative bacilli. Copyright © 2017 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  10. Development of a Model of Interprofessional Shared Clinical Decision Making in the ICU: A Mixed-Methods Study.

    Science.gov (United States)

    DeKeyser Ganz, Freda; Engelberg, Ruth; Torres, Nicole; Curtis, Jared Randall

    2016-04-01

    To develop a model to describe ICU interprofessional shared clinical decision making and the factors associated with its implementation. Ethnographic (observations and interviews) and survey designs. Three ICUs (two in Israel and one in the United States). A convenience sample of nurses and physicians. None. Observations and interviews were analyzed using ethnographic and grounded theory methodologies. Questionnaires included a demographic information sheet and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration. From observations and interviews, we developed a conceptual model of the process of shared clinical decision making that involves four stepped levels, proceeding from the lowest to the highest levels of collaboration: individual decision, information exchange, deliberation, and shared decision. This process is influenced by individual, dyadic, and system factors. Most decisions were made at the lower two levels. Levels of perceived collaboration were moderate with no statistically significant differences between physicians and nurses or between units. Both qualitative and quantitative data corroborated that physicians and nurses from all units were similarly and moderately satisfied with their level of collaboration and shared decision making. However, most ICU clinical decision making continues to take place independently, where there is some sharing of information but rarely are decisions made collectively. System factors, such as interdisciplinary rounds and unit culture, seem to have a strong impact on this process. This study provides a model for further study and improvement of interprofessional shared decision making.

  11. Nursing diagnoses in a Brazilian intensive care unit.

    Science.gov (United States)

    de Fátima Lucena, Amália; de Barros, Alba Lúcia Bottura Leite

    2006-01-01

    To identify the nursing diagnoses and their most frequent related factors or risk factors in patients admitted to an intensive care unit (ICU). Descriptive cross-sectional study with information from 991 admissions to an ICU during a 6-month period. Sixteen nursing diagnoses resulting from hospitalization were most frequently identified; six had percentages greater than 40% with 29 related/risk factors. The resulting averages were 6.9 diagnoses per hospitalization and 1.2 related/risk factors per nursing diagnoses. The nursing diagnoses identified seemed to be common to the clinical practice of nursing and their fundamental related/risk factors to precise clinical judgment, thus providing a basis for interventions for a desired outcome. The findings have contributed to the development of the standardized nursing language usage in Brazilian nursing practices.

  12. Critical care nursing.

    Science.gov (United States)

    Dracup, K

    1987-01-01

    The research pertaining to the delivery of nursing care in the ICU was reviewed to describe: the impact of the unit structure and organization, including policies and procedures, on patients, nurses, and families; the process of critical care nursing; the outcomes of critical care nursing; some of the ethical issues germane to the care of the critically ill patient. Although these areas of inquiry are quite diverse, a number of similarities can be identified. The most obvious of the similarities was that, with few exceptions, the studies pertaining to delivery of nursing care were performed by researchers from a variety of disciplines other than nursing, including medicine, psychology, public health, and economics. In many instances, such as the studies of patients' stress experiences in ICUs, these efforts enhanced our knowledge of the phenomena and complemented or replicated the efforts of nurse researchers. Unfortunately, in some areas nurse researchers were quite absent, with the result that the studies lacked a nursing perspective. For example, the large body of knowledge related to the effects of critical care on patient outcome reflected medicine's orientation toward cure. While it is important to measure the effect of nursing care in the ICU on patient survival, the effect of nursing efforts on short- and long-term quality of life, functional status, and health maintenance is also critical and remains unknown. Nurse researchers need to build on the data base already acquired about critical care. Even more important, they need to fashion programs of research focused on the concepts central to the discipline of nursing. A second similarity relates to the increasing quality of the reported research over the past decade. In general, early descriptive studies were conducted in a single critical care unit with a small and often biased sample. These gave way to more carefully designed, multicenter studies, although lack of randomization procedures continued to be

  13. Endoparasites in some Swedish Amphibians

    DEFF Research Database (Denmark)

    Cedhagen, Tomas

    1988-01-01

    A study was made of the endoparasites in specimens of Rana arvalis and R. temporaria collected on two occasions from a locality of southern Sweden. Some frogs were investigated directly after capture while other frogs were kept hibernating and the composition of the parasites as well as the behav...... not previously been reported from Sweden. The late Prof. O. Nybelin's unpublished records of parasites found in Swedish amphibians are also given....

  14. Swedish minister rebuilds scientists' trust

    CERN Multimedia

    Sylwan, P

    1999-01-01

    Thomas Ostros, Sweden's new science minister is aiming to improve links with the science community, severely strained during the tenure of Carl Tham. Significantly, he confirmed that he will not be making any further changes to the managment of the Swedish Foundation for Strategic Research. He also announced a 5 per cent increase in government funding for science which will be used to strengthen basic research and education (1 page).

  15. 2006 profile of postgraduate critical care nursing research in South ...

    African Journals Online (AJOL)

    2007-11-19

    Nov 19, 2007 ... Cardiac patients' experience of music. -. - therapy. Cardiac surgery patients' experiences of. -. - music therapy in an ICU of a public hospital in Gauteng. Critical care nurses' knowledge regarding. -. - legal liability issues. Critical care nurses' knowledge regarding. -. - patients with pulmonary embolism in the.

  16. 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.

  17. Critical care nursing practice and education in Rwanda

    African Journals Online (AJOL)

    Intensive care units are found predominantly in the state tertiary hospitals, located primarily in Kigali city. The purpose of ... article is to describe the current state of critical care nursing in Rwanda, including challenges and opportunities faced by these nurses, as well ..... Epidemiology, Outcomes, and Prognostication for ICU.

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

    Science.gov (United States)

    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.

  19. 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.

  20. 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.

  1. Analysis of the interface and data transfer from ICU to normal wards in a German University Hospital.

    Science.gov (United States)

    Vollmer, Anne-Maria; Skonetzki-Cheng, Stefan; Prokosch, Hans-Ulrich

    2013-01-01

    Typically general wards and intensive care units (ICU) have very different labor organizations, structures and IT-systems in Germany. There is a need for coordination, because of the different working arrangements. Our team investigated the interface between ICU and general ward and especially the respective information transfer in the University hospital in Erlangen (Bavaria, Germany). The research team used a combination of interviews, observations and the analysis of transfer records and forms as part of a methodical triangulation. We identified 41 topics, which are discussed or presented in writing during the handover. In a second step, we investigate the requirements of data transmission in expert interviews. A data transfer concept from the perspective of the nurses and physicians was developed and we formulated recommendations for improvements of process and communication for this interface. Finally the data transfer concept was evaluated by the respondents.

  2. 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.

  3. ICU Nurses’ Knowledge, Attitude, and Practice Towards their Role in the Organ Donation Process from Brain-Dead Patients and Factors Influencing it in Iran

    Science.gov (United States)

    Masoumian Hoseini, S. T.; Manzari, Z.; Khaleghi, I.

    2015-01-01

    Background: Nowadays, ICU nurses play a significant role in the care of brain-dead patients and their families. Therefore, their knowledge, attitude and practice towards this issue are extremely important to the success of organ donation. Objective: To assess ICU nurses’ knowledge, attitude and practice towards their role in the organ donation process from brain-dead patients and factors influencing it in Iran. Methods: In a cross-sectional analytical study, 90 ICU nurses working in Ghaem and Emam Reza Hospitals affiliated to Mashhad University of Medical Sciences were selected through a stratified random sampling. Data were collected from the participants by a questionnaire included demographic information, and factors influencing the nurses knowledge, attitude, and practice towards their roles in the organ donation process. Results: 90 nurses participated in this study. 70% of the research subjects had spoken with their own families about organ donation; 20% had organ donation cards. The mean±SD score of nurses’ knowledge was 49.13±9.6, attitude 21.49±14.32, and practice was 3.66±6.04. 80% of nurses had a mean knowledge about their roles in the organ donation process; 82% agreed with their roles in this process, and 97% showed weak practice in this regard. Conclusion: Nurses did not have adequate knowledge, attitude, and practice towards their role in organ donation process. It is suggested to include nursing courses on the organ donation process and organ transplantation as well as educational programs to acquaint nurses with their roles in the organ donation process. PMID:26306156

  4. 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.

  5. 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.

  6. Are supervisors using theoretical perspectives in their work? A descriptive survey among Swedish-approved clinical supervisors.

    Science.gov (United States)

    Berg, Agneta; Kisthinios, Marianne

    2007-11-01

    The aim of the study was to explore the theoretical perspectives in use by approved clinical nursing supervisors in Sweden. For the time being, we know little of the theoretical perspectives in use on a daily basis by the clinical nursing supervisors in Sweden. A questionnaire (n = 49) and follow-up telephone interviews (n = 14) were used. Data analysis was made by descriptive statistics and qualitative content analysis. The result from the questionnaire showed that the supervisors often used and combined different theoretical perspectives with origins in nursing, education and psychology. Surprisingly, one-fourth of the respondents did not state any nursing theoretical perspective in use during clinical nursing supervision. The result from the interviews revealed that the theory of Katie Eriksson (1987) was the most commonly used nursing perspective. As the overall aim for clinical nursing supervision is to improve nursing for the patient/family, the supervisor's competence in nursing is essential. Given this fact, and that only three-quarters of the approved clinical nursing supervisors stated a use of theoretical nursing perspective when supervising, there is obviously a need for further investigations in this area. In addition, there is also a need for approved Swedish clinical nursing supervisors, to further become aware of the theoretical perspective in use that supports their clinical nursing supervision. Clinical nursing supervision is a multifaceted activity that needs to be supported by different nursing theoretical perspectives including physical, emotional, intellectual, spiritual as well as socio-cultural aspects.

  7. Prevalence, clinical consequences and management of acute faecal incontinence with diarrhoea in the ICU: The FIRST™ Observational Study.

    Science.gov (United States)

    Binks, Rachel; De Luca, Enrico; Dierkes, Christine; Franci, Andrea; Herrero, Eva; Niederalt, Georg

    2015-11-01

    There are limited data on the incidence and management of acute faecal incontinence with diarrhoea in the ICU. The FIRST™ Observational Study was undertaken to obtain data on clinical practices used in the ICU for the management of acute faecal incontinence with diarrhoea in Germany, UK, Spain and Italy. ICU-hospitalised patients ≥18 years of age experiencing a second episode of acute faecal incontinence with diarrhoea in 24 h were recruited, and management practices of acute faecal incontinence with diarrhoea were recorded for up to 15 days. A total of 372 patients had complete data sets; the mean duration of study was 6.8 days. At baseline, 40% of patients experienced mild or moderate-to-severe skin excoriation, which increased to 63% in patients with acute faecal incontinence with diarrhoea lasting >15 days. At baseline, 27% of patients presented with a pressure ulcer, which increased to 37%, 45% and 49% at days 5, 10 and 15, respectively. Traditional methods (pads, sheets and tubes) were more commonly used compared to faecal management systems during days 1-4 (76% vs. 47% faecal management system), while the use of a faecal management system increased to 56% at days 5-9 and 61% at days 10-15. At baseline, only 26% of nurses were satisfied with traditional management methods compared to 69% with faecal management systems. For patients still experiencing acute faecal incontinence with diarrhoea after 15 days, 82% of nurses using a faecal management systems to manage acute faecal incontinence with diarrhoea were satisfied or very satisfied, compared to 37% using traditional methods. These results highlight that acute faecal incontinence with diarrhoea remains an important healthcare challenge in ICUs in Europe; skin breakdown and pressure ulcers remain common complications in patients with acute faecal incontinence with diarrhoea in the ICU.

  8. Translation and psychometric evaluation of the Swedish version of the Interdisciplinary Education Perception Scale.

    Science.gov (United States)

    Williams, Brett; Lynch, Marty; Olaussen, Alex; Lachmann, Hanna; Kalén, Susanne; Ponzer, Sari

    2017-10-23

    Interprofessional education (IPE) is widely accepted worldwide, as a key part of training for health professionals and critical to an effective, patient-centred healthcare system. Several tools have been developed to evaluate IPE programmes and interventions globally. Many of the widely-used tools have been successfully adapted to suit specific cohorts and different languages; the Interdisciplinary Education Perception Scale (IEPS), however, has not yet been translated and validated for use in Sweden. The aim of this study was to translate the IEPS into Swedish and validate the psychometric properties of this new version. The 12-item IEPS underwent translation into Swedish and back-translation into English by suitable independent translators to ensure items retained their meaning. The new Swedish version was completed by 164 medical and nursing, occupational therapy and physiotherapy students on clinical placements in Stockholm. Principal Axis Factoring (PAF) and Oblique Oblimin Rotation confirmed a three-factor structure, that explained 77.4% of variance. The new 10-item Swedish version IEPS displayed good internal consistency with an overall Cronbach's alpha of a = .88 and subscale values of .89, .88 and .66. The exclusion of two-items limits the transferability of this scale; however, the factor makeup was very similar to the original 12-item English version. It is suspected that minor differences were due to unavoidable deviations in meaning following translation (i.e. certain English words have no equivalent in Swedish). Nevertheless, the results imply that the Swedish version of the IEPS is a valid and reliable tool for assessing students' perceptions and attitudes towards IPE within the Swedish health education system.

  9. Assessment of sepsis-induced immunosuppression at ICU discharge and 6 months after ICU discharge

    National Research Council Canada - National Science Library

    Zorio, Violette; Venet, Fabienne; Delwarde, Benjamin; Floccard, Bernard; Marcotte, Guillaume; Textoris, Julien; Monneret, Guillaume; Rimmelé, Thomas

    2017-01-01

    Increase in mortality and in recurrent infections in the year following ICU discharge continues in survivors of septic shock, even after total clinical recovery from the initial septic event and its complications...

  10. Assessing family resources: validation of the Swedish version of the Family Hardiness Index.

    Science.gov (United States)

    Persson, Carina; Benzein, Eva; Årestedt, Kristofer

    2016-12-01

    All families face normative transitions. Some are perceived as stressful and calls for family resources to maintain or restore family well-being. In times of illness, families also need to develop strengths and capabilities to enhance family well-being. The way these are developed is related to family hardiness. Family hardiness is thus seen as a family resource, and the Family Hardiness Index (FHI) was developed to measure family stress resistance and adaptation resources. The index was not available in Swedish and no extensive international psychometric evaluation was found. Therefore, the aim was to translate and validate the Swedish version of the FHI. The study was approved by a Regional Ethical Review Board. Data from 174 Swedish participants, family members to persons with cognitive dysfunctions (n = 95) and nursing students (n = 79) were included. Family members were enrolled in outpatient clinics in primary care and rehabilitation, and nursing students at a nursing school. Psychometric properties were evaluated through calculations of missing data, distributions of item and scale scores, item correlations, Cronbach's alpha, confirmatory factor analyses and correlations with theoretically related constructs. Sample scores had acceptable data quality, internal consistency for the FHI total scale was satisfactory (α = 0.86), and construct validity was supported. Our findings cast some doubt on the intended interpretation since confirmatory factor analyses showed that a modified four-subscale version, excluding one subscale, showed best fit. The Control subscale lacked important psychometric properties in terms of homogeneity, internal consistency and construct validity. The sample size was probably sufficiently large for the factor analyses, but the subgroup analyses should be treated with caution. The conclusion is that the Swedish version of the FHI is a promising scale for assessing family hardiness, but more solid evidence for the factor structure in

  11. Turkish nurses' decision making in the distribution of intensive care beds.

    Science.gov (United States)

    Ersoy, Nermin; Akpinar, Aslihan

    2010-01-01

    The aim of this study was to assess the opinions and role of intensive care unit (ICU) nurses regarding the distribution of ICU beds. We conducted this research among 30% of the attendees at two ICU congresses in Turkey. A self-administered questionnaire was used, which included 13 cases and allocation criteria. Of the total (136 nurses), 53.7% participated in admission/discharge decisions. The most important criterion was quality of life as viewed by the physician; the least important was the patient's social status. According to the findings, the nurses thought that medical benefit and avoiding discrimination were important. On the other hand their ignorance of patients' autonomous preferences arouses suspicions about these nurses' role in advocating for patients' rights. For this reason, nurses' role in allocation decisions should be clearly described and should also be the basis on which intensive care nurses' duties in allocation decisions should be determined.

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

    Directory of Open Access Journals (Sweden)

    Kim Lutzen

    1999-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. The Development and Evaluation of Delirium Assessment and Nursing Care Decision-Making Assistant Mobile Application for Intensive Care Unit.

    Science.gov (United States)

    Yang, Fangyu; Ji, Meihua; Ding, Shu; Wu, Ying; Chang, Polun; Lin, Chiawei; Yang, Xin

    2016-01-01

    Delirium is a common complication among patients in ICU settings. Although it has been repeatedly confirmed that Confusion Assessment Model for Intensive Care Unit (CAM-ICU), one of the most commonly used ICU delirium assessment tool, is highly accurate in validation studies, it's sensitivity and specificity is relatively low during routine practice among bedside nurses. The aim of this study is to develop a mobile application (app) to detect delirium and to test its reliability and validity both by research nurses and among ICU bedside nurses. The app was programmed with Java and installed on a mobile device with Android system. After completion of reliability and validity testing, the app will be integrated into the existing Hospital Information System in order to automatically retrieve essential information for risk factor identification and formulation of care plan accordingly to prevent or manage ICU delirium.

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

    Science.gov (United States)

    Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck

    2015-04-01

    This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P 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.

  16. Role of a service corridor in ICU noise control, staff stress, and staff satisfaction: environmental research of an academic medical center.

    Science.gov (United States)

    Wang, Zhe; Downs, Betsy; Farell, Ashley; Cook, Kimberly; Hourihan, Peter; McCreery, Shimby

    2013-01-01

    To investigate the role of a dedicated service corridor in intensive care unit (ICU) noise control and staff stress and satisfaction. Shared corridors immediately adjacent to patient rooms are generally noisy due to a variety of activities, including service deliveries and pickups. The strategy of providing a dedicated service corridor is thought to reduce noise for patient care, but the extent to which it actually contributes to noise reduction in the patient care environment and in turn improves staff performance has not been previously documented. A before-and-after comparison was conducted in an adult cardiac ICU. The ICU was relocated from a traditional hospital environment to a new addition with a dedicated service corridor. A total of 118 nursing staff participated in the surveys regarding pre-move and post-move environmental comfort, stress, and satisfaction in the previous and new units. Acoustical measures of noise within the new ICU and a control environment of the previous unit were collected during four work days, along with on-site observations of corridor traffic. Independent and paired sample t-tests of survey data showed that the perceived noise level was lower and staff reported less stress and more satisfaction in the new ICU (p stress and satisfaction. Critical care/intensive care, noise, satisfaction, staff, work environment.

  17. A104 CRITICAL CARE: IMPROVING ICU EXERCISE, REHABILITATION, RECOVERY, AND SURVIVORSHIP: Icu Admission Skeletal Muscle Mass, In-Hospital Outcomes And 6-Months Mortality: A Prospective Study

    National Research Council Canada - National Science Library

    A Jaitovich; M Khan; R Itty; H Chieng; P Nadendla; J Fantauzzi; R Yucel; M A Judson

    2017-01-01

    To better clarify the impact of skeletal muscle mass on critical illness, we took advantage of the PMA measurement at ICU admission and investigated its association with patients' severity score, ICU...

  18. Diagnostic Accuracy of Electrographic Seizure Detection by Neurophysiologists and Non-Neurophysiologists in the Adult ICU Using a Panel of Quantitative EEG Trends.

    Science.gov (United States)

    Swisher, Christa B; White, Corey R; Mace, Brian E; Dombrowski, Keith E; Husain, Aatif M; Kolls, Bradley J; Radtke, Rodney R; Tran, Tung T; Sinha, Saurabh R

    2015-08-01

    To evaluate the sensitivity and specificity of a panel of quantitative EEG (qEEG) trends for seizure detection in adult intensive care unit (ICU) patients when reviewed by neurophysiologists and non-neurophysiologists. One hour qEEG panels (n = 180) were collected retrospectively from 45 ICU patients and were distributed to 5 neurophysiologists, 7 EEG technologists, and 5 Neuroscience ICU nurses for evaluation of seizures. Each panel consisted of the following qEEG tools, displayed separately for left and right hemisphere electrodes: rhythmicity spectrogram (rhythmic run detection and display; Persyst Inc), color density spectral array, EEG asymmetry index, and amplitude integrated EEG. The reviewers did not have access to the raw EEG data. For the reviewer's ability to detect the presence of seizures on qEEG panels when compared with the gold standard of independent raw EEG review, the sensitivities and specificities are as follows: neurophysiologists 0.87 and 0.61, EEG technologists 0.80 and 0.80, and Neuroscience ICU nurses 0.87 and 0.61, respectively. There was no statistical difference among the three groups regarding sensitivity. Quantitative EEG display panels are a promising tool to aid detection of seizures by non-neurophysiologists as well as by neurophysiologists. However, even when used as a panel, qEEG trends do not appear to be adequate as the sole method for reviewing continuous EEG data.

  19. Swedish Opinion on Nuclear Power 1986 - 2011

    Energy Technology Data Exchange (ETDEWEB)

    Holmberg, Soeren

    2012-11-01

    This report contains the Swedish opinion on Nuclear Power and European Attitudes on Nuclear Power. It also includes European Attitudes Towards the Future of Three Energy Sources; Nuclear Energy, Wind Power and Solar Power - with a focus on the Swedish opinion. Results from measurements done by the SOM Inst. are presented.

  20. Is spoken Danish less intelligible than Swedish?

    NARCIS (Netherlands)

    Gooskens, Charlotte; van Heuven, Vincent J.; van Bezooijen, Renee; Pacilly, Jos J. A.

    2010-01-01

    The most straightforward way to explain why Danes understand spoken Swedish relatively better than Swedes understand spoken Danish would be that spoken Danish is intrinsically a more difficult language to understand than spoken Swedish. We discuss circumstantial evidence suggesting that Danish is

  1. 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

  2. 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

    2017-01-01

    Background: Delirium in the intensive care unit (ICU) has received more attention in the past decade. Early detection, prevention and treatment of delirium are important, and the most commonly used tool for delirium assessment is the Confusion Assessment Method for the ICU (CAM-ICU). Aim: The aim......-ICU for delirium detection. It might be necessary to revalidate the instrument as ICU care has changed in recent years, with lighter sedation and early mobilization of patients. We recommend that nurses and physicians receive more training in the use of the CAM-ICU to address some of the issues identified in our...... study. Relevance to clinical practice: There is a need for ongoing training and clearer guidelines on how to proceed with the delirium screening of non-sedated patients....

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

    Science.gov (United States)

    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.

  4. Trend of Decreased Length of Stay in the Intensive Care Unit (ICU) and in the Hospital with Palliative Care Integration into the ICU

    Science.gov (United States)

    Mun, Eluned; Ceria-Ulep, Clementina; Umbarger, Lillian; Nakatsuka, Craig

    2016-01-01

    Context Is a decrease in length of stay (LOS) in the intensive care unit (ICU) and hospital possible with the implementation of a structured, palliative care, quality-improvement program in the ICU? Objective Incorporate palliative care into the routine ICU workflow to increase the numbers of palliative care consultations, improve end-of-life care in the ICU, and demonstrate an impact on ICU and/or hospital LOS. Design A program was developed that followed recommendations from the Center to Advance Palliative Care’s Improving Palliative Care in the ICU project. This program included selecting trigger criteria and a care model, forming guidelines, and developing evaluation criteria. The early identification of multiple measures led to proactive meetings with ICU patients’ families and/or palliative care consultations. Main Outcome Measures Early identification of advance directives, code status, goals of care, and ICU LOS and hospital LOS. Results A comparison between pre- and postintervention data showed positive trends in measured outcomes, including increased early identification of advance directives, code status, and goals of care along with a decrease in ICU LOS and hospital LOS. In addition, the number of ICU family meetings and palliative care consultations increased. Conclusion It was concluded that providing palliative care in the ICU is feasible and may decrease both ICU LOS and overall hospital LOS. PMID:27644048

  5. "Let's fika first"! A look at Swedish midwifery from a cultural perspective.

    Science.gov (United States)

    Cairns, Jo Beth

    2006-01-01

    Sweden is the third largest country in Europe and has a population of approximately nine million people. Swedish midwives are highly esteemed, autonomous and respected by the population. This article discusses cultural aspects of working as a midwife in Sweden along with the obstacle of learning a new language and various new methods of midwifery care. This personal account of my placement in Sweden is intended to offer insight to midwives and nurses who may contemplate working there.

  6. The Changing Role of Palliative Care in the ICU

    Science.gov (United States)

    Aslakson, Rebecca A.; Curtis, J. Randall; Nelson, Judith E.

    2015-01-01

    Objectives Palliative care is an interprofessional specialty as well as an approach to care by all clinicians caring for patients with serious and complex illness. Unlike hospice, palliative care is based not on prognosis but on need and is an essential component of comprehensive care for critically ill patients from the time of ICU admission. In this clinically focused article, we review evidence of opportunities to improve palliative care for critically ill adults, summarize strategies for ICU palliative care improvement, and identify resources to support implementation. Data Sources We searched the MEDLINE database from inception through January 2014. We also searched the Reference Library of The Improving Palliative Care in the ICU Project website sponsored by the National Institutes of Health and the Center to Advance Palliative Care, which is updated monthly. We hand-searched reference lists and author files. Study Selection Selected studies included all English-language articles concerning adult patients using the search terms "intensive care" or "critical care" with "palliative care," "supportive care," "end-of-life care," or "ethics." Data Extraction After examination of peer-reviewed original scientific articles, consensus statements, guidelines, and reviews resulting from our literature search, we made final selections based on author consensus. Data Synthesis Existing evidence is organized to address: 1) opportunities to alleviate physical and emotional symptoms, improve communication, and provide support for patients and families; 2) models and specific interventions for improving ICU palliative care; 3) available resources for ICU palliative care improvement; and 4) ongoing challenges and targets for future research. Key domains of ICU palliative care have been defined and operationalized as measures of quality. There is increasing recognition that effective integration of palliative care during acute and chronic critical illness may help patients and

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

    Directory of Open Access Journals (Sweden)

    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.

  8. What Is the Best Pulmonary Physiotherapy Method in ICU?

    Directory of Open Access Journals (Sweden)

    Ufuk Kuyrukluyildiz

    2016-01-01

    Full Text Available Objective. Effects of high frequency chest wall oscillation technique were investigated on intubated ICU patients. Background. Thirty intubated patients were included in the study. The control group (n=15 received routine pulmonary rehabilitation technique. In addition to the pulmonary rehabilitation technique, the study group (n=15 was given high frequency chest wall oscillation (HFCWO. APACHE II, dry sputum weight, lung collapse index, and blood gas values were measured at 24th, 48th, and 72nd hours and endotracheal aspirate culture was studied at initial and 72nd hour. The days of ventilation and days in ICU were evaluated. Results. There is no significant difference between APACHE II scores of groups. The dry sputum weights increased in the study group at 72nd hour (p=0.001. The lung collapse index decreased in study group at 48th (p=0.003 and 72nd hours (p<0.001. The PO2 levels increased in the study group at 72nd hour (p=0.015. The culture positivity at 72nd hour was decreased to 20%. The days of ventilation and staying in ICU did not differ between the groups. Conclusions. Although HFCWO is very expensive equipment, combined technique may prevent the development of lung atelectasis or hospital-acquired pneumonia more than routine pulmonary rehabilitation. It does not change intubated period and length of stay in ICU. However, more further controlled clinical studies are needed to use it in ICU.

  9. Alcohol, nicotine, and iatrogenic withdrawals in the ICU.

    Science.gov (United States)

    Awissi, Don-Kelena; Lebrun, Genevieve; Fagnan, Mylene; Skrobik, Yoanna

    2013-09-01

    The neurophysiology, risk factors, and screening tools associated with alcohol withdrawal syndrome in the ICU are reviewed. Alcohol withdrawal syndrome assessment and its treatment options are discussed. Description of nicotine withdrawal and related publications specific to the critically ill are also reviewed. A brief comment as to sedative and opiate withdrawal follows. The role of currently published alcohol withdrawal syndrome pharmacologic strategies (benzodiazepines, ethanol, clomethiazole, antipsychotics, barbiturates, propofol, and dexmedetomidine) is detailed. Studies on nicotine withdrawal management in the ICU focus mainly on the safety (mortality) of nicotine replacement therapy. Study characteristics and methodological limitations are presented. We recommend a pharmacologic regimen titrated to withdrawal symptoms in ICU patients with alcohol withdrawal syndrome. Benzodiazepines are a reasonable option; phenobarbital appears to confer some advantages in combination with benzodiazepines. Propofol and dexmedetomidine have not been rigorously tested in comparative studies of drug withdrawal treatment; their use as additional or alternative strategies for managing withdrawal syndromes in ICU patients should therefore be individualized to each patient. Insufficient data preclude recommendations as to nicotine replacement therapy and management of iatrogenic drug withdrawal in ICU patients.

  10. Evaluating Nurses' Perception of Patient Safety Design Features in Intensive Care Units.

    Science.gov (United States)

    Islam, Faria; Rashid, Mahbub

    A methodological study was conducted to test the validity and reliability of the patient safety (PS) scale developed by Rashid (2007) for evaluating nurses' perception of adult intensive care unit (ICU) design features related to patient safety. Data for the study were collected using a Web-based survey instrument. A link to the survey instrument was posted on the Web site of American Association of Critical-Care Nurses (AACN) for ICU nurses in different US states to participate. A sample of 587 valid responses was divided into 2 halves for cross-validation. The first half of the sample was used for exploratory factor analysis and the second half for confirmatory factor analysis. This method was applied to identify any latent factor structure in the PS scale. Based on the factor analyses, 4 relevant PS subscales-Efficient Work Process, Patient Room, Accessibility and Visibility, and Maintain Sterility-were identified. These PS subscales were used to investigate whether ICU unit characteristics, nurse characteristics, and hospital type affected nurses' perception of ICU design features in relation to patient safety. The study shows that nurses' perception of ICU design features related to patient safety can be influenced by such factors as nurse characteristics and unit characteristics. When using the scales, therefore, the designers can be aware of the influence of these external factors on nurses' perception. It is hoped that the PS subscales evaluating nurses' perception of ICU physical environmental features related to patient safety would help designers and health care personnel make better ICU design choices.

  11. Correlation between workplace and occupational burnout syndrome in nurses

    OpenAIRE

    Omid Ahmadi; Reza Azizkhani; Monem Basravi

    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 ...

  12. AACN CSI Academy, part 2: Nurses emerge as change leaders.

    Science.gov (United States)

    Iacono, Laura; Altman, Marian

    2015-08-01

    In the first part of this three-part series, we explored how the American Association of Critical-Care Nurses (AACN) Clinical Scene Investigator (CSI) Academy aids clinical nurses in cultivating skills that measurably demonstrate how nonproductive time is a misnomer that interferes with achieving optimal patient outcomes. Join us for part 2, as we examine how the CSI Academy helped one hospital's neurosurgical ICU (NSCU) nurses achieve zero CAUTIs.

  13. The clinical utility of the functional status score for the intensive care unit (FSS-ICU) at a long-term acute care hospital: a prospective cohort study.

    Science.gov (United States)

    Thrush, Aaron; Rozek, Melanie; Dekerlegand, Jennifer L

    2012-12-01

    Long-term acute care hospitals (LTACHs) have emerged for patients requiring medical care beyond a short stay. Minimal data have been reported on functional outcomes in this setting. The purposes of this study were: (1) to measure the clinical utility of the Functional Status Score for the Intensive Care Unit (FSS-ICU) in an LTACH setting and (2) to explore the association between FSS-ICU score and discharge setting. Data were obtained from 101 patients (median age=70 years, interquartile range [IQR]=61-78; 39% female, 61% male) who were admitted to an LTACH. Participants were categorized into 1 of 5 groups by discharge setting: (1) home (n=14), (2) inpatient rehabilitation facility (n=26), (3) skilled nursing facility (n=23), (4) long-term care/hospice/expired (n=13), or (5) transferred to a short-stay hospital (n=25). Data were prospectively collected from a 38-bed LTACH in the United States over 8 months beginning in September 2010. Functional status was scored using the FSS-ICU within 4 days of admission and every 2 weeks until discharge. The FSS-ICU consists of 5 categories: rolling, supine-to-sit transfers, unsupported sitting, sit-to-stand transfers, and ambulation. Each category was rated from 0 to 7, with a maximum cumulative FSS-ICU score of 35. Cumulative FSS-ICU scores significantly improved from a median (IQR) of 9 (3-17) to 14 (5-24) at discharge. Median (IQR) cumulative discharge FSS-ICU scores were significantly different among the discharge categories: home=28 (22-32), inpatient rehabilitation facility=21 (15-24), skilled nursing facility=14 (8-21), long-term care/hospice/expired=5 (0-11), and transfer to a short-stay hospital=4 (0-7). Patients receiving therapy at an LTACH demonstrate significant improvements from admission to discharge using the FSS-ICU. This outcome tool discriminates among discharge settings and successfully documents functional improvements of patients in an LTACH setting.

  14. Ten Myths and Misconceptions Regarding Pain Management in the ICU.

    Science.gov (United States)

    Sigakis, Matthew J G; Bittner, Edward A

    2015-11-01

    The aim of this article is to expose common myths and misconceptions regarding pain assessment and management in critically ill patients that interfere with effective care. We comprehensively review the literature refuting these myths and misconceptions and describe evidence-based strategies for improving pain management in the ICU. Current peer-reviewed academic journals, as well as standards and guidelines from professional societies. The most current evidence was selected for review based on the highest degree of supportive evidence. Data were obtained via medical search databases, including OvidSP, and the National Library of Medicine's MEDLINE database via PubMed. After a comprehensive literature review, conclusions were drawn based on the strength of evidence and the most current understanding of pain management practices in ICU. Myths and misconceptions regarding management of pain in the ICU are prevalent. Review of current evidence refutes these myths and misconceptions and provides insights and recommendations to ensure best practices.

  15. APACHE IV versus PPI for predicting community hospital ICU mortality.

    Science.gov (United States)

    Shrope-Mok, Shaffer R; Propst, Katie A; Iyengar, Rajesh

    2010-06-01

    Both the Acute Physiology and Chronic Health Evaluation (APACHE) IV and Palliative Performance Index (PPI) are scales used to estimate intensive care unit (ICU) prognosis and mortality. To Compare the diagnostic utility of the PPI and APACHE IV and their subsequent implications in predicting ICU mortality at a community hospital. This was a Prospective Cohort Study. The study was conducted at the Community hospital ICU. Participants were 211 patients admitted from December 24, 2008 to June 11, 2009. An observer gathered appropriate data and performed the APACHE IV and PPI scales within 24 hours of admission. Results were then analyzed using standard formulae. The study included 211 participants in total with 211 participants in the PPI group (n = 211) and 162 in the APACHE IV group (n = 162). The APACHE score and PPI were found to be significant for predicting ICU mortality (P value of P APACHE IV demonstrated a sensitivity of 84.6%, specificity of 96.0%, PPV of 64.7%, and NPV of 98.6%. In contrast, the PPI possessed a sensitivity of 69.2%, specificity of 96.0%, PPV of 64.7%, and NPV of 97.8%. Limitations may have occurred with the subjective nature of the PPI and Glasgow Coma Scale (GCS), along with meeting criterion for the APACHE IV. This prospective cohort study in the ICU of a community hospital demonstrated that both the APACHE IV and PPI were significant tools for predicting ICU mortality. When contrasting the 2 scales, the APACHE IV could more accurately rule in mortality when mortality occurred and rule out mortality when survival occurred.

  16. Palliative Care Needs in the Neuro-ICU

    Science.gov (United States)

    Creutzfeldt, Claire J.; Engelberg, Ruth A.; Healey, Larry; Cheever, Chong (Sherry); Becker, Kyra J.; Holloway, Robert G.; Curtis, J. Randall

    2015-01-01

    Objective Patients admitted to the neurological or neurosurgical intensive care unit (neuro-ICU) are likely to have palliative care needs. The goals of this project are to encourage the ICU team to identify palliative care needs for patients and their families and potential ways to meet those needs. Design Quality improvement project using a parallel-group prospective cohort design. Setting Single neuro-ICU at a large, academic medical center. Patients All patients admitted to the neuro-ICU from September 1, 2013 to November 30, 2013. Intervention We developed a Palliative Care Needs Screening Tool consisting of 4 questions: (1) Does the patient have distressing physical or psychological symptoms? (2) Are there specific support needs for patient or family? (3) Are treatment options matched with patient-centered goals? (4) Are there disagreements among teams and family? We implemented this daily screening tool on morning rounds for 1 of 2 neurocritical care services that alternate admitting days to a single neuro-ICU. We examined prevalence and nature of palliative care needs and actions to address those needs, comparing the services with and without screening. Measurements and main results Over the 3-month period, 130 patients were admitted to the service with screening, and 132 patients to the service without screening. The two groups did not differ in regards to age, gender, Glasgow coma scale or diagnosis. Palliative care needs were identified in 62% of screened patients (80/130). Needs were mainly social support (53%) and establishing goals of care (28%). Screening was associated with more documented family conferences (p=0.019) and a trend towards more palliative care consultations (p=0.056). Conclusions We developed a brief palliative care needs screening tool that identified palliative care needs for 62% neuro-ICU patients. This tool was associated with actions to meet these needs, potentially improving care for patients and their families. PMID:25867905

  17. [Management of technology and its influence on nursing care].

    Science.gov (United States)

    Palacios-Ceña, Domingo

    2007-01-01

    Currently, much nursing care adheres to a specific biomedical paradigm within the positivist framework. However, sometimes nursing care cannot be adapted to numerous human or vital conditions affecting our patients, their families or the environment in which nurses work. An specific example of these nursing interventions are those applied in intensive care units (ICU) where there is a large amount of technology and nursing care is specialized. Several questions that arise are whether the above-mentioned specialization is inherent to nurse care, whether technology management forms part of nursing care, whether this care has a non-nursing origin, and what is the source of nursing knowledge. The present article aims to provide basic knowledge to distinguish the nursing care performed in the ICU within the 2 predominant paradigms in current nursing: the biomedical and the holistic paradigms. The characteristics of nursing care in both paradigms are described and an integrated vision of these 2 paradigms and of nursing care with and without the use of technology is provided.

  18. [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(Pdelirium assessment" (Pdelirium management,especially in special ICUs. Delirium management should be included as a routine care in ICU to improve patients' outcome.

  19. 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.

  20. School Nurses Avoid Addressing Child Sexual Abuse

    Science.gov (United States)

    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…

  1. A nursing perspective of interprofessional work in critical care: Findings from a secondary analysis.

    Science.gov (United States)

    Kendall-Gallagher, Deborah; Reeves, Scott; Alexanian, Janet A; Kitto, Simon

    2017-04-01

    This article presents a secondary analysis of nurse interviews from a 2-year comparative ethnographic study exploring cultures of collaboration across intensive care units (ICU). Critically ill patients rely on their interprofessional health care team to communicate and problem-solve quickly to give patients the best outcome available. Critical care nurses function at the hub of patient care giving them a distinct perspective of how interprofessional interactions impact collaborative practice. Secondary analysis of a subset of primary qualitative data is appropriate when analysis extends rather than exceeds the primary study aim. Primary ethnographic data included 178 semistructured interviews of ICU professionals from 8 medical-surgical ICUs in North America; purposeful maximum variation sampling was used to represent each profession accurately. Fifteen anonymized ICU nurse interview transcripts were coded iteratively to identify emerging themes impacting interprofessional collaborative practice. Findings suggest that quality of interprofessional collaboration is a product of a multitude of factors occurring at multiple levels within the organization. Managerial and organizational factors related to ICU nurse training and staffing may impede development of nurses' interprofessional skills. Deliberative development of ICU nurses' interprofessional skills is essential if nursing is to move from primary coordinator to active collaborator in patient management. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Sleep promotion in the intensive care unit-a survey of nurses' interventions.

    Science.gov (United States)

    Eliassen, Kirsten M; Hopstock, Laila A

    2011-06-01

    Sleep deprivation is common amongst patients in intensive care units (ICU) and can lead to physiological and psychological dysfunctions that affect the healing process and increase morbidity and mortality. A focus on the effects of the ICU environment on patient sleep quality has lead to strategies for improvements in patient care. The aim of this small-scale study was to investigate the perceptions of the sleep-promoting interventions that ICU nurses believe they provide. A review of the literature identified four main approaches, i.e., noise reduction, light reduction, patient comfort improvement and clustering of patient care activities, to allow uninterrupted time for adequate sleep. A questionnaire was created to collect information on the nurses' interventions to promote night- and daytime patient sleep in accordance with the literature findings. A total of 25 ICU nurses working in an ICU with medical and surgical patients at the University Hospital of Northern Norway completed the e-mail-administered web-based questionnaire. The ICU nurses reported an overall interest and awareness in sleep-promoting interventions utilising all four approaches, but the challenge of caring for critically ill patients with demands of frequent assessment and nursing may influence which interventions are prioritised. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Gender Integration and the Swedish Armed Forces

    DEFF Research Database (Denmark)

    Gustafsson, Daniel Marcus Sunil

    This paper discusses different gender aspects of the Swedish Armed Forces with specific references to sexual harassment and prostitution. By using the concept of Hegemonic Masculinity, sexual harassment of the women in the Swedish Armed Forces is explained in terms of a need of the men within...... the organisation to reinforce the notion of women as inferior and subordinate to men, whereby the external hegemony is believed to be restored. Likewise, male Swedish peacekeepers’ demand for prostitution during international peacekeeping missions is explained in terms of a need to confirm manhood and as homo...

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

    Directory of Open Access Journals (Sweden)

    Lúcia Nazareth Amante

    2009-03-01

    Full Text Available O objetivo foi implementar a Sistematização da Assistência de Enfermagem (SAE, tendo como referencial a Teoria das Necessidades Humanas Básicas de Wanda de Aguiar Horta e o Diagnóstico de Enfermagem da North American Nursing Diagnosis Association (NANDA, partindo da avaliação do conhecimento da equipe de enfermagem sobre a SAE e incluindo a sua participação nesse processo. É uma pesquisa-ação de cunho qualitativo, realizada na Unidade de Terapia Intensiva de um Hospital da cidade de Brusque, Santa Catarina, de outubro de 2006 a março de 2007. Pode-se perceber que os profissionais da enfermagem sabem pouco sobre a SAE, porém possuem grande interesse em aprender e desenvolvê-la em sua prática diária. Conclui-se que foi possível realizar uma sistematização de assistência de fácil aplicação, através da utilização de impressos simples que forneceram todas as informações necessárias para o desenvolvimento qualificado do cuidado de enfermagem.El objetivo fue implementar la Sistematización de la Asistencia de Enfermería (SAE utilizando como marco teórico la Teoría de las Necesidades Humanas Básicas de Wanda de Aguiar Horta y el Diagnóstico de Enfermería de la North American Nursing Diagnosis Asociation (NANDA, partiendo de la evaluación del conocimiento del equipo de enfermería sobre la SAE e incluyendo su participación en ese proceso. Se trata de una investigación de tipo cualitativo, realizada en la Unidad de Terapia Intensiva de un Hospital de la ciudad de Brusque, en el estado de Santa Catarina, en los meses de octubre de 2006 a marzo de 2007. Se puede percibir que los profesionales de enfermería saben poco sobre la SAE; sin embargo poseen un gran interés en aprenderla y desarrollarla en su práctica diaria. Se concluye que fue posible realizar una sistematización de la asistencia de fácil aplicación, a través de la utilización de folletos simples que ofrecen todas las informaciones necesarias para el

  5. Inhalational anaesthetics in the ICU: theory and practice of inhalational sedation in the ICU, economics, risk-benefit.

    Science.gov (United States)

    Meiser, Andreas; Laubenthal, H

    2005-09-01

    ICU sedation poses many problems. The action and side-effects of intravenous drugs in the severely ill patient population of an ICU are difficult to control. The incidence of post-traumatic stress disorder after long-term sedation is high. The recent focus on propofol infusion syndrome entails restrictions in the use of this drug. On the other hand, volatile anaesthetics very selectively suppress consciousness but leave many autonomic functions intact. In the absence of perception and disturbed information processing the number of adverse experiences should be lower, leading to a better psychological outcome. Respiration and intestinal motility are not depressed, facilitating modern therapeutic concepts such as early enteral feeding and augmentation of spontaneous breathing. Awakening after inhalational ICU sedation is quick and predictable, extubation can be planned and organized, and the time during which the patient needs very close observation will be short. Technological advances have greatly simplified the application of inhalational anaesthetics. New anaesthesia ventilators offer ventilatory modes and high flow generation comparable to ICU ventilators. However, they are not yet licensed for stand-alone use. The introduction of a volatile anaesthetic reflection filter for the first time enables the concept of inhalational sedation to be performed with very little effort by many ICUs. This 'anaesthetic conserving device' (AnaConDa) is connected between the patient and a normal ICU ventilator, and it retains 90% of the volatile anaesthetic inside the patient just like a heat and moisture exchanger. In this chapter possible advantages of the new concept and the choice of the inhalational agent are discussed. The technical prerequisites are explained, and the practice and pitfalls of inhalational ICU sedation in general and when using the AnaConDa are described in detail.

  6. 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.

  7. Studies in Swedish Energy Opinion

    Energy Technology Data Exchange (ETDEWEB)

    Holmberg, Soeren; Hedberg, Per

    2012-07-01

    the 1970s, energy production was politicized big time in the industrialized world. The birth of the environmental movement, the oil crises in 1973 - 74 and the beginning conflict surrounding civilian nuclear power, put energy issues center stage on the political agenda. Energy policies - especially related to the development of nuclear power - came to dominate election campaigns, like in Sweden in 1976 or be the subject of referendums, like in Austria in 1978 or in Sweden in 1980. Critical voices toward the peaceful use of nuclear power - having started in America before being exported to Europe - gained real strength and public support all over the Western world by the nuclear accident at the Three Mile Island plant in Harrisburg, Pennsylvania in 1979. The energy genie was out of the bottle and out to stay. Fueled by the nuclear meltdowns in Chernobyl in 1986 and in Fukushima in 2011 and supplemented by conflicts over how to reduce the use of oil and coal, how to sensibly exploit the waste gas reserves, and how to develop renewable energy sources based on sun, wind and waves – have made all kinds of energy issues the focal point of political contentions ever since the early 1970s. In Sweden, as in many other countries, energy policies - often with nuclear power in the center - have been one of the most fought-over policy areas during the last thirty-forty years. And the contentious character of energy policies is not limited to the elite level of politics - to politicians, to media pundits or to lobbyists. It is also manifest among ordinary citizens. Energy issues - nuclear power and wind power in particular - are highly polarizing among voters as well. Given this historic background, starting in the 1970s, it was rather natural that energy questions - featuring most prominently questions related to nuclear power - would be important parts of the voter surveys performed by the Swedish National Elections Studies (SNES) at the Univ. of Gothenburg. The first book

  8. Nursing students' perceptions of knowledge: an international perspective

    OpenAIRE

    Majda Pahor; Barbara Domajnko; Elisabeth Lindahl

    2015-01-01

    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 questio...

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

    Science.gov (United States)

    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.

  10. [What lipid emulsion should be administered to ICU patients?].

    Science.gov (United States)

    Kreymann, G

    2014-01-01

    The review deals with a question what lipid emulsion should be administered to ICU patients according to recently published official parenteral and enteral nutrition guidelines. Classic lipid emulsions based on omega-6 fatty acids are immunosuppressive and should not be used with ICU patients. The olive/soy emulsion is immunoneutral and can be used for most patients. Many ICU patients are in an inflammatory state (e.g. sepsis, ARDS, pancreatitis). A common belief is that this "hyperinflammed patient population" would profit from an anti-inflammatory lipid component of their parenteral nutrition solution, such as fish oil. On the other hand, every anti-inflammatory therapy has the disadvantage of also being immunosuppressive. Inflammation is a necessary part of the host defense against infection and any correct anti-inflammatory medication presupposes the exact immunologic knowledge that there is too much inflammation for a given situation. This "too much" is certainly not fulfilled in every patient with sepsis, ARDS or pancreatitis. At the bedside it is nearly impossible to determine the degree of "hyper" inflammation. In reality, a number of these patients may be adequately inflamed or, in fact, even hypoinflammed. Specific emulsions which can be used in hyper- or hypoinflammation should be developed in the future. As long as these difficulties in the immunologic diagnosis prevail, the clinician might be best advised to use an immunoneutral lipid emulsion when choosing a lipid preparation for the ICU patients.

  11. Topical honey: for bears, not for ICU catheters?

    OpenAIRE

    Timsit, Jean-François

    2013-01-01

    Catheters are most often colonized and become infected via the skin and their external surfaces in the ICU. Therefore, topical antimicrobials, including medical honey, placed at the insertion site should decrease skin colonization and catheter infections. This commentary reviews the main studies on, and the possible reasons of, topical antimicrobial failure in ICUs compared to the reported efficacy of chlorhexidine-impregnated dressings.

  12. Dysmagnesaemia and outcome in a trauma ICU | Ilicki | Southern ...

    African Journals Online (AJOL)

    Objective. To determine the prevalence of dysmagnesaemia among patients admitted to a trauma intensive care unit (ICU) and to investigate whether dysmagnesaemia at admission correlated with a worse outcome. Methods. In this retrospective case study of patients admitted to a regional level 1 trauma unit, from April ...

  13. Intra-abdominal pressure at ICU admission: Evaluation as a ...

    African Journals Online (AJOL)

    Data relating to demographic profile, cause of pancreatitis, ICU admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, IAP, interventions instituted and mortality were analysed. Results. Biliary stones (38%) were the most common cause of ...

  14. Outcome evaluation of a South African ICU - a baseline study ...

    African Journals Online (AJOL)

    Demographic information, admission diagnosis, surgery classification (elective or emergency) and co-morbidities were recorded on admission to the unit. APACHE II score was calculated. The two outcomes of ICU length of stay (LOS) and mortality were recorded on discharge from the unit. Results. Patients were 49 ± 19.95 ...

  15. Does the addition of RDW improve current ICU scoring systems?

    Science.gov (United States)

    Loveday, Sarah; Sinclair, Leanne; Badrick, Tony

    2015-06-01

    The aim of this study was to evaluate whether the addition of red blood cell distribution width (RDW) improves the prognostic value of current intensive care unit (ICU) scoring systems, namely APACHE III. All patients admitted to a mixed ICU in Brisbane between June 2013 and July 2014 for whom RDW was available were included in the study. Analyses included descriptive statistics, linear regression correlation, and receiver operating characteristic (ROC) curves. The study included 708 patients for whom both ICU mortality prediction and RDW were available. In univariate analysis higher RDW values were associated with increased hospital mortality. Adding RDW to APACHE III increased the area under the ROC marginally (from 0.9586 to 0.9613). RDW was not correlated with C-reactive protein, white cell count, or patient's length of stay in ICU. RDW was an independent predictor of mortality. The addition of RDW to APACHE III improved its mortality prediction marginally. The underlying mechanism of RDW elevation warrants further investigation. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  16. From ICU to Outreach: A South African experience

    African Journals Online (AJOL)

    2008-11-11

    Nov 11, 2008 ... discharged from the ICU to the wards, and phase 2 incorporated the introduction of the Modified Early Warning. Scoring System (MEWS) and referral algorithm to the surgical wards ... cardiac arrest that can alert staff to deterioration and enable early intervention. Subsequent studies by Smith and Wood5 in ...

  17. From ICU top Outreach: A South African experience | Carter ...

    African Journals Online (AJOL)

    The adapted form of the programme was introduced in two phases. Phase 1 consisted of following up of patients discharged from the ICU to the wards, and phase 2 incorporated the introduction of the Modified Early Warning Scoring System (MEWS) and referral algorithm to the surgical wards in the hospital. Owing to staff ...

  18. Design and implementation of an ICU incident registry

    NARCIS (Netherlands)

    van der Veer, Sabine; Cornet, Ronald; de Jonge, Evert

    2007-01-01

    Due to its complexity intensive care is vulnerable to errors. On the ICU adults of the AMC (Amsterdam, The Netherlands) the available registries used for error reporting did not give insight in the occurrence of unwanted events, and did not lead to preventive measures. Therefore, a new registry has

  19. Design and implementation of an ICU incident registry

    NARCIS (Netherlands)

    van der Veer, Sabine; Cornet, Ronald; de Jonge, Evert

    2005-01-01

    Due to its complexity intensive care is vulnerable to errors. On the ICU Adults of the AMC (Amsterdam, the Netherlands) the available registries used for error reporting did not give insight in the occurrence of unwanted events, and did not lead to preventive measures. Therefore, a new registry has

  20. Outcome evaluation of a South African ICU - a baseline study ...

    African Journals Online (AJOL)

    Objectives. To describe the baseline data of patients admitted to the surgical intensive care unit in a tertiary hospital in the Western Cape, and their outcome at discharge from the ICU. Design. Prospective cohort observational study. Setting. Ten-bed closed surgical unit in a university-affiliated tertiary hospital. Sample.

  1. Red blood cell transfusion during septic shock in the ICU

    DEFF Research Database (Denmark)

    Perner, A; Smith, S H; Carlsen, S

    2012-01-01

    Transfusion of red blood cells (RBCs) remains controversial in patients with septic shock, but current practice is unknown. Our aim was to evaluate RBC transfusion practice in septic shock in the intensive care unit (ICU), and patient characteristics and outcome associated with RBC transfusion....

  2. Effect of electrical muscle stimulation on prevention of ICU acquired ...

    African Journals Online (AJOL)

    Objective: ICU acquired muscle weakness (ICUAMW) is an acquired neuromuscular disorder associated with increased duration of mechanical ventilation and weaning suggesting a possible relation between the limb and respiratory neuromuscular involvement. There is no preventive tool and no specific treatment has ...

  3. What Is the Best Pulmonary Physiotherapy Method in ICU?

    Science.gov (United States)

    Kuyrukluyildiz, Ufuk; Binici, Orhan; Kupeli, İlke; Erturk, Nurel; Gulhan, Barış; Akyol, Fethi; Ozcicek, Adalet; Onk, Didem; Karabakan, Guldane

    2016-01-01

    Objective. Effects of high frequency chest wall oscillation technique were investigated on intubated ICU patients. Background. Thirty intubated patients were included in the study. The control group (n = 15) received routine pulmonary rehabilitation technique. In addition to the pulmonary rehabilitation technique, the study group (n = 15) was given high frequency chest wall oscillation (HFCWO). APACHE II, dry sputum weight, lung collapse index, and blood gas values were measured at 24th, 48th, and 72nd hours and endotracheal aspirate culture was studied at initial and 72nd hour. The days of ventilation and days in ICU were evaluated. Results. There is no significant difference between APACHE II scores of groups. The dry sputum weights increased in the study group at 72nd hour (p = 0.001). The lung collapse index decreased in study group at 48th (p = 0.003) and 72nd hours (p pneumonia more than routine pulmonary rehabilitation. It does not change intubated period and length of stay in ICU. However, more further controlled clinical studies are needed to use it in ICU.

  4. Anaemia and blood transfusion in the ICU | Wilson | Southern ...

    African Journals Online (AJOL)

    Southern African Journal of Critical Care. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 20, No 1 (2004) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Anaemia and blood transfusion in the ICU. GS Wilson. Abstract.

  5. Dependency in autonomous caring--night nurses' working conditions for caring in nursing.

    Science.gov (United States)

    Gustafsson, Christine; Fagerberg, Ingegerd; Asp, Margareta

    2010-06-01

    Few research studies have focused on nurses' working conditions for caring provided at night, and these studies have mainly described nurses' work in hospital settings, not in a municipal, social-care context. In Swedish municipal care, nurses have responsibility for hundreds of older people in need of care. This working condition compromises caring encounters; instead the nurses' caring is mainly mediated through care staff (or relatives). In considering that caring based on caring encounters is fundamental to ethical nursing practice questions leads to the aim: to explore Swedish municipal night nurses' experiences of their working conditions for caring in nursing. All municipal night-duty nurses (n = 7) in a medium-sized community in Sweden participated in interviews, while six of them also wrote diaries. Thematic content analysis has been used in analysing the data. The findings revealed that the nurses experienced their working conditions for caring in nursing in the themes of Dependency in the Organisation and Other Staff, Vocational Responsibility, Deficiency in Conditions for Caring and Autonomous Caring. The findings illustrate privileged, as well as, poor working conditions for caring in nursing. The nurses' role as consultants emerge as their main function. The consultant function implies that nurses do not participate in ordinary bed-side caring, which makes it easier for them to find time for caring in situations that arise when nurses' skills, expertise and authority are called upon. Conversely the consultancy function entails short-term solution of complex caring problems, which can signify deficient caring due to prevailing working conditions. The findings also point to nurses' possible problems in fulfilling their own and vocational demands for ethics in the practice of caring in nursing related to existing working conditions.

  6. Methods of Blood Pressure Measurement in the ICU

    Science.gov (United States)

    Lehman, Li-wei H.; Saeed, Mohammed; Talmor, Daniel; Mark, Roger; Malhotra, Atul

    2013-01-01

    Objective Minimal clinical research has investigated the significance of different blood pressure monitoring techniques in the ICU and whether systolic vs. mean blood pressures should be targeted in therapeutic protocols and in defining clinical study cohorts. The objectives of this study are to compare real-world invasive arterial blood pressure with noninvasive blood pressure, and to determine if differences between the two techniques have clinical implications. Design We conducted a retrospective study comparing invasive arterial blood pressure and noninvasive blood pressure measurements using a large ICU database. We performed pairwise comparison between concurrent measures of invasive arterial blood pressure and noninvasive blood pressure. We studied the association of systolic and mean invasive arterial blood pressure and noninvasive blood pressure with acute kidney injury, and with ICU mortality. Setting Adult intensive care units at a tertiary care hospital. Patients Adult patients admitted to intensive care units between 2001 and 2007. Interventions None. Measurements and Main Results Pairwise analysis of 27,022 simultaneously measured invasive arterial blood pressure/noninvasive blood pressure pairs indicated that noninvasive blood pressure overestimated systolic invasive arterial blood pressure during hypotension. Analysis of acute kidney injury and ICU mortality involved 1,633 and 4,957 patients, respectively. Our results indicated that hypotensive systolic noninvasive blood pressure readings were associated with a higher acute kidney injury prevalence (p = 0.008) and ICU mortality (p invasive arterial blood pressure in the same range (≤70 mm Hg). Noninvasive blood pressure and invasive arterial blood pressure mean arterial pressures showed better agreement; acute kidney injury prevalence (p = 0.28) and ICU mortality (p = 0.76) associated with hypotensive mean arterial pressure readings (≤60 mm Hg) were independent of measurement technique

  7. Ferride geochemistry of Swedish precambrian iron ores

    Science.gov (United States)

    Loberg, B. E. H.; Horndahl, A.-K.

    1983-10-01

    Chemical analysis for major and trace elements have been performed on 30 Swedish Precambrian iron ores and on some from Iran and Chile. The Swedish ores consist of apatite iron ores, quartz-banded iron ores, skarn and limestone iron ores from the two main ore districts of Sweden, the Bergslagen and the Norrbotten province. Some Swedish titaniferous iron ores were also included in the investigation. The trace element data show that the Swedish ores can be subdivided into two major groups: 1. orthomagmatic and exhalative, 2. sedimentary. Within group 1 the titaniferous iron ores are distinguished by their high Ti-contents. From the ferride contents of the Kiruna apatite iron ores, the ores are considered to be mobilization products of skarn iron ores from the Norbotten province.

  8. 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.

  9. Team cohesion in intensive care nursing: at the interface of nurse self-concept and unit structure

    DEFF Research Database (Denmark)

    Paunova, Minna; Li-Ying, Jason

    2017-01-01

    their teams as cohesive. A multi-source and multi-level study of approximately 140 nurses employed in 20 ICUs across Denmark demonstrates the critical role of self-concept in easing and enhancing the constraints workplaces impose on team cohesion. Furthermore, the study confirms the positive relationship....... In this study, we focus on the nursing group in intensive care units (ICU). Not researched, yet important for employee attitudes towards their workplaces and workgroups, is the interface between the characteristics of individual care providers and those of the teams and organizations in which they are employed....... This study examines the effects of three levels of self-concept– individual, relational, and collective–and ICU structural characteristics such as size (number of nurses), nurse training profile, and number of beds. These factors are investigated as they jointly shape the degree to which nurses perceive...

  10. Hospital factors associated with discharge bias in ICU performance measurement.

    Science.gov (United States)

    Reineck, Lora A; Pike, Francis; Le, Tri Q; Cicero, Brandon D; Iwashyna, Theodore J; Kahn, Jeremy M

    2014-05-01

    Performance assessments based on in-hospital mortality for ICU patients can be affected by discharge practices such that differences in mortality may reflect variation in discharge patterns rather than quality of care. Time-specific mortality rates, such as 30-day mortality, are preferred but are harder to measure. The degree to which the difference between 30-day and in-hospital ICU mortality rates-or "discharge bias"-varies by hospital type is unknown. The aim of this study was to quantify variation in discharge bias across hospitals and determine the hospital characteristics associated with greater discharge bias. Retrospective cohort study. Nonfederal Pennsylvania hospital discharges in 2008. Eligible patients were 18 years old or older and admitted to an ICU. None. We used logistic regression with hospital-level random effects to calculate hospital-specific risk-adjusted 30-day and in-hospital mortality rates. We then calculated discharge bias, defined as the difference between 30-day and in-hospital mortality rates, and used multivariable linear regression to compare discharge bias across hospital types. A total of 43,830 patients and 134 hospitals were included in the analysis. Mean (SD) risk-adjusted hospital-specific in-hospital and 30-day ICU mortality rates were 9.6% (1.3) and 12.7% (1.5), respectively. Hospital-specific discharge biases ranged from -1.3% to 6.6%. Discharge bias was smaller in large hospitals compared with small hospitals, making large hospitals appear comparatively worse from a benchmarking standpoint when using in-hospital mortality instead of 30-day mortality. Discharge practices bias in-hospital ICU mortality measures in a way that disadvantages large hospitals. Accounting for discharge bias will prevent these hospitals from being unfairly disadvantaged in public reporting and pay-for-performance.

  11. Children and terror casualties receive preference in ICU admissions.

    Science.gov (United States)

    Peleg, Kobi; Rozenfeld, Michael; Dolev, Eran

    2012-03-01

    Trauma casualties caused by terror-related events and children injured as a result of trauma may be given preference in hospital emergency departments (EDs) due to their perceived importance. We investigated whether there are differences in the treatment and hospitalization of terror-related casualties compared to other types of injury events and between children and adults injured in terror-related events. Retrospective study of 121 608 trauma patients from the Israel Trauma Registry during the period of October 2000-December 2005. Of the 10 hospitals included in the registry, 6 were level I trauma centers and 4 were regional trauma centers. Patients who were hospitalized or died in the ED or were transferred between hospitals were included in the registry. All analyses were controlled for Injury Severity Score (ISS). All patients with ISS 1-24 terror casualties had the highest frequency of intensive care unit (ICU) admissions when compared with patients after road traffic accidents (RTA) and other trauma. Among patients with terror-related casualties, children were admitted to ICU disproportionally to the severity of their injury. Logistic regression adjusted for injury severity and trauma type showed that both terror casualties and children have a higher probability of being admitted to the ICU. Injured children are admitted to ICU more often than other age groups. Also, terror-related casualties are more frequently admitted to the ICU compared to those from other types of injury events. These differences were not directly related to a higher proportion of severe injuries among the preferred groups.

  12. 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.

  13. Nurses' communication with families in the intensive care unit - a literature review.

    Science.gov (United States)

    Adams, Amn; Mannix, T; Harrington, A

    2017-03-01

    This review examined the literature across 12 years that explored nurses' perceptions of their role when communicating with families in adult intensive care units (ICUs). The objectives were: (1) to describe how ICU nurses facilitated communication with families; (2) the perceived barriers to that communication; (3) strategies to improve their skills. Evidence demonstrates that effective communication by health care providers can improve families' understanding of their situation and decrease their psychological burden. The continuous presence of ICU nurses, combined with the use of effective empathic communication skills, can impact on families' ICU experience in a positive way. Nevertheless, research continues to demonstrate that communication with families in ICU is inadequate and of poor quality. Eight databases were systematically searched to identify peer reviewed studies published in English between 2002 and 2014. The results are presented via a thematic literature review. Four major themes emerged from a synthesis of the review findings: 'Nurses as information and communication facilitators', 'Nurses as family support providers', 'Nurses' non-supportive behaviours' and 'Improving nurses' communication skills'. Most ICU nurses considered communicating with families a vital part of their role, and described supportive behaviours. However, they perceived significant barriers to effective communication; some as a result of active decisions on their part, and some beyond their control. These barriers often resulted in nurses believing that families received suboptimal information and support. Peer support and formal training were identified as key strategies to overcome inadequacies. This review summarizes nurses' perceptions of the means and barriers for communicating with families in ICUs. Intensive care nurses need skills and knowledge in how to communicate effectively with families. This skill can be learnt formally, or acquired from role modelling of more

  14. Lazer - um caminho para aliviar as tensões no ambiente de trabalho em UTI: uma concepção da equipe de enfermagem Recreación - un camino para aliviar las tensiones el ambiente de trabajo en UTI: una concepción del equipo de enfermería Leisure - one way to alleviate tension in the ICU work environment: one conception of the nursing team

    Directory of Open Access Journals (Sweden)

    Maria Elizabeth Roza Pereira

    1997-10-01

    ón. Conceptúan recreación como diversión/descontración (80%, relajamiento (20%, etc, resaltando la importancia de discutir el asunto. Desprendemos que ellos admiten atención/estress provocado en el trabajo, destacando la necesidad de recreación en el trabajo, para favorecer la comunicación y alivio las tensiones. Sugerimos a los enfermeros atención especial en este sentido.In the present study, we aimed at verifying close to ICU nursing team the service representation and this unit meaning, looking at finding the sense of leisure and its implication in the professional environment. We worked with DUMAZEDIER framework, considering the application of leisure in health promotion, through a quali-quantitative survey. We have investigated 10 members of the nursing team, among different categories, most of them were women, half single, from 28 to 45 years old, with predominantly 10 years in service. They showed pleasure in their job (90%, although they consider it stressing (50%. The job was identified as assistance (80% and requiring vocation/donation (50%. They also showed relationship and communication. They have the concept of leisure as entertainment/deconcentration (80%, relaxation (20% etc., emphasizing the importance of discussing the theme. They admit tension/stress caused in the location, considering the need of leisure in the service, to help communication and alleviate the tension. We suggest to nurses special attention on this.

  15. Early Physical Rehabilitation in the ICU: A Review for the Neurohospitalist

    OpenAIRE

    Mendez-Tellez, Pedro A.; Nusr, Rasha; Feldman, Dorianne; Needham, Dale M.

    2012-01-01

    Advances in critical care have resulted in improved intensive care unit (ICU) mortality. However, improved ICU survival has resulted in a growing number of ICU survivors living with long-term sequelae of critical illness, such as impaired physical function and quality of life (QOL). In addition to critical illness, prolonged bed rest and immobility may lead to severe physical deconditioning and loss of muscle mass and muscle weakness. ICU-acquired weakness is associated with increased duratio...

  16. 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....

  17. 4-Nonylphenol and bisphenol A in Swedish food and exposure in Swedish nursing women

    NARCIS (Netherlands)

    Gyllenhammar, I.; Glynn, A.; Darnerud, P.O.; Lignell, S.; Delft, R. van; Aune, M.

    2012-01-01

    4-Nonylphenol (NP) and bisphenol A (BPA) are phenolic substances used in high volumes by the industry. Studies on cells and in experimental animals have shown that both these compounds can be classified as estrogenic hormone disrupters. Information about the exposure of humans to NP and BPA is still

  18. [Model for unplanned self extubation of ICU patients using system dynamics approach].

    Science.gov (United States)

    Song, Yu Gil; Yun, Eun Kyoung

    2015-04-01

    In this study a system dynamics methodology was used to identify correlation and nonlinear feedback structure among factors affecting unplanned extubation (UE) of ICU patients and to construct and verify a simulation model. Factors affecting UE were identified through a theoretical background established by reviewing literature and preceding studies and referencing various statistical data. Related variables were decided through verification of content validity by an expert group. A causal loop diagram (CLD) was made based on the variables. Stock & Flow modeling using Vensim PLE Plus Version 6.0 b was performed to establish a model for UE. Based on the literature review and expert verification, 18 variables associated with UE were identified and CLD was prepared. From the prepared CLD, a model was developed by converting to the Stock & Flow Diagram. Results of the simulation showed that patient stress, patient in an agitated state, restraint application, patient movability, and individual intensive nursing were variables giving the greatest effect to UE probability. To verify agreement of the UE model with real situations, simulation with 5 cases was performed. Equation check and sensitivity analysis on TIME STEP were executed to validate model integrity. Results show that identification of a proper model enables prediction of UE probability. This prediction allows for adjustment of related factors, and provides basic data do develop nursing interventions to decrease UE.

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

    Directory of Open Access Journals (Sweden)

    Kristina Lykkegaard

    2015-03-01

    Full Text Available 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.

  20. 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.

  1. 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

  2. Perceptions, attitudes, and current practices regards delirium in China: A survey of 917 critical care nurses and physicians in China.

    Science.gov (United States)

    Xing, Jinyan; Sun, Yunbo; Jie, Yaqi; Yuan, Zhiyong; Liu, Wenjuan

    2017-09-01

    The purpose of this study is to assess the knowledge, attitudes, and managements regarding delirium of intensive care nurses and physicans, and to assess the perceived barriers related to intensive care unit (ICU) delirium monitoring in China. A descriptive survey was distributed to 1156 critical care nurses and physicians from 74 tertiary and secondary hospitals across Shandong province, China. The overall response rate was 86.18% (n = 917). The majority of respondents (88%) believed that deirium was associated with prolonged mechanical ventilation, and 79.72% thought delirium was associated with prolonged length of hospitalization. Only 14.17% of respondents believed that delirium was common in the ICU setting. Only 25.62% of the respondents reported routine screening of ICU delirium, and only 15.81% utilized Confusion Assessment Method for Intensive Care Unit screening tools. "Lack of appropriate screening tools" and "time restraints" were the most common perceived barriers. 45.4% of the participants had never received any education on ICU delirium. In conclusion, most nurses and physicians consider ICU delirium to be a serious problem, but lack knowledge on delirium and monitor this condition poorly. The survey infers a disconnection between the perceived significance and current monitoring of ICU delirium. There is a critical unmet need for in-service education on ICU delirium for physicians and nurses in China.

  3. Satisfaction with quality of ICU care for patients and families : the euroQ2 project

    NARCIS (Netherlands)

    Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty; Downey, Lois; Engelberg, Ruth A; Curtis, J Randall; Spronk, Peter E; Zijlstra, Jan G; Ørding, Helle

    2017-01-01

    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 with

  4. Increased Early Systemic Inflammation in ICU-Acquired Weakness; A Prospective Observational Cohort Study

    NARCIS (Netherlands)

    Witteveen, Esther; Wieske, Luuk; van der Poll, Tom; van der Schaaf, Marike; van Schaik, Ivo N.; Schultz, Marcus J.; Verhamme, Camiel; Horn, Janneke; de Beer, Friso M.; Bos, Lieuwe D. J.; Glas, Gerie J.; van Hooijdonk, Roosmarijn T. M.; Hoogendijk, Arie J.; Huson, Mischa A.; Schouten, Laura R. A.; Straat, Marleen; van Vught, Lonneke A.; Wiewel, Maryse A.

    2017-01-01

    To investigate whether patients who develop ICU-acquired weakness have a different pattern of systemic inflammatory markers compared with critically ill patients who do not develop ICU-acquired weakness. Prospective observational cohort study. Mixed medical-surgical ICU of a tertiary care hospital

  5. 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 ...

  6. Trauma admissions to the ICU of a tertiary hospital in a low resource ...

    African Journals Online (AJOL)

    The aim of this study is to assess the outcome of the trauma cases admitted to the ICU. Methods: We performed an eight-year retrospective review of all trauma admissions into our multidisciplinary six bed intensive care unit (ICU) to assess the impact of trauma on the ICU. Data collected was processed using the Statistical ...

  7. 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...... after ICU discharge....

  8. Autonomic dysfunction in ICU-acquired weakness: a prospective observational pilot study

    NARCIS (Netherlands)

    Wieske, L.; Chan Pin Yin, D. R. P. P.; Verhamme, C.; Schultz, M. J.; van Schaik, I. N.; Horn, J.

    2013-01-01

    Intensive care unit-acquired weakness (ICU-AW) is a frequent complication of critical illness. It is unknown if patients with ICU-AW also have autonomic dysfunction, another frequent neurological complication of critical illness. We hypothesized that patients who develop ICU-AW also develop

  9. Seizure detection in adult ICU patients based on changes in EEG synchronization likelihood

    NARCIS (Netherlands)

    Slooter, A. J. C.; Vriens, E. M.; Spijkstra, J. J.; Girbes, A. R. J.; van Huffelen, A. C.; Stam, C. J.

    2006-01-01

    Introduction: Seizures are common in Intensive Care Unit (ICU) patients, and may increase neuronal injury. Purpose: To explore the possible value of synchronization likelihood (SL) for the automatic detection of seizures in adult ICU patients. Methods: We included EEGs from ICU patients with a

  10. 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...

  11. [Job satisfaction, job burnout and their relationships with work'and patients' characteristics: a comparison between intensive care units (ICU) and not-intensive care units (not-ICU)].

    Science.gov (United States)

    Viotti, Sara; Converso, Daniela; Loera, Barbara

    2012-01-01

    Health worker's population is espoused to high level of stress, and several studies highlight differences between intensive care units (ICU) and non-intensive care unit (non-ICU). Particular features of the job in ICU concern responsibilities for critically patients, highly advanced technology and need for quick decision. Aims of this study are: (1) to examine differences between ICU's and not-ICU's workers on several dimensions describing work environment and workers' health; (2) investigate which specific work conditions have a role in determining psychological work reactions in ICU's and not-ICU's workers. 144 ICUs' and not-ICU's 114 workers employed in an Italian Hospital filled out a questionnaire concerning decision authority, autonomy, colleagues' and supervisors' support, physical and cognitive demands as antecedents; job satisfaction and job burnout (EE, DP) as consequences. 1) MANOVA highlighted how ICU workers reported significantly higher scores on depersonalization, job satisfaction, aggressive customers, while physical demands and proportionate customer expectations were significantly higher for not-ICU workers; (2) Six Multiple Linear Regressions were carried out. Those indicated decision authority, autonomy and supervisors' support as predictors of emotional exhaustions in ICU. In not-ICU only cognitive demands and colleagues' support are significant predictors. Depersonalization is predicted in ICU by colleagues' support. Predictors of job satisfaction both in ICU and not-ICU are: decision authority and colleagues support. Current study highlighted several differences among ICU and non-ICU workers' referred to work environment and psychological reactions.

  12. Patient, family-centred care interventions within the adult ICU setting: An integrative review.

    Science.gov (United States)

    Mitchell, Marion L; Coyer, Fiona; Kean, Susanne; Stone, Renee; Murfield, Jenny; Dwan, Toni

    2016-11-01

    Patient, Family-Centred Care (PFCC) is internationally advocated as a way to improve patient care. The aim of this integrative review was to extend the knowledge and understanding by synthesising empirical evidence of PFCC interventions within the adult intensive care unit (ICU) setting. An integrative review methodological framework was employed, permitting the inclusion of all research designs. A comprehensive and systematic search, selection, quality appraisal, and data extraction of research were conducted to synthesise knowledge and identify research gaps. A systematic search of the following databases was conducted: MEDLINE; CINHAL; PsycINFO; Cochrane Library; Web of Science-Current Contents Connect; Web of Science-Core Collection; The Joanna Briggs Institute EBP Database; ProQuest Sociological Abstracts; and ProQuest Dissertation and Theses Global. Primary research in adult ICUs was included. Data extracted from the studies included authors, year, country of origin, design, setting, sample, intervention, data collection strategies, main findings and limitations. Study quality was assessed using the Mixed Methods Appraisal Tool. Forty-two articles met the inclusion criteria and were included in the review. Only a third of the papers stated the theory underpinning their study. Three themes emerged with interventions predominantly around Interacting with the target sample; Culture and Connection and Service Delivery interventions were also identified. Few studies integrated more than one dimension of PFCC. Research into PFCC interventions is diverse; however, few researchers present a multi-dimensional approach incorporating a culture shift to enact PFCC throughout the ICU trajectory. There is an opportunity for future research to describe, develop, and test instruments that measure PFCC based on its multiple dimensions and not on one component in isolation. Importantly, for PFCC to successfully individualise quality patient care, a commitment and enactment of

  13. How much teamwork exists between nurses and junior doctors in the intensive care unit?

    Science.gov (United States)

    Nathanson, Brian H; Henneman, Elizabeth A; Blonaisz, Elaine R; Doubleday, Nancy D; Lusardi, Paula; Jodka, Paul G

    2011-08-01

    The aim of this study was to measure the degree of similarity of attitudes on collaboration between nurses and junior doctors (known as residents in the United States) in the ICU. Existing research shows that nurses and physicians view the amount of teamwork they experience in the ICU differently though the attitudes of junior doctors and critical care nurses on collaboration remain unknown. Thirty-one nurses and 46 junior doctors completed a modified version of the Baggs Collaboration and Satisfaction about Care Decisions instrument during 2006-2007 in a 24 bed medical/surgical ICU in the northeastern United States. Score responses of nurses and junior doctors were compared with the Wilcoxon (Mann-Whitney) rank-sum test. Nurses consistently gave more negative responses on every survey question than junior doctors. While nurses said that the amount of collaboration was inadequate, junior doctors were satisfied and views between groups were most divergent (P teamwork that occurs in the ICU. Junior doctors' views are similar to those of more experienced physicians observed in previous studies. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    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...

  15. Oral care of critically ill patients: practice of attending nurses at the ...

    African Journals Online (AJOL)

    Methods: This was a cross sectional, questionnaire-based study of the oral care practices of critically ill patients among attending nurses in the University of Benin Teaching Hospital. Selfadministered questionnaires were distributed to nurses of different cadre and years of experiences in the ICU, stroke ward and ...

  16. The Critical Nursing Situation Index for safety assessment in intensive care

    NARCIS (Netherlands)

    Binnekade, J. M.; de Mol, B. A.; Kesecioglu, J.; de Haan, R. J.

    2001-01-01

    OBJECTIVE: The assessment of critical nursing situations can be a valuable tool in the detection of weak elements in the safety of patients and the quality of care in the ICU. A critical nursing situation can be defined as any observable situation, which deviates from good clinical practice and

  17. Swedish health care in perspective.

    Science.gov (United States)

    Anderson, O W

    1992-01-01

    The evolution and current problems of the Swedish health services are placed in an international comparative perspective with other industrially developed democratic states as to cost control, distribution of facilities and personnel, management of waiting lists for services, and differences in use of services. All of these countries are experiencing the same aforementioned problems differing mainly in degree. It is suggested that Sweden as well as other countries needs to reconceptualize the meaning of equality of access relative to the apparent emergence of private insurance as waiting lists grow for quality of life procedures such as lens and hip replacement. A concept of a basic service for everybody and so-called luxury service for those who wish to buy it needs to be faced in political debate. It is clear that government is unable to finance and supply the range of demand of a consumption good represented by a modern medicine. In so far as Sweden has been regarded as a model it appears that no country is a model anymore. The complexities of a modern health service has overwhelmed all countries and can be regarded as a sublime loss of innocence.

  18. Effects of a multidisciplinary care program on disability, autonomy, and nursing needs in subjects recovering from acute respiratory failure in a chronic ventilator facility

    National Research Council Canada - National Science Library

    Vitacca, Michele; Paneroni, Mara; Peroni, Roberta; Barbano, Luca; Dodaj, Valmira; Piaggi, Giancarlo; Vanoglio, Fabio; Luisa, Alberto; Giordano, Amerigo; Ceriana, Piero

    2014-01-01

    The aim of this study was to analyze the effects of a multidisciplinary program carried out in a chronic ventilator facility on disability, autonomy, and nursing needs of patients after a prolonged ICU stay...

  19. Interrater reliability of Nursing Activities Score among Intensive Care Unit health professionals

    Directory of Open Access Journals (Sweden)

    Marit Stuedahl

    2015-12-01

    Full Text Available ABSTRACT Objective To analyze the interrater reliability of NAS among critical care nurses and managers in an ICU. Method This was a methodological study performed in an adult, general ICU in Norway. In a random selection of patients, the NAS was scored on 101 patients by three raters: a critical care nurse, an ICU physician and a nurse manager. Interrater reliability was analyzed by agreement between groups and kappa statistics. Results The mean NAS were 88.4 (SD=16.2 and 88.7 (SD=24.5 respectively for the critical care nurses and nurse managers. A lower mean of 83.7 (SD=21.1 was found for physicians. The 18 medical interventions showed higher agreement between critical care nurses and physicians (85.6%, than between critical care nurses and nurse managers (78.7. In the five nursing activities the Kappa-coefficients were low for all activities in all compared groups. Conclusion The study indicated a satisfactory agreement of nursing workload between critical care nurses and managers.

  20. Indicators of the need for ICU admission following suicide bombing attacks

    Directory of Open Access Journals (Sweden)

    Bala Miklosh

    2012-03-01

    Full Text Available Abstract Introduction Critical hospital resources, especially the demand for ICU beds, are usually limited following mass casualty incidents such as suicide bombing attacks (SBA. Our primary objective was to identify easily diagnosed external signs of injury that will serve as indicators of the need for ICU admission. Our secondary objective was to analyze under- and over-triage following suicidal bombing attacks. Methods A database was collected prospectively from patients who were admitted to Hadassah University Hospital Level I Trauma Centre, Jerusalem, Israel from August 2001-August 2005 following a SBA. One hundred and sixty four victims of 17 suicide bombing attacks were divided into two groups according to ICU and non-ICU admission. Results There were 86 patients in the ICU group (52.4% and 78 patients in the non-ICU group (47.6%. Patients in the ICU group required significantly more operating room time compared with patients in the non-ICU group (59.3% vs. 25.6%, respectively, p = 0.0003. For the ICU group, median ICU stay was 4 days (IQR 2 to 8.25 days. On multivariable analysis only the presence of facial fractures (p = 0.014, peripheral vascular injury (p = 0.015, injury ≥ 4 body areas (p = 0.002 and skull fractures (p = 0.017 were found to be independent predictors of the need for ICU admission. Sixteen survivors (19.5% in the ICU group were admitted to the ICU for one day only (ICU-LOS = 1 and were defined as over-triaged. Median ISS for this group was significantly lower compared with patients who were admitted to the ICU for > 1 day (ICU-LOS > 1. This group of over-triaged patients could not be distinguished from the other ICU patients based on external signs of trauma. None of the patients in the non-ICU group were subsequently transferred to the ICU. Conclusions Our results show that following SBA, injury to ≥ 4 areas, and certain types of injuries such as facial and skull fractures, and peripheral vascular injury, can serve

  1. Clinical ultrasound in the ICU: changing a medical paradigm.

    Science.gov (United States)

    Álvarez-Fernández, J A; Núñez-Reiz, A

    2016-05-01

    In recent decades there has been an evolution from the traditional paradigm of sporadic ultrasound performed by radiologists and cardiologists in the ICU to clinical ultrasound performed by intensivists as an extension of patient evaluation rather than as a complementary test. Such clinical ultrasound aims to diagnose and treat the patient directly. All ultrasound modalities could be interesting in the ICU, either helping in decision making or guiding procedures. Clinical ultrasound training should include all the possibilities of ultrasound, and the tutelage of other trained intensivists and other specialists with more experience should be available at all times. Training should be phased into basic, advanced and expert levels, with adjustment to the contents of the CoBaTrICE Project and the recommendations of the SEMICYUC. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  2. Exploration of the association between professional interactions and emotional distress of intensive care unit nursing personnel.

    Science.gov (United States)

    Karanikola, Maria N K; Papathanassoglou, Elizabeth D E; Kalafati, Maria; Stathopoulou, Hariklia

    2012-01-01

    : Several studies provide evidence for the association between the quality of collaboration among intensive care unit (ICU) professionals and patients' outcomes, as well as nurses' moral distress and professional satisfaction. However, potential associations between collaboration and nurses' mental health indices have not been explored. The aim of this descriptive correlational study was to investigate the degree of satisfaction from interaction among ICU nursing personnel, as well as between ICU nursing personnel and physicians, and potential associations with ICU nursing personnel's anxiety symptoms. The sample consisted of ICU nursing personnel from 11 adult general hospitals in Greece (n = 229). Hamilton's Anxiety scale was applied for the quantitative assessment of anxiety symptoms and Stamps' Index of Work Satisfaction for the appraisal of nursing personnel's satisfaction from professional interactions. Demographic, vocational, and educational data were also recorded. Descriptive statistics were explored, and group comparisons, correlation, and regression analysis were used. The average satisfaction score from interaction among nursing personnel was moderate to high (5.3 [SD, 1.0]) and from nurse-to-physician interaction was moderate (4.0 [SD, 1.4]) (scale range, 1-7). The score of satisfaction from nurse-to-physician interaction was negatively mildly correlated with participants' (a) total anxiety score (τ = -0.160, P = .001), (b) tension (τ = -0.125, P = .015), and (c) depressive symptoms (τ = -0.148, P = .005). Weak negative correlations were detected between satisfaction from interaction among nursing personnel and participants' (a) total anxiety state (τ = -0.139, P = .003), (b) tension (τ = -0.137, P = .008), and (c) sleep disturbances (τ = -0.150, P = .003). Overall, female respondents had higher levels of anxiety symptoms than male respondents (Mann-Whitney U, P = .007). Satisfaction from professional interaction was not a strong predictor of

  3. Methods of Blood Pressure Measurement in the ICU*

    OpenAIRE

    Talmor, Daniel; Malhotra, Atul; Lehman, Li-Wei; Saeed, Mohammed; Mark, Roger G

    2013-01-01

    OBJECTIVE:: Minimal clinical research has investigated the significance of different blood pressure monitoring techniques in the ICU and whether systolic vs. mean blood pressures should be targeted in therapeutic protocols and in defining clinical study cohorts. The objectives of this study are to compare real-world invasive arterial blood pressure with noninvasive blood pressure, and to determine if differences between the two techniques have clinical implications. DESIGN:: We conducted a re...

  4. Decisions not to resuscitate in a Swedish university hospital.

    Science.gov (United States)

    Friberg, H; Adolfsson, A; Lundberg, D

    1997-11-01

    Cardiopulmonary resuscitation (CPR) has the potential to save many lives. Used indiscriminately though, it may be harmful and not in the best interest of the patient. An advance directive to refrain from resuscitation in selected patients is probably not uncommon in Sweden, but guidelines ruling this are still generally lacking. This study was performed to evaluate the use and documentation of do-not-resuscitate orders in a Swedish university hospital. Adult inpatients at 7 medical, 3 surgical and 2 neurological wards, a total of 220, were investigated on one specific day by interviewing the physicians and nurses responsible for their care. We found a discrepancy in doctors' and nurses' perception concerning the appropriateness of CPR in selected patients. CPR was judged by doctors to be inappropriate for 45 patients (20%). Out of these 45 patients, only 24 had a written do-not-resuscitate order in their medical record, in most cases noted as a code word or sign only. Rarely were the patient or his/her relatives involved in the decision-making process. We conclude that a decision to refrain from resuscitation is often not made, even when considered medically and ethically justifiable. Also, the use of coded information as a sole indicator for a patient not to be resuscitated is still common practice. The patient or his/her relatives are rarely involved in this decision.

  5. Predicting ICU survival: A meta-level approach

    Directory of Open Access Journals (Sweden)

    Stamoulis Konstantinos

    2008-07-01

    Full Text Available Abstract Background The performance of separate Intensive Care Unit (ICU status scoring systems vis-à-vis prediction of outcome is not satisfactory. Computer-based predictive modeling techniques may yield good results but their performance has seldom been extensively compared to that of other mature or emerging predictive models. The objective of the present study was twofold: to propose a prototype meta-level predicting approach concerning Intensive Care Unit (ICU survival and to evaluate the effectiveness of typical mining models in this context. Methods Data on 158 men and 46 women, were used retrospectively (75% of the patients survived. We used Glasgow Coma Scale (GCS, Acute Physiology And Chronic Health Evaluation II (APACHE II, Sequential Organ Failure Assessment (SOFA and Injury Severity Score (ISS values to structure a decision tree (DTM, a neural network (NNM and a logistic regression (LRM model and we evaluated the assessment indicators implementing Receiver Operating Characteristics (ROC plot analysis. Results Our findings indicate that regarding the assessment of indicators' capacity there are specific discrete limits that should be taken into account. The Az score ± SE was 0.8773± 0.0376 for the DTM, 0.8061± 0.0427 for the NNM and 0.8204± 0.0376 for the LRM, suggesting that the proposed DTM achieved a near optimal Az score. Conclusion The predicting processes of ICU survival may go "one step forward", by using classic composite assessment indicators as variables.

  6. Percutaneous dilatational tracheostomy for ICU patients with severe brain injury

    Directory of Open Access Journals (Sweden)

    Guo Dongyuan

    2014-12-01

    Full Text Available 【Abstract】Objective: To sum up our experience in percutaneous dilatational tracheostomy (PDT in ICU patient with severe brain injury. Methods: Between November 2011 and April 2014, PDTs were performed on 32 severe brain injury patients in ICU by a team of physicians and intensivists. The success rate, effi cacy, safety, and complications including stomal infection and bleeding, paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, as well as clinically significant tracheal stenosis were carefully monitored and recorded respectively. Results: The operations took 4-15 minutes (mean 9.1 minutes±4.2 minutes. Totally 4 cases suffered from complications in the operations: 3 cases of stomal bleeding, and 1 case of intratracheal bloody secretion, but none required intervention. Paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, or clinically signifi cant tracheal stenosis were not found in PDT patients. There was no procedure-related death occurring during or after PDT. Conclusion: Our study demonstrats that PDT is a safe, highly effective, and minimally invasive procedure. The appropriate sedation and airway management perioperatively help to reduce complication rates. PDT should be performed or supervised by a team of physicians with extensive experience in this procedure, and also an intensivist with experience in diffi cult airway management. Key words: Brain injuries; Percutaneous dilatational tracheostomy; ICU

  7. [Nephrologist and ICU: the need of new expertise].

    Science.gov (United States)

    Mariano, Filippo; Pozzato, Marco

    2017-04-01

    Episodes of dialytic Acute Kidney Injury (AKI stage III KDIGO) can lead to chronic kidney disease (CKD), even after a long time. Prelimary data indicate that the relationship between AKI and CKD is affected by dialysis technical modalities and factors in part modifiable, such as an early dialysis timing, dose adeguacy, continuous treatment, use of biocompatible membranes and regional citrate anticoagulation. However, in most ICUs involvement of nephrologist consultant is marginal. Of more, nephrological follow-up after discharge, which allows to slow down the progression rate of CKD even just by a correct pharmacological and dietetic approach (sartans, ACEis), is an uncommon practice. Indeed, a better organ survival could lead to a delay of the dialytic treatment, reducing the costs sustained by the National Health Service. To face such challenges locally, in Piedmont and Aosta Valley the Dialysis Units were required to put themselves at disposal for ICU needs both in terms of dedicated staff and resources. Additionally, since many years consultant nephrologists have established the "Acuti" work-group, which has been able to provide an high level of professional expertise, while incentivizing innovation and training in ICU environment. In order to cope with these new requirements a redefinition of the nephrologist's role in ICU through a constant exchange with the intensive care background is needed. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

  8. 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.

  9. Manual hyperinflation combined with expiratory rib cage compression for reduction of length of ICU stay in critically ill patients on mechanical ventilation.

    Science.gov (United States)

    Berti, Juliana Savini Wey; Tonon, Elisiane; Ronchi, Carlos Fernando; Berti, Heloisa Wey; Stefano, Laércio Martins de; Gut, Ana Lúcia; Padovani, Carlos Roberto; Ferreira, Ana Lucia Anjos

    2012-01-01

    Although manual hyperinflation (MH) is widely used for pulmonary secretion clearance, there is no evidence to support its routine use in clinical practice. Our objective was to evaluate the effect that MH combined with expiratory rib cage compression (ERCC) has on the length of ICU stay and duration of mechanical ventilation (MV). This was a prospective randomized controlled clinical trial involving ICU patients on MV at a tertiary care teaching hospital between January of 2004 and January of 2005. Among the 49 patients who met the study criteria, 24 and 25 were randomly assigned to the respiratory physiotherapy (RP) and control groups, respectively. Of those same patients, 6 and 8, respectively, were later withdrawn from the study. During the 5-day observation period, the RP patients received MH combined with ERCC, whereas the control patients received standard nursing care. The two groups were similar in terms of the baseline characteristics. The intervention had a positive effect on the duration of MV, as well as on the ICU discharge rate and Murray score. There were significant differences between the control and RP groups regarding the weaning success rate on days 2 (0.0% vs. 37.5%), 3 (0.0% vs. 37.5%), 4 (5.3% vs. 37.5%), and 5 (15.9% vs. 37.5%), as well as regarding the ICU discharge rate on days 3 (0% vs. 25%), 4 (0% vs. 31%), and 5 (0% vs. 31%). In the RP group, there was a significant improvement in the Murray score on day 5. Our results show that the use of MH combined with ERCC for 5 days accelerated the weaning process and ICU discharge.

  10. Nurses: advocates for nursing.

    Science.gov (United States)

    Servodidio, C A

    1992-12-01

    Based on the nursing literature and my own ophthalmic nursing experience, there appears to be some confusion about how the general public, our colleagues, and physicians view the duties and responsibilities of the profession of nursing. We, as nurses, can serve as advocates for our own profession and educate the public about who we are, how we have achieved our current status and goals, and where we expect to be in the future.

  11. 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.

    Science.gov (United States)

    Noome, Marijke; Beneken Genaamd Kolmer, Deirdre M; van Leeuwen, Evert; Dijkstra, Boukje M; Vloet, Lilian C M

    2016-12-01

    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). Three electronic databases, PubMed, CINAHL and EMBASE, and reference lists of included studies were searched for studies in English, Dutch or German between January 2002 and August 2015. Studies were included if they presented data about EOLC in the adult ICU, and the role of ICU nurses around EOLC. Quantitative and qualitative studies and opinion articles were extracted. Inductive content analysis was carried out to analyse and categorise the data. Twenty studies were included. Four categories emerged: care for the ICU patient, care for the family, environmental aspects of EOLC and organisational aspects of EOLC. Regarding the care triad, a gap exists between theoretical models and the actual care provided by ICU nurses during EOLC. The relational aspect of care, like aimed with care triad, is absent. The literature clearly indicates that the role of ICU nurses concerns care for the patient, family and environment. It described which care should be given, but it remains unclear how care should be given (attitude). Therefore, it is difficult for ICU nurses to provide this care. Further, it seems that care provided to family mainly consists of giving advice on how to care for the patient; care for family members themselves was only mentioned in a few studies. Therefore, it seems that family does not always receive adequate care yet, which may be helpful in preventing problems like depression, anxiety or post-traumatic stress disorder. It can be concluded that it is important for ICU nurses to be aware of the existing relationships; however, comparing the literature, care triad does not appear to be reached. © 2016 Nordic College of Caring Science.

  12. 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.

  13. "Burnout" in intensive care nurses.

    Science.gov (United States)

    Chen, S M; McMurray, A

    2001-12-01

    The purpose of this research was to examine the relationship between burnout components and selected demographic variables in a group of intensive care unit nurses. This research hopes to heighten awareness of both intensive care nurses and hospital administrators of the importance of burnout in their work setting. A descriptive correlational study design was used to examine the extent of burnout according to selected demographic variables. Sixty-eight intensive care nurses from two hospitals and critical care courses at one university completed a demographic data form and the research questionnaire of the Maslach Burnout Inventory (MBI). Statistical analysis included non-parametric tests. Study results indicated low to moderate levels of total component scores in all intensive care nurses and on all three subscales of the assessment instrument. Results also indicated that, in this sample, younger nurses (20-29 years of age), separated and divorced nurses, and staff who work full time in ICUs were the most prone to emotional exhaustion. These research findings recommend support for ICU nurses to prevent burnout in their work setting. Further research is necessary to examine what kinds of working environments (job related stress) are effective in mitigating burnout amongst staff in the intensive care field.

  14. Tensions in Stakeholder Relations for a Swedish Football Club

    DEFF Research Database (Denmark)

    Junghagen, Sven

    2016-01-01

    Swedish football is an industry not yet being as commercial as the big leagues and is regulated in terms of ownership of clubs. This implies a need for management of stakeholder relations for a Swedish football club. This paper identifies important stakeholders in Swedish football and discusses...

  15. Working on an historical dictionary: the Swedish academy dictionary ...

    African Journals Online (AJOL)

    Working on an historical dictionary: the Swedish academy dictionary project. P Stille, B-O Wendt. Abstract. The Swedish Academy Dictionary is one of the world's largest dictionary projects. Work on it was started in 1884 and it will be completed by 2017. The dictionary describes the written standard language of Swedish ...

  16. Viewing eCare through Nurses' Eyes: A Phenomenological Study

    Science.gov (United States)

    Willey, Jeffrey Allan

    2013-01-01

    Published research suggests that the future of health care will be dependent on new technologies that serve to decrease the need for increased numbers of critical-care nurses while also increasing the quality of patient care delivery. The eCare technology is one technology that provides this service in the intensive care unit (ICU) setting. The…

  17. Spirituality in self-care for intensive care nursing professionals

    OpenAIRE

    Dezorzi,Luciana Winterkorn; Crossetti,Maria da Graça Oliveira

    2008-01-01

    This study aimed to understand how spirituality permeates the process of caring for oneself and for others in the intensive care scenario from nursing professionals' point of view. This study used the qualitative approach of Cabral's Creative-Sensitive Method to guide information production and analysis in nine art and experience workshops. Nine nursing caregivers from the Intensive Care Unit (ICU) of a university hospital participated in the study. This article presents one of the topics tha...

  18. Phonology of a southern Swedish idiolect

    OpenAIRE

    Svantesson, Jan-Olof

    2001-01-01

    In this egocentric article I describe briefly the segmental phonology of my own southern Swedish idiolect. I grew up in Getinge in central Halland, about 20 km north of Halmstad, speaking a regional variant of southern Standard Swedish. Although my dialect has certainly changed somewhat after I moved to Lund in 1964 at the age of 20, I believe that I still retain the basic pronunciation of vowels and consonants from my original dialect. There is one older description of the Getinge dialect by...

  19. Market reforms in Swedish health care

    DEFF Research Database (Denmark)

    Diderichsen, Finn

    1993-01-01

    This report presents the main characteristics of reforms in the Swedish health services, as exemplified by the "Stockholm Model" introduced in 1992 in Stockholm county. The author discusses the motives behind these reforms, the already-evident increases in costs that are occurring, and the effect...... of these reforms on public support for the welfare state.......This report presents the main characteristics of reforms in the Swedish health services, as exemplified by the "Stockholm Model" introduced in 1992 in Stockholm county. The author discusses the motives behind these reforms, the already-evident increases in costs that are occurring, and the effect...

  20. 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…

  1. Estresse Ocupacional em Profissionais de Saúde: um Estudo com a Equipe de Enfermagem da Unidade de Terapia Intensiva - UTI de um Hospital Escola em Minas Gerais /Occupational Stress in Health Professionals: A study with the Nursing Team of the Intensive Care Unit – ICU in a School Hospital from Minas Gerais.

    Directory of Open Access Journals (Sweden)

    Rejane Vianna da Silva Andrade

    2014-12-01

    Full Text Available Objetivo: identificar no Hospital Escola de Itajubá - HE, o nível de estresse da equipe de enfermagem atuante nas UTIs, no ano de 2014. Materiais e Métodos: Foram aplicados o Inventário de Sintomas de Stress para Adultos de Lipp (ISSL e um Questionário sociodemográfico, com perguntas sobre idade, procedência, estado civil, escolaridade, entre outros. Após a análise do ISSL e do questionário, foi feita a tabulação da frequência dos sintomas de estresse apresentada pela equipe de enfermagem e uma correlação com as variáveis apresentadas no questionário sociodemográfico. Resultados: Foram observados sintomas de estresse em 50% da amostra, sendo estes mais prevalentes entre a população feminina (92% versus 8%, os solteiros (60% versus 40%, com maior grau de escolaridade (55,55% versus técnico 46,87%, moradores de cidades vizinhas (72,70% versus 43,60% e da zona rural (85,70% versus 44,20%. Entre as quatro fases do estresse, houve maior predominância na fase de resistência (80%, seguidos da fase de exaustão e quase exaustão. O principal sintoma observado foi o psicológico (64%. Conclusão: De fato observou-se presença de estresse na equipe, com maior predominância na fase de resistência e com maior indicativo de sintomas psicológicos. Objective: identify the level of stress in an active nursing team at the ICUs of the School Hospital of Itajubá - HE, during 2014. Materials and Methods: The Inventory of Stress Symptoms of Lipp’s for Adults (ISSL was used as well as a sociodemographic Questionnaire, containing questions about age, origins, marital status, school level, and others. After analysis of the ISSL and the Questionnaire, resulting in the tabulation of the stress symptom frequency presented in the nursing team and its correlation to the variations presented in the sociodemographic Questionnaire. Results: Stress symptoms were observed in 50% of the sample, being most prevalent in feminine population (92% vs 8

  2. Ambassadors of the Swedish Nation: National Images in the Teaching of the Swedish Lecturers in Germany 1918-1945

    Science.gov (United States)

    Åkerlund, Andreas

    2015-01-01

    This article analyses the teaching of Swedish language lecturers active in Germany during the first half of the twentieth century. It shows the centrality of literature and literary constructions and analyses images of Swedishness and the Swedish nation present in the teaching material of that time in relation to the national image present in…

  3. Early Physical Rehabilitation in the ICU: A Review for the Neurohospitalist.

    Science.gov (United States)

    Mendez-Tellez, Pedro A; Nusr, Rasha; Feldman, Dorianne; Needham, Dale M

    2012-07-01

    Advances in critical care have resulted in improved intensive care unit (ICU) mortality. However, improved ICU survival has resulted in a growing number of ICU survivors living with long-term sequelae of critical illness, such as impaired physical function and quality of life (QOL). In addition to critical illness, prolonged bed rest and immobility may lead to severe physical deconditioning and loss of muscle mass and muscle weakness. ICU-acquired weakness is associated with increased duration of mechanical ventilation and weaning, longer ICU and hospital stay, and increased mortality. These physical impairments may last for years after ICU discharge. Early Physical Medicine and Rehabilitation (PM&R) interventions in the ICU may attenuate or prevent the weakness and physical impairments occurring during critical illness. This article reviews the evidence regarding safety, feasibility, barriers, and benefits of early PM&R interventions in ICU patients and discusses the limited existing data on early PM&R in the neurological ICU and future directions for early PM&R in the ICU.

  4. Perceptions of Risk and Safety in the ICU: A Qualitative Study of Cognitive Processes Relating to Staffing.

    Science.gov (United States)

    D'Lima, Danielle M; Murray, Eleanor J; Brett, Stephen J

    2018-01-01

    The aims of this study were to 1) examine individual professionals' perceptions of staffing risks and safe staffing in intensive care and 2) identify and examine the cognitive processes that underlie these perceptions. Qualitative case study methodology with nurses, doctors, and physiotherapists. Three mixed medical and surgical adult ICUs, each on a separate hospital site within a 1,200-bed academic, tertiary London hospital group. Forty-four ICU team members of diverse professional backgrounds and seniority. None. Four themes (individual, team, unit, and organizational) were identified. Individual care provision was influenced by the pragmatist versus perfectionist stance of individuals and team dynamics by the concept of an "A" team and interdisciplinary tensions. Perceptions of safety hinged around the importance of achieving a "dynamic balance" influenced by the burden of prevailing circumstances and the clinical status of patients. Organizationally, professionals' risk perceptions affected their willingness to take personal responsibility for interactions beyond the unit. This study drew on cognitive research, specifically theories of cognitive dissonance, psychological safety, and situational awareness to explain how professionals' cognitive processes impacted on ICU behaviors. Our results may have implications for relationships, management, and leadership in ICU. First, patient care delivery may be affected by professionals' perfectionist or pragmatic approach. Perfectionists' team role may be compromised and they may experience cognitive dissonance and subsequent isolation/stress. Second, psychological safety in a team may be improved within the confines of a perceived "A" team but diminished by interdisciplinary tensions. Third, counter intuitively, higher "situational" awareness for some individuals increased their stress and anxiety. Finally, our results suggest that professionals have varying concepts of where their personal responsibility to minimize

  5. Factors associated with family satisfaction with end-of-life care in the ICU: a systematic review.

    Science.gov (United States)

    Hinkle, Laura J; Bosslet, Gabriel T; Torke, Alexia M

    2015-01-01

    Family satisfaction with end-of-life care in the ICU has not previously been systematically reviewed. Our objective was to perform a review, synthesizing published data identifying factors associated with family satisfaction with end-of-life care in critically ill adult populations. The following electronic databases were searched: MEDLINE (Medical Literature Analysis and Retrieval System Online), MEDLINE Updated, EMBASE (Excerpta Medical Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycInfo, and PubMed. Two authors reviewed retrieved titles and abstracts. Studies describing nonadult and non-ICU populations or not addressing end-of-life care, family satisfaction, or factors affecting satisfaction were excluded. The remaining articles underwent full review and data extraction by two authors. Quality was assessed using a checklist based on the recommendations of the Consolidated Standards for Reporting Trials group. The search yielded 1,072 articles, with 23 articles describing 14 studies meeting inclusion criteria. All studies obtained satisfaction data from family members via surveys and structured interviews. Specific communication strategies increasing satisfaction included: expressions of empathy, nonabandonment, and assurances of comfort and provision of written information. Additionally, support for shared decision-making, family presence at time of death, and specific patient-care measures such as extubation before death were associated with increased satisfaction. Good-quality communication, support for shared decision-making, and specific patient-care measures were associated with increased satisfaction with end-of-life care. Assessing the family's desire to participate in shared decision-making may also be an important factor. Few interventions increased satisfaction. Future research is needed to further define optimal communication strategies, understand effective integration of palliative care into the ICU, and define

  6. Improving the quality of nurse-influenced patient care in the intensive care unit.

    Science.gov (United States)

    Sutton, Lynsey J; Jarden, Rebecca J

    2017-11-01

    Quality of care is a major focus in the intensive care unit (ICU). To describe a nurse-initiated quality improvement (QI) project that improved the care of critically ill patients in a New Zealand tertiary ICU. A framework for QI was developed and implemented as part of a practice change initiative. Audit data were collected, analysed and reported across seven nurse-influenced patient care standards. The seven standards were enteral nutrition delivered within 24 h of admission, timely administration of antibiotics, sedation holds for eligible patients, early mobilization and three pressure ulcer prevention strategies. Comparison of audit data collected in 2014 and 2015 demonstrated improvements in five of the seven standards. Those standards with the largest practice improvements were related to the following standards: all eligible patients have enteral nutrition commenced within the first 24 h of ICU admission (3% increase); all eligible patients receive antibiotics within 30 min of prescription time (6% increase); all eligible patients have a daily sedation interruption (DSI; 24% increase); and all eligible patients are mobilized daily in their ICU stay (11% increase in percentage of patients mobilized daily). The nursing-initiated QI project demonstrated improved ICU patient care in relation to early enteral nutrition commencement, DSIs and early and daily mobilizing. The use of a nursing QI framework incorporating audit and feedback is one method of evaluating and enhancing the quality of care and improving patient outcomes. This initiative demonstrated the improved quality of nursing care for ICU patients, particularly in relation to early enteral nutrition commencement, timely antibiotics, DSIs and daily mobilizing. It is thus highly relevant to critical care nursing teams, particularly those working to create a culture where change is safe, achievable and valued. © 2016 British Association of Critical Care Nurses.

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

    Science.gov (United States)

    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

  8. Nurse-driven, protocol-directed weaning from mechanical ventilation improves clinical outcomes and is well accepted by intensive care unit physicians.

    Science.gov (United States)

    Danckers, Mauricio; Grosu, Horiana; Jean, Raymonde; Cruz, Raul B; Fidellaga, Amelita; Han, Qifa; Awerbuch, Elizabeth; Jadhav, Nagesh; Rose, Keith; Khouli, Hassan

    2013-08-01

    Ventilator weaning protocols can improve clinical outcomes, but their impact may vary depending on intensive care unit (ICU) structure, staffing, and acceptability by ICU physicians. This study was undertaken to examine their relationship. We prospectively examined outcomes of 102 mechanically ventilated patients for more than 24 hours and weaned using nurse-driven protocol-directed approach (nurse-driven group) in an intensivist-led ICU with low respiratory therapist staffing and compared them with a historic control of 100 patients who received conventional physician-driven weaning (physician-driven group). We administered a survey to assess ICU physicians' attitude. Median durations of mechanical ventilation (MV) in the nurse-driven and physician-driven groups were 2 and 4 days, respectively (P = .001). Median durations of ICU length of stay (LOS) in the nurse-driven and physician-driven groups were 5 and 7 days, respectively (P = .01). Time of extubation was 2 hours and 13 minutes earlier in the nurse-driven group (P ventilator-associated pneumonia, or reintubation rates between the 2 groups. We identified 4 independent predictors of weaning duration: nurse-driven weaning, Acute Physiology and Chronic Health Evaluation II score, vasoactive medications use, and blood transfusion. Intensive care unit physicians viewed this protocol implementation positively (mean scores, 1.59-1.87 on a 5-point Likert scale). A protocol for liberation from MV driven by ICU nurses decreased the duration of MV and ICU LOS in mechanically ventilated patients for more than 24 hours without adverse effects and was well accepted by ICU physicians. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Practical knowledge of experienced nurses in critical care: a qualitative study of their narratives

    OpenAIRE

    Acebedo-Urdiales, María Sagrario; Medina-Noya, José Luis; Ferré-Grau, Carme

    2014-01-01

    Background Scholars of nursing practices have claimed practical knowledge is source of knowledge in its own right, nevertheless we know little about this knowledge associated with day-to-day practice. The purpose of this study is to describe knowledge that the more experienced nurses the in ICU make use of and discover the components of care it includes. Understanding this knowledge can contribute to improving the working practices of nurses with less experience. Methods We used a phenomenolo...

  10. Role of APACHE score in predicting mortality in chest ICU.

    Science.gov (United States)

    Haidri, Fakhir Raza; Rizvi, Nadeem; Motiani, Balchand

    2011-06-01

    To determine the first 24 hours mean values of APACHE II score for two outcomes (alive or dead) in patients admitted in chest ICUs. A prospective study was conducted in the Department of Chest, Jinnah Postgraduate Medical Centre Hospital, Karachi from January 2009 to December 2009. Patients of all ages and either gender admitted in chest ICU for any cause, were consecutively enrolled. All patients with incomplete records and missing variables including laboratory investigations or who had not been followed up due to any reason were excluded. Patients who were readmitted in the ICU were also excluded. The main outcomes were the first 24 hours mean APACHE II score of the sample and first 24 hours mean APACHE II score of patients who were later discharged or had died. The mean age of the patients was 53.16 +/- 19.29 years. Out of 143 participants 84 (58.7%) were males and 59 (41.3%) females. The main diagnosis included COPD with acute exacerbation 63 (44.05%), post TB fibrosis 17 (11.88%), acute severe asthma 14 (9.79%) and pneumonia 12 (8.39%) patients. The results found that 63 out of 143 patients were alive whereas 80 patients died. The mean APACHE II score on first 24 hours was 20.09 +/- 7.49. The mean 24 hours APACHE II score of patients who were discharged and who died was 18.93 +/- 7.19 and 22.33 +/- 7.80 respectively. Our preliminary results showed that it is recommended to determine the cut off levels of APACHE II scores in patients admitted with chest ICU.

  11. Blurred Lines: Dysbiosis and Probiotics in the ICU.

    Science.gov (United States)

    Morrow, Lee E; Wischmeyer, Paul

    2017-02-01

    Clinicians have traditionally dichotomized bacteria as friendly commensals or harmful pathogens. However, the line separating the two has become blurred with the recognition that the intestinal microbiome is a complex entity in which species can shift sides-from friend to foe and back again-based on crucial factors in their local environment. Significant disruptions in the homeostasis of the microbiome, a phenomenon called dysbiosis, is increasingly associated with a host of untoward effects. Patients in the ICU are at high risk for dysbiosis given the high rate of antibiotic use, acute changes in diet, and the stress of critical illness. Probiotics are living microbes of human origin that when ingested in sufficient quantities, can colonize sites such as the oropharynx and GI tract and provide benefits to the host. In recent years, we have increasingly explored the utility of using probiotics to reverse the intestinal dysbiosis associated with critical illness, thereby reducing select ICU complications associated with increased morbidity and mortality. Although these preliminary efforts have demonstrated varying degrees of success, our present studies suffer from a host of limitations that hinder the strength of their conclusions and the generalizability of their results. Probiotic investigations have been further hobbled by current regulatory requirements, which were designed to serve as the framework for pharmaceutical research. Although such measures are intended to ensure patient safety, they inadvertently impose barriers that stifle innovation regarding nutraceuticals. This review strives to summarize the current evidence regarding the efficacy and safety of probiotics in the ICU as well as to provide an overview of the obstacles probiotic researchers face going forward. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  12. Delivering best care and maintaining emotional wellbeing in the intensive care unit: the perspective of experienced nurses.

    Science.gov (United States)

    Siffleet, Joanne; Williams, Anne M; Rapley, Pat; Slatyer, Susan

    2015-11-01

    This study explored the perspective of experienced intensive care nurses regarding maintenance of their emotional wellbeing. Caring for critically ill patients has been identified as stressful. The demand for critical care nurses continues to grow in a climate of an ongoing nursing shortage and an aging workforce. This study sought to understand what environmental elements optimized the maintenance of emotional wellbeing. Grounded theory. Fifteen experienced intensive care unit registered nurses from a metropolitan hospital in Western Australia, were interviewed. Five categories were identified: 'achieving best care', 'caring for the patient's family', 'autonomy within the ICU environment', 'teamwork', and 'previous nursing and life experience'. The findings from this study increase our understanding of the environmental elements that can optimize the emotional wellbeing of intensive care nurses. These findings will assist in the development of strategies to retain nurses in the ICU area. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

  13. Leisure, Government and Governance: A Swedish Perspective

    Science.gov (United States)

    Lindstrom, Lisbeth

    2011-01-01

    The leisure sector has witnessed a tremendous expansion since 1960. The purpose of this article is to analyse the decisions and goals of Swedish government policy during the period 1962 to 2005. The empirical analysis covers government Propositions and governmental investigations. The fields covered are sports, culture, exercise, tourism and…

  14. Training Entrepreneurship at Universities: A Swedish Case.

    Science.gov (United States)

    Klofsten, Magnus

    2000-01-01

    The Entrepreneurship and New Business Development Program trains Swedish individuals in the startup of technology- or knowledge-based enterprises. Built on the characteristics of entrepreneurial behavior, the program features a holistic outlook, a network of established entrepreneurs, mentoring, a mix of theory and practice, and focus on the…

  15. Exergy use in the Swedish society 1994

    Energy Technology Data Exchange (ETDEWEB)

    Wall, G.

    1997-07-01

    The exergy concept is reviewed as a tool for resource accounting. Conversions of energy and material resources in the Swedish society in 1994 are described in terms of exergy. Necessary concepts and conventions are introduced. Exergy losses in transformations of material resources and in conversions of various forms of energy into heat are described in some detail

  16. SWEDISH CRIME FICTION AS SOCIALLY INVOLVED LITERATURE

    Directory of Open Access Journals (Sweden)

    Monika Samsel-Chojnacka

    2011-01-01

    Full Text Available Swedish crime novel has been transforming for many years to become more socially involved. The ambition of many writers is not only to entertain the readers but also to participating in the social debate, criticizing the political and economical system, focusing on important issues such as violence against women, exploitation of working class by the privileged ruling class, the problems of a modern family and the situation of immigrants. Since the moment when in the mid 60’s two journalists Maj Sjöwall and Per Wahlöö decided to use popular literature to spread social matters many other Swedish writers have decided to follow their way. Some of them are journalists – like Liza Marklund, Börge Hellström and Anders Roslund or Stieg Larsson. Their novels as well as the ones written by Henning Mannkel on Kurt Wallander have become crucial evidence of changes of Swedish society in the past twenty years. Modern Swedish crime fiction illustrates the population in the model fashion that is the reason why it can become one of the interests of the sociology of literature.

  17. Mathematics and Didactic Contract in Swedish Preschools

    Science.gov (United States)

    Delacour, Laurence

    2016-01-01

    The purpose of this article is to study and analyse how a teacher implements an outdoor realistic problem situation for children aged 4-5 in a Swedish preschool. By an "outdoor realistic problem situation", I mean a situation initiated by a teacher in which children come into contact with mathematical concepts and in which the outside…

  18. Patients' experiences of being mechanically ventilated in an ICU

    DEFF Research Database (Denmark)

    Baumgarten, Mette; Poulsen, Ingrid

    2015-01-01

    BACKGROUND: Being a patient in an intensive care unit (ICU) and being mechanically ventilated is a scary and unpleasant experience to many patients. Qualitative studies describe these Patients' experiences, but the findings have not yet been synthesised. AIM: The aim of this study was to gather......, consisting of anxiety, fear and loneliness. IMPLICATIONS FOR PRACTICE: In future practice, it is expected that patients will be more awake during mechanical ventilation. It is therefore important that health professionals have the knowledge that their presence and their support of the relationship between...... the patient and his/her relatives are of great importance in the care of patients....

  19. [Identity of gender and intensive care: influence of masculinity and femininity in the perception of nursing care].

    Science.gov (United States)

    Via Clavero, G; Sanjuán Naváis, M; Martínez Mesas, M; Pena Alfaro, M; Utrilla Antolín, C; Zarragoikoetxea Jáuregui, I

    2010-01-01

    Nursing has essentially been the work of women. The increase in men incorporating into nursing makes us think about whether there are different ways of expressing and practicing a profession in relationship to gender. To describe if there are different ways of perceiving and assessing ICU work from a gender perspective. A qualitative phenomenological study. 6 male nurses and 6 female nurses from the ICU of the Hospital Universitario de Bellvitge (HUB). In-depth semi-constructed interview. Content analysis. Male nurses describe ICU work in terms of autonomy in making decisions and professional competence. They claim responsibility for their identity as nurses and stress the low social recognition of the profession. They prioritize the responsibility of decision making over the final outcome and evaluate family satisfaction in terms of prestige and competence. They are more practical. Female nurses describe the work in terms of control and follow-up of the patient's evolution. They emphasize the final care outcome and evaluate satisfaction in terms of a relationship of confidence and warm patient care. They are more meticulous. There are differences in how they classify their ICU work, in the self-evaluation of professional identity, behavior in the development of the nursing care and in perception of family satisfaction. No differences are observed regarding problem solving with the technology. Copyright 2009 Elsevier España, S.L. y SEEIUC. All rights reserved.

  20. ICU-Acquired Weakness: A Rehabilitation Perspective of Diagnosis, Treatment, and Functional Management.

    Science.gov (United States)

    Zorowitz, Richard D

    2016-10-01

    ICU-acquired weakness (ICUAW) occurs with reported incidence rates from 25% to 100%. Risk factors include immobility, sepsis, persistent systemic inflammation, multiorgan system failure, hyperglycemia, glucocorticoids, and neuromuscular blocking agents. The pathophysiology remains unknown. Clinical features may be neuropathic, myopathic, or a combination of both. Although manual muscle testing is more practical in diagnosing ICUAW, the "gold standard" for the diagnosis of ICUAW remains electromyography and nerve conduction studies. The only potential interventions known to date to prevent ICUAW include insulin therapy and early rehabilitation, but patients still may develop activity limitations in the acute care hospital. For these patients, rehabilitation may continue in long-term care hospitals, inpatient rehabilitation facilities, or skilled nursing facilities. ICUAW is a catastrophic and debilitating condition that potentially leaves patients with permanent residual activity limitations and participation restrictions. Further research on ICUAW needs to better understand its pathophysiology so that more definitive preventive and therapeutic interventions may be developed. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  1. Process Reengineering for Quality Improvement in ICU Based on Taylor's Management Theory.

    Science.gov (United States)

    Tao, Ziqi

    2015-06-01

    Using methods including questionnaire-based surveys and control analysis, we analyzed the improvements in the efficiency of ICU rescue, service quality, and patients' satisfaction, in Xuzhou Central Hospital after the implementation of fine management, with an attempt to further introduce the concept of fine management and implement the brand construction. Originating in Taylor's "Theory of Scientific Management" (1982), fine management uses programmed, standardized, digitalized, and informational approaches to ensure each unit of an organization is running with great accuracy, high efficiency, strong coordination, and at sustained duration (Wang et al., Fine Management, 2007). The nature of fine management is a process that breaks up the strategy and goal, and executes it. Strategic planning takes place at every part of the process. Fine management demonstrates that everybody has a role to play in the management process, every area must be examined through the management process, and everything has to be managed (Zhang et al., The Experience of Hospital Nursing Precise Management, 2006). In other words, this kind of management theory demands all people to be involved in the entire process (Liu and Chen, Med Inf, 2007). As public hospital reform is becoming more widespread, it becomes imperative to "build a unified and efficient public hospital management system" and "improve the quality of medical services" (Guidelines on the Pilot Reform of Public Hospitals, 2010). The execution of fine management is of importance in optimizing the medical process, improving medical services and building a prestigious hospital brand.

  2. Swedish attitudes towards persons with mental illness.

    Science.gov (United States)

    Högberg, Torbjörn; Magnusson, Annabella; Lützén, Kim; Ewalds-Kvist, Béatrice

    2012-04-01

    Negative and stigmatizing attitudes towards persons with mental illness must be dealt with to facilitate the sufferers' social acceptance. The present study aimed at survey Swedish attitudes towards persons with mental illness related to factors impacting these attitudes. New CAMI-S based on the questionnaire "Community Attitudes to Mental Illness in Sweden" ([CAMI] Taylor & Dear, 1981) was developed with nine behavioral-intention items and thus comprised a total of 29 items. Of 5000 Swedish people, 2391 agreed to complete the questionnaire. Principal component analysis rendered four factors reflecting attitudes towards the mentally ill: Intention to Interact, Fearful and Avoidant, Open-minded and Pro-Integration, as well as Community Mental Health Ideology. The factors were analyzed for trends in attitudes. By MANOVA, the experience of mental illness effects on mind-set towards the sufferers was assessed. By means of logistic regression, demographic factors contributing to positive attitudes towards persons with mental illness residing in the neighborhood were assessed. By New CAMI-S, the Swedish attitudes towards the mentally ill were surveyed and trends in agreement with living next to a person with mental illness were revealed in three out of four factors derived by principal component analysis. Aspects impacting the Swedish attitudes towards persons with mental illness and willingness to have him/her residing in the neighborhood comprised experience of mental illness, female gender, age (31-50 years), born in Scandinavia or outside Europe, only 9 years of compulsory school and accommodation in flat. The New CAMI-S came out as a useful tool to screen Swedish attitudes towards persons with mental illness. Most Swedes were prepared to live next to the mentally ill.

  3. Professional reinventions: Swedish psychologists, 1990-2010.

    Science.gov (United States)

    Skagius, Peter; Münger, Ann-Charlotte

    2016-11-01

    Since the early 20th century, the Swedish psychology profession has undergone several changes in its essential tasks, epistemological foundations, and social roles. These changes occurred through an ongoing "tuning" with Swedish society, in which the profession strove to appear relevant to society's concerns and problems as well as enroll others to share the profession's goals and aims. Studying the history of the profession can thus shed light on the changing definitions and contours of the psychology profession itself as well as on the organization of the society in which it acts. This article examines the history of the Swedish psychology profession from 1990 to 2010, through an analysis of the discussions and debates taking place in the Swedish Psychological Association's journal. The analytical framework used draws on work done within actor-network theory and science studies. We argue that the profession's institutional connections, defining tasks, epistemological underpinnings, and social position have changed in major ways during these 2 decades. Overall, as a result of an increasingly felt insecurity, the profession has turned outward and tried to find new ways to legitimize itself to politicians, the media, patients, and customers through means such as a more economized vocabulary and novel forms of empirical research. These changes have led to a more socialized profession, now more closely tuned to other actors in Swedish society, leading to conflicts within the profession over whether this is an opportunity to better control their own destiny or if it will lead to a loss of autonomy. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  4. Prevalence of footrot in Swedish slaughter lambs

    Directory of Open Access Journals (Sweden)

    Nyman Ann-Kristin J

    2011-04-01

    Full Text Available Abstract Background Footrot is a world-wide contagious disease in sheep and goats. It is an infection of the epidermis of the interdigital skin, and the germinal layers of the horn tissue of the feet. The first case of footrot in Swedish sheep was diagnosed in 2004. Due to difficulties in distinguishing benign footrot from early cases of virulent footrot and because there is no possibility for virulence testing of strains of Dichelobacter nodosus in Sweden, the diagnosis is based of the presence or absence of clinical signs of footrot in sheep flocks. Ever since the first diagnosed case the Swedish Animal Health Service has worked intensively to stop the spread of infection and control the disease at flock level. However, to continue this work effectively it is important to have knowledge about the distribution of the disease both nationally and regionally. Therefore, the aims of this study were to estimate the prevalence of footrot in Swedish lambs at abattoirs and to assess the geographical distribution of the disease. Methods A prevalence study on footrot in Swedish lambs was performed by visual examination of 2000 feet from 500 lambs submitted from six slaughter houses. Each foot was scored according to a 0 to 5 scoring system, where feet with score ≥2 were defined as having footrot. Moreover, samples from feet with footrot were examined for Dichelobacter nodosus by culture and PCR. Results The prevalence of footrot at the individual sheep level was 5.8%, and Dichelobacter nodosus was found by culture and PCR in 83% and 97% of the samples from feet with footrot, respectively. Some minor differences in geographical distribution of footrot were found in this study. Conclusions In a national context, the findings indicate that footrot is fairly common in Swedish slaughter lambs, and should be regarded seriously.

  5. Nursing staff and nursing students' emotions towards homosexual patients and their wish to refrain from nursing, if the option existed.

    Science.gov (United States)

    Röndahl, Gerd; Innala, Sune; Carlsson, Marianne

    2004-03-01

    Studies have reported that homosexual patients fear they will not receive adequate care if they openly show their sexual orientation, for example, when introducing their partner. The aims of this study were to investigate the emotions of nursing staff and nursing students, and possible relations to cultural background and gender, towards homosexual patients; whether nursing staff and nursing students would choose to refrain from nursing homosexual patients, if the option existed; and, if so, how they express their wish to refrain from nursing this group of patients. All participants received verbal and written information before the study started. Returning a completed questionnaire indicated a participant's tacit consent. Approval was obtained from the heads of departments and persons in charge of nursing and nursing assistant programmes. The study had a descriptive, comparative design, and an Affect Adjective Checklist (AAC) and specially designed Nursing Behaviour Questionnaire (NBQ) were used. The participants included nurses and assistant nurses from an infectious disease clinic, and students enrolled in a university nursing programme and upper secondary assistant nurses' training, all in central Sweden. The findings showed that both professional nursing staff (response rate 67%, n = 57), and students (response rate 62%, n = 165), expressed emotions of homophobic anger, homophobic guilt and delight. Groups with a cultural background other than Swedish expressed more homophobia. No gender differences were indicated for homophobic emotions. In the professional group, 36% would refrain from nursing for homosexual patients if given the option. The corresponding figure for the students was 9%. The limitations were that the sample was small and not randomly selected, and as participation was anonymous no follow-up could be done. It was concluded that the emotional factors of homosexual anger and homosexual guilt might be of value in helping to explain and predict

  6. Nursing theories as nursing ontologies.

    Science.gov (United States)

    Flaming, Don

    2004-10-01

    By understanding the constructions of knowledge we currently label nursing theories as nursing ontologies, nurses can perceive these conceptualizations differently. Paul Ricoeur and Stephen White offer a conceptualization of ontology that differs from traditional, realist perspectives because they assume that a person's experience of a phenomenon (e.g., nursing) will change, but also maintain some stability. Discussing nursing ontologies, rather than nursing theories, might increase philosophy's status in nursing and may also more accurately reflect the experience of being a nurse.

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

    Science.gov (United States)

    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.

  8. 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.

  9. The daily life of relatives of patients admitted in icu: a study with social representations

    OpenAIRE

    Vasconcelos, Esleane Vilela; Freitas, Karina de Oliveira; Silva,Sílvio Éder Dias da; Baia, Ronaldo de Sousa Moreira; Tavares, Roseneide dos Santos; Araújo, Jeferson Santos

    2016-01-01

    Identifying which social representations of family members of patients admitted to the Intensive Care Unit (ICU) about the ICU and the hospitalization process and analyzing the implications of these for their everyday life. Method: this was a qualitative study based on the Theory of Social Representations. Results: the Statements of the relatives were synthesized in four themes: the perception of family members with respect to ICU; the family of the suffering of daily life; the "technologi...

  10. Out-of-Hospital ICU Transfers to an Oncological Referral Center.

    Science.gov (United States)

    Gutierrez, Cristina; Cárdenas, Yenny R; Bratcher, Kristie; Melancon, Judd; Myers, Jason; Campbell, Jeannee Y; Feng, Lei; Price, Kristen J; Nates, Joseph L

    2016-01-01

    To determine resource utilization and outcomes of out-of-hospital transfer patients admitted to the intensive care unit (ICU) of a cancer referral center. Single-center cohort. A tertiary oncological center. Patients older than 18 years transferred to our ICU from an outside hospital between January 2013 and December 2015. A total of 2127 (90.3%) were emergency department (ED) ICU admissions and 228 (9.7%) out-of-hospital transfers. The ICU length of stay (LOS) was longer in the out-of-hospital transfers when compared to all other ED ICU admissions ( P = .001); however, ICU and hospital mortality were similar between both groups. The majority of patients were transferred for a higher level of care (77.2%); there was no difference in the amount of interventions performed, ICU LOS, and ICU mortality between nonhigher level-of-care and higher level-of-care patients. Factors associated with an ICU LOS ≥10days were a higher Sequential Organ Failure Assessment (SOFA) score, weekend admissions, presence of shock, need for mechanical ventilation, and acute kidney injury on admission or during ICU stay ( P transferred patients was 17.5% and associated risk factors were older age, higher SOFA score on admission, use of mechanical ventilation and vasopressors during ICU stay, and renal failure on admission ( P transfer such as LOS at the outside facility, time of transfer, delay in transfer, and longer distance traveled were not associated with increased LOS or mortality in our study. Organ failure severity on admission, and not transfer-related factors, continues to be the best predictor of outcomes of critically ill patients with cancer when transferred from other facilities to the ICU. Our data suggest that transferring critically ill patients with cancer to a specialized center does not lead to worse outcomes or increased resource utilization when compared to patients admitted from the ED.

  11. Feasibility and acceptability of a resilience training program for intensive care unit nurses.

    Science.gov (United States)

    Mealer, Meredith; Conrad, David; Evans, John; Jooste, Karen; Solyntjes, Janet; Rothbaum, Barbara; Moss, Marc

    2014-11-01

    The critical nursing shortage is particularly apparent in specialty areas such as intensive care units (ICUs). Some nurses develop resilient coping strategies and adapt to stressful work experiences, mitigating the development of common maladaptive psychological symptoms. To determine if a multimodal resilience training program for ICU nurses was feasible to perform and acceptable to the study participants. In a randomized and controlled 12-week intervention study, treatment and control groups completed demographic questions and measures of resilience, anxiety, depression, posttraumatic stress disorder (PTSD), and burnout syndrome before and after the intervention. The intervention included a 2-day educational workshop, written exposure sessions, event-triggered counseling sessions, mindfulness-based stress reduction exercises, and a protocolized aerobic exercise regimen. Nurses in the intervention arm also completed satisfaction surveys for each component of the intervention. This mulitmodal resilience training program was feasible to conduct and acceptable to ICU nurses. Both nurses randomized to the treatment group and nurses randomized to the control group showed a significant decrease in PTSD symptom score after the intervention. A multifaceted resilience training program for ICU nurses was both feasible and acceptable. A sufficiently powered, randomized clinical trial is needed to assess the effect of the intervention on improving individuals' level of resilience and improving psychological outcomes such as symptoms of anxiety, depression, burnout syndrome, and PTSD. ©2014 American Association of Critical-Care Nurses.

  12. Basic Competence of Intensive Care Unit Nurses: Cross-Sectional Survey Study

    Science.gov (United States)

    Lakanmaa, Riitta-Liisa; Suominen, Tarja; Ritmala-Castrén, Marita; Vahlberg, Tero; Leino-Kilpi, Helena

    2015-01-01

    Critical care patients benefit from the attention of nursing personnel with a high competence level. The aim of the study was to describe and evaluate the self-assessed basic competence of intensive care unit nurses and related factors. A cross-sectional survey design was used. A basic competence scale (Intensive and Critical Care Nursing Competence Scale version 1, Likert scale 1–5, 1 = poor and 5 = excellent) was employed among Finnish intensive care unit nurses (n = 431). Intensive care unit nurses' self-assessed basic competence was good (mean 4.19, SD 0.40). The attitude and value base of basic competence was excellent whereas experience base was the poorest compared to the knowledge base and skill base of intensive and critical care nursing. The strongest factor explaining nurses' basic competence was their experience of autonomy in nursing care (F value 60.85, β 0.11, SE 0.01, and P ≤ 0.0001). Clinical competence was self-rated as good. Nurses gave their highest competence self-ratings for ICU patient care according to the principles of nursing care. The ICU nurses also self-rated their professional competence as good. Collaboration was self-rated as the best competence. In basic and continuing education and professional self-development discussions it is meaningful to consider and find solutions for how to improve nurses' experienced autonomy in nursing. PMID:26557676

  13. Basic Competence of Intensive Care Unit Nurses: Cross-Sectional Survey Study.

    Science.gov (United States)

    Lakanmaa, Riitta-Liisa; Suominen, Tarja; Ritmala-Castrén, Marita; Vahlberg, Tero; Leino-Kilpi, Helena

    2015-01-01

    Critical care patients benefit from the attention of nursing personnel with a high competence level. The aim of the study was to describe and evaluate the self-assessed basic competence of intensive care unit nurses and related factors. A cross-sectional survey design was used. A basic competence scale (Intensive and Critical Care Nursing Competence Scale version 1, Likert scale 1-5, 1 = poor and 5 = excellent) was employed among Finnish intensive care unit nurses (n = 431). Intensive care unit nurses' self-assessed basic competence was good (mean 4.19, SD 0.40). The attitude and value base of basic competence was excellent whereas experience base was the poorest compared to the knowledge base and skill base of intensive and critical care nursing. The strongest factor explaining nurses' basic competence was their experience of autonomy in nursing care (F value 60.85, β 0.11, SE 0.01, and P ≤ 0.0001). Clinical competence was self-rated as good. Nurses gave their highest competence self-ratings for ICU patient care according to the principles of nursing care. The ICU nurses also self-rated their professional competence as good. Collaboration was self-rated as the best competence. In basic and continuing education and professional self-development discussions it is meaningful to consider and find solutions for how to improve nurses' experienced autonomy in nursing.

  14. Swedish emergency department triage and interventions for improved patient flows: a national update.

    Science.gov (United States)

    Farrokhnia, Nasim; Göransson, Katarina E

    2011-12-08

    In Scandinavia, emergency department triage and patient flow processes, are under development. In Sweden, the triage development has resulted in two new triage scales, the Adaptive Process Triage and the Medical Emergency Triage and Treatment System. Both these scales have logistic components, aiming to improve patient flows. The aim of this study was to report the development and current status of emergency department triage and patient flow processes in Sweden. In 2009 and 2010 the Swedish Council on Health Technology Assessment sent out a questionnaire to the ED managers in all (74) Swedish hospital emergency departments. The questionnaire comprised questions about triage and interventions to improve patient flows. Nearly all (97%) EDs in Sweden employed a triage scale in 2010, which was an increase from 2009 (73%). Further, the Medical Emergency Triage and Treatment System was the triage scale most commonly implemented across the country. The implementation of flow-related interventions was not as common, but more than half (59%) of the EDs have implemented or plan to implement nurse requested X-ray. There has been an increase in the use of triage scales in Swedish EDs during the last few years, with acceleration for the past two years. Most EDs have come to use the Medical Emergency Triage and Treatment System, which also indicates regional co-operation. The implementation of different interventions for improved patient flows in EDs most likely is explained by the problem of crowding. Generally, more studies are needed to investigate the economical aspects of these interventions.

  15. Nursing Students? Views on Promoting Successful Breastfeeding in Sweden

    OpenAIRE

    Pajalic, Zada

    2014-01-01

    Promoting breastfeeding is important work for health-care personnel in the Swedish context. This promotion is multifaceted and demands the ongoing development of knowledge and competence among both health-care personnel and patients. The aim of the present study was to describe the nursing students’ perspectives on breastfeeding in Sweden. Data were obtained in the form of written reflections from nursing students (n=65) and examined using manifest content analysis. The results...

  16. Dysthanasia: nursing professionals' perception Distanasia: percepción de los profesionales de enfermería Distanásia: percepção dos profissionais da enfermagem

    National Research Council Canada - National Science Library

    Milene Barcellos de Menezes; Lucilda Selli; Joseane de Souza Alves

    2009-01-01

    Dysthanasia means slow and painful death without quality of life. This study aimed to know whether nurses identify dysthanasia as part of the final process of the lives of terminal patients hospitalized at an adult ICU...

  17. Burnout syndrome in critical care nursing staff.

    Science.gov (United States)

    Poncet, Marie Cécile; Toullic, Philippe; Papazian, Laurent; Kentish-Barnes, Nancy; Timsit, Jean-Francçois; Pochard, Frédéric; Chevret, Sylvie; Schlemmer, Benoît; Azoulay, Elie

    2007-04-01

    Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The intensive care unit (ICU) is a highly stressful environment. Little is known about BOS in critical care nursing staff. To identify determinants of BOS in critical care nurses. We conducted a questionnaire survey in France. Among 278 ICUs contacted for the study, 165 (59.4%) included 2,525 nursing staff members, of whom 2,392 returned questionnaires with complete Maslach Burnout Inventory data. Of the 2,392 respondents (82% female), 80% were nurses, 15% nursing assistants, and 5% head nurses. Severe BOS-related symptoms were identified in 790 (33%) respondents. By multivariate analysis, four domains were associated with severe BOS: (1) personal characteristics, such as age (odds ratio [OR], 0.97/yr; confidence interval [CI], 0.96-0.99; p=0.0008); (2) organizational factors, such as ability to choose days off (OR, 0.69; CI, 0.52-0.91; p=0.009) or participation in an ICU research group (OR, 0.74; CI, 0.56-0.97; p=0.03); (3) quality of working relations (1-10 scale), such as conflicts with patients (OR, 1.96; CI, 1.16-1.30; p=0.01), relationship with head nurse (OR, 0.92/point; CI, 0.86-0.98; p=0.02) or physicians (OR, 0.81; CI, 0.74-0.87; p=0.0001); and (4) end-of-life related factors, such as caring for a dying patient (OR, 1.39; CI, 1.04-1.85; p=0.02), and number of decisions to forego life-sustaining treatments in the last week (OR, 1.14; CI, 1.01-1.29; p=0.04). One-third of ICU nursing staff had severe BOS. Areas for improvement identified in our study include conflict prevention, participation in ICU research groups, and better management of end-of-life care. Interventional studies are needed to investigate these potentially preventive strategies.

  18. Palliative Care Processes Embedded in the ICU Workflow May Reserve Palliative Care Teams for Refractory Cases.

    Science.gov (United States)

    Mun, Eluned; Umbarger, Lillian; Ceria-Ulep, Clementina; Nakatsuka, Craig

    2018-01-01

    Palliative Care Teams have been shown to be instrumental in the early identification of multiple aspects of advanced care planning. Despite an increased number of services to meet the rising consultation demand, it is conceivable that the numbers of palliative care consultations generated from an ICU alone could become overwhelming for an existing palliative care team. Improve end-of-life care in the ICU by incorporating basic palliative care processes into the daily routine ICU workflow, thereby reserving the palliative care team for refractory situations. A structured, palliative care, quality-improvement program was implemented and evaluated in the ICU at Kaiser Permanente Medical Center in Hawaii. This included selecting trigger criteria, a care model, forming guidelines, and developing evaluation criteria. These included the early identification of the multiple features of advanced care planning, numbers of proactive ICU and palliative care family meetings, and changes in code status and treatment upon completion of either meeting. Early identification of Goals-of-Care, advance directives, and code status by the ICU staff led to a proactive ICU family meeting with resultant increases in changes in code status and treatment. The numbers of palliative care consultations also rose, but not significantly. Palliative care processes could be incorporated into a daily ICU workflow allowing for integration of aspects of advanced care planning to be identified in a systematic and proactive manner. This reserved the palliative care team for situations when palliative care efforts performed by the ICU staff were ineffective.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  1. Utilization of DVT Prophylaxis in non ICU Hospitalized Patients

    Directory of Open Access Journals (Sweden)

    Sukhendu Shekhar Bhowmik

    2012-10-01

    Full Text Available The aim of this study was to assess all aspects of the routine clinical practices of DVT prophylaxis followed in the non ICU hospitalised (both medical & surgical patients in various ward of multispecialty, tertiary care hospital in India (Kolkata. All patients admitted in AMRI hospital in general ward were screened for inclusion and exclusion criteria. Those patients meeting the inclusion criteria were assessed for the risk factor and appropriateness of DVT prophylaxis on third day of hospitalization during August-2009 to April-2010. Further assessment was done to see the light on the thromboprophylaxis practices according to the recommendations given by the American College of Chest Physician (ACCP in the 8th ACCP Conference on Antithrombotic and Thrombolytic Therapy, (June-2008. Total 1938 patients were enrolled of which 267 patients (13.78% were excluded (did not meet inclusion criteria and 1671 patients (86.22% were included. From included patients 331(19.8% received any form of prophylaxis and majority of patients 80.2% did not receive any form of prophylaxis. Appropriateness of the prophylaxis practices was low (81.57% and many patients experienced inappropriate prophylaxis practices (18.43%. Mechanical prophylaxis was used predominantly and GCS was used more than IPC. In pharmacological form of prophylaxis LMWH was used more than UFH and appears to be the prophylaxis of choice. Inspite of multiple guidelines on risk factors assessment for venous thromboembolism (VTE, utilization of deep venous thrombosis (DVT prophylaxis remains less than satisfactory in non ICU hospitalized patients

  2. The Integrative Weaning Index in Elderly ICU Subjects.

    Science.gov (United States)

    Azeredo, Leandro M; Nemer, Sérgio N; Barbas, Carmen Sv; Caldeira, Jefferson B; Noé, Rosângela; Guimarães, Bruno L; Caldas, Célia P

    2017-03-01

    With increasing life expectancy and ICU admission of elderly patients, mechanical ventilation, and weaning trials have increased worldwide. We evaluated a cohort with 479 subjects in the ICU. Patients younger than 18 y, tracheostomized, or with neurologic diseases were excluded, resulting in 331 subjects. Subjects ≥70 y old were considered elderly, whereas those elderly. Besides the conventional weaning indexes, we evaluated the performance of the integrative weaning index (IWI). The probability of successful weaning was investigated using relative risk and logistic regression. The Hosmer-Lemeshow goodness-of-fit test was used to calibrate and the C statistic was calculated to evaluate the association between predicted probabilities and observed proportions in the logistic regression model. Prevalence of successful weaning in the sample was 83.7%. There was no difference in mortality between elderly and non-elderly subjects (P = .16), in days of mechanical ventilation (P = .22) and days of weaning (P = .55). In elderly subjects, the IWI was the only respiratory variable associated with mechanical ventilation weaning in this population (P elderly subjects that may contribute to the critical moment of this population in intensive care. Copyright © 2017 by Daedalus Enterprises.

  3. Belgian hand hygiene campaigns in ICU, 2005-2015.

    Science.gov (United States)

    Fonguh, Sylvanus; Uwineza, Annie; Catry, Boudewijn; Simon, Anne

    2016-01-01

    Healthcare-associated infections (HCAI) are still a major problem especially in most intensive care units (ICU). Incompliance by clinical staff with hand hygiene (HH) increases rates of preventable infections. We report the outcome of the Belgian national hand hygiene campaign from 2005 to 2015 with focus on intensive care units. Using the World Health organisation (WHO) standardised observation roster, trained infection control teams measured adherence to HH guidelines by direct observation. HH opportunities were counted and the actual episodes of HH were scored as no HH, HH with water and soap, or HH with alcohol-based hand rub. Measurements were repeatedly done before and after a one month awareness campaign every second year. Compliance was stratified by indication and by type of healthcare worker, and computed as a percentage of the number of HH episodes with water and soap or with alcohol-based hand rub, divided by the number of opportunities. A total of 108,050 hand hygiene opportunities were observed in ICU during this period. HH compliance increased significantly from 49.6 % before campaign in 2005 to 72.0 % before campaign in 2015. Over the same time frame, post campaign compliance increased from 67.0 to 80.2 %. The number of opportunities observed substantially increased when automated feedback was installed. In Belgian intensive care units, hand hygiene compliance is getting improved overtime, though consecutive campaigns with immediate feedback are required to achieve and sustain a high compliance rate.

  4. Acute kidney injury: Renal disease in the ICU.

    Science.gov (United States)

    Seller-Pérez, G; Más-Font, S; Pérez-Calvo, C; Villa-Díaz, P; Celaya-López, M; Herrera-Gutiérrez, M E

    2016-01-01

    Acute kidney injury (AKI) in the ICU frequently requires costly supportive therapies, has high morbidity, and its long-term prognosis is not as good as it has been presumed so far. Consequently, AKI generates a significant burden for the healthcare system. The problem is that AKI lacks an effective treatment and the best approach relies on early secondary prevention. Therefore, to facilitate early diagnosis, a broader definition of AKI should be established, and a marker with more sensitivity and early-detection capacity than serum creatinine - the most common marker of AKI - should be identified. Fortunately, new classification systems (RIFLE, AKIN or KDIGO) have been developed to solve these problems, and the discovery of new biomarkers for kidney injury will hopefully change the way we approach renal patients. As a first step, the concept of renal failure has changed from being a "static" disease to being a "dynamic process" that requires continuous evaluation of kidney function adapted to the reality of the ICU patient. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  5. Intelligent closed-loop insulin delivery systems for ICU patients.

    Science.gov (United States)

    Wang, Youqing; Xie, Hongzhi; Jiang, Xu; Liu, Bo

    2014-01-01

    Good glycemic control through insulin administration among intensive care unit (ICU) patients can reduce mortality significantly; however, it remains a big challenge because of scarcity of individualized models for ICU patients. To deal with this challenge, a new combination of particle swarm optimization (PSO) and model predictive control (MPC) has been proposed to identify the model online as well as to optimally design the input, i.e., the insulin delivery rate automatically. According to the population distribution, ten typical linear dynamic models were selected such that any patient's model could be approximated by a linear combination of these ten typical models. PSO was used to update the weight coefficients while MPC was used to design the insulin delivery rate based on the combination model identified by using PSO. The proposed strategy was compared with the Yale protocol on 30 virtual subjects. According to the control-variability grid analysis, the percentage values in A + B zone were, respectively, 100% under the proposed strategy and while 51% under the Yale protocol, which demonstrates the superior performance of the proposed strategy. As a good candidate for the full closed-loop insulin delivery method, this new combination can control the glucose level by bringing it to a safe range promptly thereby reducing the risk of death.

  6. Night shift decreases cognitive performance of ICU physicians.

    Science.gov (United States)

    Maltese, François; Adda, Mélanie; Bablon, Amandine; Hraeich, Sami; Guervilly, Christophe; Lehingue, Samuel; Wiramus, Sandrine; Leone, Marc; Martin, Claude; Vialet, Renaud; Thirion, Xavier; Roch, Antoine; Forel, Jean-Marie; Papazian, Laurent

    2016-03-01

    The relationship between tiredness and the risk of medical errors is now commonly accepted. The main objective of this study was to assess the impact of an intensive care unit (ICU) night shift on the cognitive performance of a group of intensivists. The influence of professional experience and the amount of sleep on cognitive performance was also investigated. A total of 51 intensivists from three ICUs (24 seniors and 27 residents) were included. The study participants were evaluated after a night of rest and after a night shift according to a randomized order. Four cognitive skills were tested according to the Wechsler Adult Intelligence Scale and the Wisconsin Card Sorting Test. All cognitive abilities worsened after a night shift: working memory capacity (11.3 ± 0.3 vs. 9.4 ± 0.3; p sleep. The other three cognitive skills were altered, regardless of the amount of sleep during the night shift. The cognitive abilities of intensivists were significantly altered following a night shift in the ICU, regardless of either the amount of professional experience or the duration of sleep during the shift. The consequences for patients' safety and physicians' health should be further evaluated.

  7. Nurse Research Experiences and Attitudes Toward the Conduct of Intensive Care Research: A Questionnaire Study.

    Science.gov (United States)

    Smith, Orla M; Dale, Craig; Mehta, Sangeeta; Pinto, Ruxandra; Rose, Louise

    2016-01-01

    To characterize ICU nurses' research experience, work environments, and attitudes toward clinical research in critically ill adults and children. Cross-sectional survey. Eight (seven adult and one pediatric) academic ICUs affiliated with the Canadian Critical Care Trials Group. Four hundred eighty-two ICU nurses. None. Response rate was 56%. Most participants had over 6 years of ICU experience (61%) and held a baccalaureate nursing degree (57%). Most participants (63%) had provided care for patients receiving research study procedures more than five times in the past 12 months and agreed that research leads to improved care for the critically ill (78%) and eligible patients should be approached for research participation (78%). Few perceived practicalities of nursing care are considered in study design (20%); 41% agreed that research studies increases nursing workload. Few participants reported receiving adequate information about study progress (24%) or findings (26%). Principal factor analysis identified three factors each in the environmental and attitudinal domains. Linear regression models demonstrated that positive relationships between researchers and clinicians were associated with favorable perceptions of research impact on nursing care (p research acceptability (p research (p research (p research acceptability (p study protocol development and/or data analysis was associated with less favorable attitudes about nursing engagement in research (p research on nursing care (p research-intensive ICUs, nurses frequently care for research participants and believe ICU research is important. Inclusion of nurses in study protocol development, improved communication of study progress and findings, and investigation of research-related nursing workload are warranted. Such interventions will support intervention fidelity and data reliability during study conduct and translation of evidence into practice on study completion.

  8. Inappropriate care in European ICUs: confronting views from nurses and junior and senior physicians.

    Science.gov (United States)

    Piers, Ruth D; Azoulay, Elie; Ricou, Bara; DeKeyser Ganz, Freda; Max, Adeline; Michalsen, Andrej; Azevedo Maia, Paulo; Owczuk, Radoslaw; Rubulotta, Francesca; Meert, Anne-Pascale; Reyners, Anna K; Decruyenaere, Johan; Benoit, Dominique D

    2014-08-01

    ICU care providers often feel that the care given to a patient may be inconsistent with their professional knowledge or beliefs. This study aimed to assess differences in, and reasons for, perceived inappropriate care (PIC) across ICU care providers with varying levels of decision-making power. We present subsequent analysis from the Appropricus Study, a cross-sectional study conducted on May 11, 2010, which included 1,218 nurses and 180 junior and 227 senior physicians in 82 European adult ICUs. The study was designed to evaluate PIC. The current study focuses on differences across health-care providers regarding the reasons for PIC in real patient situations. By multivariate analysis, nurses were found to have higher PIC rates compared with senior and junior physicians. However, nurses and senior physicians were more distressed by perceived disproportionate care than were junior physicians (33%, 25%, and 9%, respectively; P = .026). A perceived mismatch between level of care and prognosis (mostly excessive care) was the most common cause of PIC. The main reasons for PIC were prognostic uncertainty among physicians, poor team and family communication, the fact that no one was taking the initiative to challenge the inappropriateness of care, and financial incentives to provide excessive care among nurses. Senior physicians, compared with nurses and junior physicians, more frequently reported pressure from the referring physician as a reason. Family-related factors were reported by similar proportions of participants in the three groups. ICU care providers agree that excessive care is a true issue in the ICU. However, they differ in the reasons for the PIC, reflecting the roles each caregiver has in the ICU. Nurses charge physicians with a lack of initiative and poor communication, whereas physicians more often ascribe prognostic uncertainty. Teaching ICU physicians to deal with prognostic uncertainty in more adequate ways and to promote ethical discussions in their

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

    Science.gov (United States)

    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

  10. [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.

  11. An observational study of activities and multitasking performed by clinicians in two Swedish emergency departments.

    Science.gov (United States)

    Berg, Lena M; Ehrenberg, Anna; Florin, Jan; Ostergren, Jan; Göransson, Katarina E

    2012-08-01

    To explore the type and frequency of activities and multitasking performed by emergency department clinicians. Eighteen clinicians (licensed practical nurses, registered nurses and medical doctors), six from each occupational group, at two Swedish emergency departments were followed in their clinical work for 2 h each to observe all their activities and multitasking practices. Data were analysed using qualitative and quantitative content analysis. Fifteen categories of activities could be identified based on 1882 observed activities during the 36 h of observation. The most common activity was information exchange, which was most often performed face-to-face. This activity represented 42.1% of the total number of observed activities. Information exchange was also the most common activity to be multitasked. Registered nurses performed most activities and their activities were multitasked more than the other clinicians. The nurses' and doctors' offices were the most common locations for multitasking in the emergency department. This study provides new knowledge regarding the activities conducted by clinicians in the emergency department. The most frequent activity was information exchange, which was the activity most often performed by the clinicians when multitasking occurred. Differences between clinicians were found for activities performed and multitasked, with registered nurses showing the highest frequencies for both.

  12. 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

    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 i