The purpose of this research was to determine if significant differences exist between the APACHE II scores of intubated mechanically ventilated patients who ultimately received a tracheostomy and those who did not. In addition to this inquiry, the study also investigated the possibility of a range of APACHE II scores, a particular age group, and the presence of chronic organ insufficiencies and their relationship to the tracheostomy result. Methodology was non-experimental, quantitative, and retrospective. It was observational in that the goal was to simply record and quantify the potential association between these variables. Data was obtained from patients at Bristol Regional Medical Center from January 1- August 31, 2011. Information was calculated using descriptive statistics and the t-test for independent samples. Participants included all intubated mechanically ventilated patients who were at least eighteen years of age with a documented APACHE II score in the allotted time frame. There were 468 total patients, 79 (16.9%) of which received a tracheostomy. The mean APACHE II score for patients who received a tracheostomy was 21.8354 as compared to the mean APACHE II score of 21.6735 for those who were extubated. There was no significant difference between the APACHE II scores of these groups. The tracheostomy group had the highest frequency of patients with APACHE II scores of less than 25 and a range of 20-29. 84.8% of tracheostomy patients had some form of chronic organ dysfunction. Respiratory failure was the most frequent admitting diagnosis for all 468 patients and respiratory insufficiency was the most prevalent co-morbidity for the tracheostomy patients. The age range that included more tracheostomy patients was 65-74. 40% of re-intubated patients eventually received a tracheostomy and 69.6% of tracheostomy patients had the procedure performed early (within the first seven days of intubation). The managerial team of this respiratory therapy department decided to stop calculating the APACHE II score on all intubated patients in an attempt to save time and staff resources.

The purpose of the study was to identify NANDA - I diagnoses, NOC outcomes, and NIC interventions used in nursing care plans for ICU patient care and determine the factors which influenced the change of the NOC outcome scores. This study was a retrospective and descriptive study using clinical data extracted from the electronic patient records of a large acute care hospital in the Midwest. Frequency analysis, one-way ANOVA analysis, and multinomial logistic regression analysis were used to analyze the data. A total of 578 ICU patient records between March 25, 2010 and May 31, 2010 were used for the analysis. Eighty - one NANDA - I diagnoses, 79 NOC outcomes, and 90 NIC interventions were identified in the nursing care plans. Acute Pain - Pain Level - Pain Management was the most frequently used NNN linkage. The examined differences in each ICU provide knowledge about care plan sets that may be useful. When the NIC interventions and NOC outcomes used in the actual ICU nursing care plans were compared with core interventions and outcomes for critical care nursing suggested by experts, the core lists could be expanded. Several factors contributing to the change in the five common NOC outcome scores were identified: the number of NANDA - I diagnoses, ICU length of stay, gender, and ICU type. The results of this study provided valuable information for the knowledge development in ICU patient care. This study also demonstrated the usefulness of NANDA - I, NOC, and NIC used in nursing care plans of the EHR. The study shows that the use of these three terminologies encourages interoperability, and reuse of the data for quality improvement or effectiveness studies.

A pediatric intensivist in the University of Iowa Hospitals and Clinic's (UIHC) Pediatric Intensive Care Unit (PICU) was concerned about antimicrobial use in the unit. However, no one had quantified antimicrobial use in the UIHC's PICU or described the patterns of antimicrobial use in this unit. To address the intensivist's concern, the principal investigator (PI) conducted a retrospective study to determine the percentage of patients who received antimicrobial treatments, to determine the indications for antimicrobial use, and to identify antimicrobial agents used most frequently in the unit. On basis of our data, we hypothesized that empiric antimicrobial use, particularly the duration of therapy, could be decreased. We implemented a six-month intervention during which we asked the pediatric intensivists to complete an antimicrobial assessment form (AA) to document their rationale for starting antimicrobial treatments. We postulated that this documentation process might remind physicians to review antimicrobial therapies, especially empiric therapies, when the microbiologic data became available. In addition, we utilized the AA form to identify factors pediatric intensivists considered when deciding to prescribe empiric antimicrobial treatments. Data from the AA forms suggested that pediatric intensivists in the UIHC's PICU often considered elevated C-reactive protein, elevated white blood cell counts, and elevated temperatures when deciding to start empiric antimicrobial therapy. Data from the three nested periods showed that the median duration of empiric and targeted treatments decreased during the intervention and remained stable during the post-intervention period. The PI estimated that 193 days of empiric antimicrobial therapy and 59 days of targeted antimicrobial therapy, respectively, may have been saved by the decreased durations of therapy. Time series analysis assessing the trend in use of piperacillin-tazobactam, cefepime, and ceftriaxone (measured in mg/wk) did not reveal a significant change over time. On the basis of our results, an intervention strategy using an AA form alone may not be an effective strategy for antimicrobial stewardship in PICUs. Additional measures such as automatic stop orders and computer decision support may be useful for reducing the duration of empiric therapy in PICUs.

<p>Syftet med denna studie var att beskriva i vilka situationer IVA-sjuksköterskor upplever stress och hur de hanterar stressen i det vardagliga arbetet. Studien hade en beskrivande design med kvalitativ ansats. I studien deltog 10 intensivvårdssjuksköterskor. Inklusionskriterierna var att sjuksköterskorna skulle ha en specialistutbildning, och de skulle ha arbetat mer än ett år som intensivvårdsjuksköterska. Data samlades in med en semistrukturerad intervju som varade mellan 7 till 25 minuter. De teman som växte fram under bearbetning av data var ´Låg påverkansmöjlighet, höga arbetskrav och avsaknad av bekräftelse leder till rädsla för att tappa kontrollen´, Obalans mellan krav och bemanning´ samt ´Stödjande faktorer och eget ansvar kan minska stressupplevelsen´. Slutresultatet visade på att IVA-sjuksköterskor upplevde stress i situationer när arbetskraven var för många och ledde till oro för att tappa kontrollen. De höga kraven och otillräcklig bemanning ledde till en obalans där IVA-sjuksköterskorna upplevde otillräcklighet i sitt arbete. Stöd från arbetskollegorna samt individuella sätt att hantera den egna stressen, ansågs vara ett sätt att hantera stress på arbetsplatsen bland intensivvårdssjuksköterskorna. Sammanfattningsvis kan sägas att IVA-sjuksköterskorna upplevde stress på sin arbetsplats av olika orsaker samt att hanteringen av stressen skedde främst via ventilering med arbetskollegor.</p> / <p>The aim of the study was to describe in what situations Intensive Care Unit (ICU) nurses experiences stress and how they cope with the stress in the ordinary work. The study had a descriptive design with a qualitative approach. Ten intensive care nurses took part in the study. The inclusions criteria were that the nurses had an education in intensive care and had worked more than a year as an intensive care nurse. The data were collected with a semi- structured interview that lasted between 7 to 25 minutes. The themes developed from the data were ‘Low influence possibility, high work demands and lack of confirmation leads to fear of loosing the control’, ‘Imbalance between demands and number of staff’, and ‘Supportive factors and own responsibility can reduce the stress experience’ The final result showed that nurses experience stress in situations when the work demands were to high which led to anxiety of loosing control. High demands and insufficient number of staff led to an imbalance and the nurses felt inadequacy in their work. Support from the colleagues and own individual ways to handle the stress, were considered to be ways to cope with it among the nurses. To sum up, the intensive care nurses experienced stress their workplace from various causes and they coped with their stress principally through ventilation with their colleagues.</p>

Syftet med denna studie var att beskriva i vilka situationer IVA-sjuksköterskor upplever stress och hur de hanterar stressen i det vardagliga arbetet. Studien hade en beskrivande design med kvalitativ ansats. I studien deltog 10 intensivvårdssjuksköterskor. Inklusionskriterierna var att sjuksköterskorna skulle ha en specialistutbildning, och de skulle ha arbetat mer än ett år som intensivvårdsjuksköterska. Data samlades in med en semistrukturerad intervju som varade mellan 7 till 25 minuter. De teman som växte fram under bearbetning av data var ´Låg påverkansmöjlighet, höga arbetskrav och avsaknad av bekräftelse leder till rädsla för att tappa kontrollen´, Obalans mellan krav och bemanning´ samt ´Stödjande faktorer och eget ansvar kan minska stressupplevelsen´. Slutresultatet visade på att IVA-sjuksköterskor upplevde stress i situationer när arbetskraven var för många och ledde till oro för att tappa kontrollen. De höga kraven och otillräcklig bemanning ledde till en obalans där IVA-sjuksköterskorna upplevde otillräcklighet i sitt arbete. Stöd från arbetskollegorna samt individuella sätt att hantera den egna stressen, ansågs vara ett sätt att hantera stress på arbetsplatsen bland intensivvårdssjuksköterskorna. Sammanfattningsvis kan sägas att IVA-sjuksköterskorna upplevde stress på sin arbetsplats av olika orsaker samt att hanteringen av stressen skedde främst via ventilering med arbetskollegor. / The aim of the study was to describe in what situations Intensive Care Unit (ICU) nurses experiences stress and how they cope with the stress in the ordinary work. The study had a descriptive design with a qualitative approach. Ten intensive care nurses took part in the study. The inclusions criteria were that the nurses had an education in intensive care and had worked more than a year as an intensive care nurse. The data were collected with a semi- structured interview that lasted between 7 to 25 minutes. The themes developed from the data were ‘Low influence possibility, high work demands and lack of confirmation leads to fear of loosing the control’, ‘Imbalance between demands and number of staff’, and ‘Supportive factors and own responsibility can reduce the stress experience’ The final result showed that nurses experience stress in situations when the work demands were to high which led to anxiety of loosing control. High demands and insufficient number of staff led to an imbalance and the nurses felt inadequacy in their work. Support from the colleagues and own individual ways to handle the stress, were considered to be ways to cope with it among the nurses. To sum up, the intensive care nurses experienced stress their workplace from various causes and they coped with their stress principally through ventilation with their colleagues.

The purpose of this study was to develop a theory to explain how nurses experience and respond to uncertainty arising from patient care-related situations and the influence of uncertainty on their information behaviour. Strauss and Corbin’s (1998) grounded theory approach guided the study. Semi-structured face-to-face interviews were conducted with 14 staff nurses working in an adult medical-surgical intensive care unit (MSICU) at one of two participating hospitals. The grounded theory recognizing and responding to uncertainty was developed from constant comparison analysis of transcribed interview data. The theory explicates recognizing, managing, and learning from uncertainty in patient care-related situations. Recognizing uncertainty involved a complex recursive process of assessing, reflecting, questioning and/or predicting, occurring concomitantly with facing uncertain aspects of patient care situations. Together, antecedent conditions and the process of recognizing uncertainty shaped the experience of uncertainty. Two main responses to uncertainty were physiological/affective responses and strategies used to manage uncertainty. Resolved uncertainty, unresolved uncertainty, and learning from uncertainty experiences were three consequences of managing uncertainty. The ten main categories of antecedent, actions and interactions, and consequences that comprised the theory were interrelated and connected through temporal and causal statements of relationship. Nurse, patient, and contextual factors were linked through patterns of conditions and intervening relational statements. Together, these conceptual relationships formed an explanatory theory of how MSICU nurses experienced and responded to uncertainty in their practice. This theory provides understanding of how nurses think through, act and interact in patient situations for which they are uncertain, and provides insight into the nature of the processes involved in recognizing and responding to uncertainty. Study implications for practice, nursing education, and further theory development and research are discussed.

The purpose of this study was to develop a theory to explain how nurses experience and respond to uncertainty arising from patient care-related situations and the influence of uncertainty on their information behaviour. Strauss and Corbin’s (1998) grounded theory approach guided the study. Semi-structured face-to-face interviews were conducted with 14 staff nurses working in an adult medical-surgical intensive care unit (MSICU) at one of two participating hospitals. The grounded theory recognizing and responding to uncertainty was developed from constant comparison analysis of transcribed interview data. The theory explicates recognizing, managing, and learning from uncertainty in patient care-related situations. Recognizing uncertainty involved a complex recursive process of assessing, reflecting, questioning and/or predicting, occurring concomitantly with facing uncertain aspects of patient care situations. Together, antecedent conditions and the process of recognizing uncertainty shaped the experience of uncertainty. Two main responses to uncertainty were physiological/affective responses and strategies used to manage uncertainty. Resolved uncertainty, unresolved uncertainty, and learning from uncertainty experiences were three consequences of managing uncertainty. The ten main categories of antecedent, actions and interactions, and consequences that comprised the theory were interrelated and connected through temporal and causal statements of relationship. Nurse, patient, and contextual factors were linked through patterns of conditions and intervening relational statements. Together, these conceptual relationships formed an explanatory theory of how MSICU nurses experienced and responded to uncertainty in their practice. This theory provides understanding of how nurses think through, act and interact in patient situations for which they are uncertain, and provides insight into the nature of the processes involved in recognizing and responding to uncertainty. Study implications for practice, nursing education, and further theory development and research are discussed.

Bakgrund: Att bli mamma till ett för tidigt fött barn (&lt;37 gestationsveckor) innebär en oväntad stress vilket påverkar hela familjen. Under de senaste årtionden har stora förbättringar skett inom perinatal vård och numera är chansen till överlevnad stor. Att barnet efter födseln vårdas på neonatal intensivvårdsavdelning (NICU) får konsekvenser för mamman både känslomässigt och i omvårdnaden av barnet. Syfte: Att undersöka föräldrastress och beskriva faktorer som påverkar tidig föräldrastress hos mammor till för tidigt födda barn när barnet är två månader i korrigerad ålder. Metod: Studien utfördes på fyra NICU i Sverige. Inklusionskriterierna för studien var att barnet var för tidigt fött samt vårdades på neonatalavdelning i minst 72 timmar. För att mäta upplevd föräldrastress fick mammorna (n=276) svara på enkäten Swedish Parental Stress Questionnaire (SPSQ) när barnet var två månader i korrigerad ålder. Resultat: Mammor vars barn inte vårdades på en samvårdsavdelning, som hade barn i kuvös, mammor till barn med äldre syskon, var äldre, rökte och/eller ammade helt upplevde mer föräldrastress än övriga mammor. Slutsats: Studien visar att faktorer i framför allt i miljön samt hos mamman har betydelse för upplevd föräldrastress. Våra resultat innebär att omhändertagandet bör bli bättre, både under tiden på neonatalavdelning men även efter utskrivning. Då studien också påvisar vikten av samvårdsavdelning bör förbättringar ske i den fysiska vårdmiljön för att minimera upplevelsen av föräldrastress. / Background: When an infant is born preterm (&lt;37 gestational weeks) unexpected stresses affect the whole family. Significant improvements in the perinatal care has been made in the recent decades and now the chance of survival is high. To become a mother in a Neonatal Intensive Care Unit (NICU) entail consequences for the mother emotionally and in her care for her infant. Aim: To investigate parental stress and describe factors associated to early parenting stress in mothers of preterm infants at two months of corrected age. Method: The study was conducted in four NICUs in Sweden. The inclusion criteria were that the infant was born prematurely and had a hospital stay for at least 72 hours. To measure perceived parental stress, the mothers (n=276) answered the Swedish Parental Stress Questionnaire (SPSQ) at two months of corrected age. Results: Mothers whose infants were not cared for in a NICU with co-care, whose infants were cared for in an incubator, who were multiparous, older, who smoked and/or who were breastfeeding exclusively, experienced more stress than their counterparts in various dimensions explored. Conclusion: The study shows that factors relating to the environment and the mother are associated to parental stress among mothers’ of preterm infants. These findings show the need for improved support, both during the NICU stay and after discharge. These findings also highlight the need for improvements in the physical environment of the NICUs to reduce the risk for parental stress.

Inledning Intrahospitala transporter av intensivvårdpatient är ett ansvarsfullt arbetsmoment och en stor del av intensivvårdssjuksköterskans och undersköterskans arbete. Det är riskfyllt eftersom tillbud med patient och utrustning kan ske. Syfte: Syftet var att beskriva förekomsten av tillbud och typ av tillbud under intrahospitala transporter av intensivvårdspatienter, samt jämföra om det finns skillnader i förekomst av antalet tillbud under olika tidpunkter på dygnet och skillnad mellan akut respektive planerad transport. Syftet var också att undersöka sjuksköterskors och undersköterskors upplevda grad av stress och trötthet under transporten samt om det finns skillnad i förekomst av trötthet och/eller stress vid transporter där det sker tillbud respektive inte sker tillbud. Metod: Studien är kvantitativ, deskriptiv och jämförande. Förekomst av tillbud samt upplevelse av stress/trötthet besvarades på ett svarsformulär av sjuksköterska och undersköterska under eller direkt efter intrahospital transport. Totalt ingår 42 transporter. Resultat: Tillbud förekom vid 19 transporter. Inga skillnader i förekomst av tillbud mellan dagtransporter och nattransporter eller mellan akuta och planerade transporter kunde ses. Sjuksköterskor och undersköterskor rapporterade mer stress vid de transporter där det förekommit tillbud än vid de där tillbud inte förekommit. Slutsats: Tillbud förekommer i knappt hälften av intrahospitala transporter och sjuksköterskor och undersköterskor rapporterar mer stress i samband med transporter med tillbud än transporter utan tillbud. / Introduction: Intrahospital transport of critical care patient is a responsible working operation and much of the critical care nurse and the assistant nurses´ work. It is risky, because incidents of patient and equipment can happen. Purpose: The objective was to describe the occurrence of incidents and types of incidents during intrahospital transport of ICU patients, and compare if there are differences in the occurrence of incidents during different times of day and the difference between emergency and planed transportation. The aim was to investigate nurses and assistans nurses´ perceived level of stress and fatigue during transport and if there are differences in the incidence of fatigue and/or stress during transport where  incidents occurs or not occurs. Method: The study is quantitative, descriptive and comparative. The presence of the incident and the experience of stress/fatigue were answered on a response form of nurses and assistant nurse during or immediately after intrahospital transport. A total of 42 transports are included. Results: Adverse events occurred at 19 transports. No differences in the occurrence of incidents between day transports and night transport or between acute and planned transports could be seen. Nurses and assistant nurses reported more stress during the transports, where there have been adverse events than in those were adverse events had not occurred. Conclusion: Adverse events occurs in almost half of intrahospital transport and nurses and assistant nurses reported more stress associated with transports with adverse events other than the transports without adverse events.

Vårdas på en intensivvårdsavdelning och vara allvarligt sjuk är för många en obehaglig upplevelse. Övervakning och behandling av vitala funktioner sker dygnet runt i en miljö som är främmande för patienten. Många patienter har på grund av läkemedel och behandling svårt att kommunicera, vilket kan leda till minnesförlust och hallucinationer. Sjuksköterskan kan som en del i omvårdnaden skriva en dagbok över vårdtiden. Syftet med litteraturstudien var att belysa patientens upplevelser av att läsa sin dagbok över vårdtiden på intensivvårdavdelningen och hur det kan påverka patientens återhämtning. Tolv artiklar analyserades och sammanställdes i fem kategorier: Upplevelse av att få och läsa sin dagbok, Betydelsen av att känna sig omhändertagen, Att få insikt i sin egen sårbarhet, Att tolka minnen och fylla minnesluckor och Dagbokens betydelse för återhämtningen. Många patienter mår psykiskt dåligt efter intensivvårdstiden. Resultat visar att dagboken hjälpte dem att hantera tiden efteråt med att fylla minnesluckor och snabbare återhämta sig. Patienterna upplevde sig mer omhändertagna och såg dagboken som en gåva. För att hjälpa patienten på bästa sätt skulle vidare forskning om vad dagboken bör innehålla vara av intresse. / To become seriously ill and cared for in an intensive care unit is for many an unpleasant experience. Monitoring and treatment of vital functions takes place around the clock in an environment that is foreign to the patient. Many patients, due to drug treatment and difficulties in communication, can suffer from memory loss and hallucinations. As an act of caring, the nurse can write a diary throughout the hospital stay. The aim of this study was to focus on the patient's experience of reading a personal diary of their time in the intensive care unit and assess how it can affect the patient's recovery. Twelve articles were analyzed and summarized in five categories: Experience of receiving and reading the diary, The importance of feeling cared for, To gain insight into their own vulnerability, To interpret memories and fill memory gaps and The diary's importance for recovery. Many patients feel unpleasant after a period of intensive care. Results have shown that the diary helped them cope with time afterwards as it filled memory gaps which supported a faster recovery. Patients felt a greater level of care and received the diary as a gift. To optimize this support for the patient, further research on what the diary should contain would be of interest.