PURPOSE: The purpose of this qualitative descriptive study was to describe critical care nurses’ experiences of moral challenges, moral distress, and moral resilience during the COVID-19 pandemic. The specific aims of this study were to: 1. Describe the moral challenges experienced by ICU nurses. 2. Describe moral resilience in terms of integrity, buoyancy, moral efficacy, self-regulation, and self-stewardship among ICU nurses (from Rushton’s framework). 3. Explore the relationship between moral distress and moral resilience to advance the concept of moral resilience in the face of the COVID-19 pandemic. FRAMEWORK: This study was undergirded by an adaptation of Rushton’s conceptual framework of moral concepts. DESIGN: A qualitative descriptive design was used. Participants were recruited between January to May 2021, and a semi-structured interview guide was utilized to interview participants. RESULTS: 17 participants were interviewed for the study. Participants described the four themes of moral challenges: death and dying, pain and suffering, being alone, and being helpless and not in control. Moral resilience was described as: integrity, buoyancy, moral efficacy, self-regulation, self-stewardship, and self-perception. The relationship between moral distress and moral resilience was described as iterative and fluid. CONCLUSION: The findings of the study provided a new domain of moral resilience called self-perception and a revised adaptation of the conceptual framework for moral resilience.

Sleep deprivation is a multifactorial phenomenon, occurring frequently in the intensive care unit (ICU) and linked to adverse patient healthcare outcomes. The key practice question of this project focused on determining if retiming of routine laboratory and imaging testing outside of the designated “quiet time” can improve sleep quality among adult patients in the ICU. The purpose was to evaluate the effectiveness of implementing an evidence-based intervention to improve sleep quality in the ICU setting. The theoretical framework was the plan-do-study-act model, which offered a process for implementing a practice change and reevaluation of the intervention’s sustainability within the organization. A thorough literature search of over 100 scholarly journal articles, book references, and expert scholarly reports was completed to gain an understanding of this phenomenon in the ICU setting. The Richards-Campbell Sleep Questionnaire (RCSQ) was the data collection tool used to measure improvement in sleep quality. There were 72 participants that are included in the project. The Wilcoxon rank sum and chi square tests were used for the statistical analysis. The findings did not show statistical significance in the improvement in the RCSQ scores after implementation of the intervention. The recommendations include sleep deprivation training for nursing staff and providers, routine use of the RCSQ for data collection, and repeating the study with an increased number of participants and redefined inclusion and exclusion criteria to be more representative of the ICU patient population. The implication for social change is that this project empowers nursing to embrace a leadership role in using evidence-based practice to change clinical guidelines and improve patient outcomes.

Please read the abstract in the front section of this document / Dissertation (MSc (Medical Microbiology))--University of Pretoria, 2005. / Medical Microbiology / unrestricted

Intensivvårdsplatserna är få och behövs till de mest kritisk sjuka. Patienten på intensivvårdsavdelningen (IVA) är kontinuerligt övervakad och personalen är ständigt nära. På vårdavdelningen lämnas patienten ensam i större utsträckning då färre personal vårdar fler patienter. Otillräcklig kommunikation vid förflyttning kan leda till att viktig information missas. Det leder till brister i patientsäkerheten. Frågan är om det finns något i förflyttningsprocessen som kan förbättras för att öka patientsäkerheten? Syftet med denna kvalitativa intervjustudie var att belysa hur sjuksköterskan på vårdavdelning upplevde förflyttning av patient från intensivvård till vårdavdelning. Studien gjordes i form av fokusgruppsintervjuer och nio sjuksköterskor deltog. Resultatet redovisades i fyra huvudkategorier. Det som framkom var att sjuksköterskan på vårdavdelningen inte upplevde sig delaktig i förflyttningsprocessen. Det resulterade i att det blev kort tid för förberedelser och svårt att hinna ordna en plats på avdelningen. Det var oftast en bra rapport från IVA- sjuksköterskan men det saknades behandlingsplan och mål vilket försvårade arbetet och gjorde sjuksköterskan osäker på hur hon/han skulle agera. Ordinationerna var många gånger bristfälliga och resulterade i att mycket tid gick åt att reda ut oklarheter. Arbetsbördan ökade för sjuksköterskan på vårdavdelningen när IVA- patienten överlämnades. Patienten var inte alltid tillräckligt stabil medicinskt och krävde ständig tillsyn. Sjuksköterskorna skrev sällan avvikelser på oönskade händelser i samband med förflyttningen. Slutsatsen var att samarbete och stöd mellan IVA och vårdavdelning förstärkte patientsäkerheten. / The beds in the Intensive Care Unit (ICU) are few and are for the most critically ill people. The patient in the ICU is under constant supervision and the personnel are close at all times. The patients in the general ward are often left alone for longer periods of time, because a small amount of personnel is treating large number of patients. Inadequate communication during transformation can lead to missing information. It leads to deficiencies in the patient safety. The question is if there is something that can make the transfer process better to increase the patient safety? The purpose with this qualitative interview study was to illustrate how the ward nurse experience the transfer of a patient from the ICU to the general ward. Data was collected from focus group interviews. A total of nine nurses participated. The result was declared in four different main categories. It was shown that the nurse on the ward did not feel assessorial in the transfer process. The result of that makes it harder to prepare a place for the patient, there is not enough time. Most of the time the nurse would get a good report from the ICU- nurse but there was some missing information. The missing information was a plan and what the goal was. It made the work harder and it made the nurse unsure of how she/he should act. The ordinations were often inaccurate. It resulted in a lot of time spent to sort out obscurities. The workload increased for the nurse on the ward when the ICU-patient was delivered. The patient was not always fully stable medically and it claimed constant supervision. The nurses rarely wrote deviations on the unwished incidence associated with the transfer. The conclusion was that a good collaboration and support between the ICU and the ward increased the patient safety.

Background: Critical Care Nurses (CCNs) frequently provide end of life (EOL) care in intensive care units (ICUs). Barriers to EOL care in ICUs exist and have been previously published, but qualitative reports from CCNs themselves remain scarce. Qualitative data exploring barriers faced during ICU EOL care may increase awareness of obstacles and help remove them. Objective: Excluding family experiences, what are the major themes recounted by CCNs when asked to share common obstacles experienced in providing ICU EOL care? Methods: Members of the American Association of Critical-Care Nurses were randomly surveyed and responses to a single qualitative question were used. Results: There were 104 participants who provided 146 responses reflecting EOL obstacles which were divided into 11 themes; 6 physician- related obstacles and 5 nursing-and-other related obstacles. Top three EOL ICU barrier themes were inadequate physician communication, physicians giving false hope and nursing-related obstacles. Conclusion: Poor physician communication is the main obstacle noted by CCNs during ICU EOL care followed by physicians giving false hope. Heavy patient workloads were also a major barrier in CCNs providing EOL care.

Approximately 55% of intensive care unit (ICU) patients require the use of a central venous catheter (CVC). CVCs are often an essential component of care; however, CVCs can create avenues for pathogens to enter the bloodstream and cause a central line-associated bloodstream infections (CLABSI), which can lead to increased mortality and morbidity, prolonged length of stay, increased cost of care, decreased patient satisfaction, and increased workload. In 2017, the CLABSI rate at the project site was 4.3 per 1,000 catheter days as compared to the national rate of 0.8 per 1,000 catheter days. Based on Piaget's theory of constructivism, a simulation-based staff educational program was developed and implemented by ICU staff (n=20). Following the implementation of the simulation-based program, adherence to CVC maintenance guidelines improved from 41.5% to 87.9%. A sample t-test showed that this improvement was statistically significant and the CLABSI rate declined to 1.24 per 1,000 catheter days in the 4-week period following implementation of the program. Findings show that introducing a simulation-based training program might help to reduce CLABSI rates in the ICU setting and contribute to positive social change by improving health outcomes in ICU patients with a CVC.

Clinical social workers have roles in providing end-of-life care in the United States. Although clinical social workers are present in the intensive care unit (ICU) setting and have expertise to address end-of-life care dynamics, social workers are not consistently included in end-of-life discussions in the ICU setting. The purpose of this action research study was to explore the barriers that prevent clinical social workers from being included in end-of-life discussions in the ICU and how clinical social workers perceive their roles in end-of-life discussions in the adult ICU setting. Open-ended questions were used to gather data by facilitating 4 focus groups with 17 clinical social workers employed at a Florida hospital. This study was guided by complexity theory, which is concerned with complex systems and how systems can produce order while simultaneously creating unpredictable system behavior. A thematic analysis coding technique was used to analyze the data collected. Three themes emerged from data analysis: the ICU setting as chaotic, complex, and unpredictable; role ambiguity; and lack of confidence of social workers to perform expected roles in end-of-life discussions. The implications of this study for social work practice and social change relate to closing the gap between the patient, family members, social workers, and the medical team by developing protocols that consistently include social workers in end-of-life discussions, including education for the multidisciplinary team in the ICU on the skill set and role of clinical social workers in end-of-life discussions and formal training and education for clinical social workers regarding end-of-life care.

Indiana University-Purdue University Indianapolis (IUPUI) / Healthcare providers in hospital intensive care units (ICUs) maintain patient situation awareness by following task management and communication practices. They create and manipulate several paper-based and digital information sources, with the overall aim to constantly inform themselves and their colleagues of dynamically evolving patient conditions. However, when increased communication means that healthcare providers potentially interrupt each other, enhanced patient-situation awareness comes at a price. Prior research discusses both the use of technology to support increased communication and its unintended consequence of (wanted and unwanted) notification interruptions. Using qualitative research techniques, I investigated work practices that enhance the patient-situation awareness of physicians, fellows, residents, nurses, students, and pharmacists in a medical ICU. I used the Locales Framework to understand the observed task management and communication work practices. In this study, paper notes were observed to act as transitional artifacts that are later digitized to organize and coordinate tasks, goals, and patient-centric information at a team and organizational level. Non digital information is often not immediately digitized, and only select information is communicated between certain ICU team members through synchronous mechanisms such as face-to-face or telephone conversations. Thus, although ICU providers are exceptionally skilled at working together to improve a critically ill patient’s condition, the use of paper-based artifacts and synchronous communication mechanisms induces several interruptions while contextually situating a clinical team for patient care. In this dissertation, I also designed and evaluated a mobile health technology tool, known as PANI (Patient-centered Notes and Information Manager), guided by the Locales framework and the participatory involvement of ICU healthcare providers as co designers. PANI-supported task management induces minimal interruptions by: (1) rapidly generating, managing, and sharing clinical notes and action-items among clinicians and (2) supporting the collaboration and communication needs of clinicians through a novel visual and tactile notification system. The long-term contribution of this research suggests guidelines for designing mobile health technology interventions that enhance ICU patient situation-awareness and reduce unwanted interruptions to clinical workflow.

The incidence of acute myocardial infarction is still high. One of the methods of reperfusion therapy is the cardiac surgery by coronary artery bypass graft, which may be postoperatively complicated by the development of postcardiotomy cardiogenic shock with the urgency of the venoarterial extracorporeal membrane oxygenation (V-A ECMO). The quality of very specialized and complex care for these long-term hospitalized patients depends on understanding their needs and ways of saturation. The aim of this study is to present these needs from the perspective of the patient and their family. Research questions ain to identify the main aspect of recovery, the factors negatively affecting the mental state of patients, the ways to help them by healthcare professionals and family, how can healthcare professionals help the family and how this experience has affected both the family and the patient. The research is carried out using a qualitative method of semistructured interview with six respondents with this type of anamnesis, who were hospitalized between 2015 and 2021 in the ICU of cardiac surgery department, and three of their relatives. According to the study's findings the main aspect of recovery is the patient's mental well-being. The dependence on help of others, muscle weakness and loss of intimacy...

京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第20504号 / 情博第632号 / 新制||情||110(附属図書館) / 京都大学大学院情報学研究科知能情報学専攻 / (主査)教授 鹿島 久嗣, 教授 山本 章博, 教授 阿久津 達也 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM