Lidande utgör ett hot mot hela människan som ej kan undflys. Patientens lidande påverkar vårdaren. Det skapar ett eget lidande i sjuksköterskan som inte kan lindra patientens lidande eller till och med orsakar ytterligare lidande. Också anhörigas lidande påverkar intensivvårdssjuksköterskan. Syftet med uppsatsen var att beskriva hur intensivvårdssjuksköterskor upplevde att vårda patienter med svårt lidande. En deskriptiv, semistrukturerad intervjuundersökning genomfördes med tre intensivvårdssjuksköterskor och tolkades medelst innehållsanalys. Resultat: Temat Lidandet genomsyrar sjuksköterskans värld identifierades och handlade om hur sjuksköterskan måste hantera sitt eget lidande likväl som patientens och anhörigas. Temat var uppbyggt av tre kategorier. Lidandets former beskrev det lidande informanterna mötte på intensivvårdsavdelningen. Lidandets samspel beskrev hur positiva och negativa känslor väcktes i samarbetet med lidande patienter, anhöriga och kollegor. Att göra den andres lidande till sitt eget beskrev sjuksköterskans personliga, ofta negativa, känsloupplevelser som aktualiserades vid mötet med stort lidande. / Suffering is an unavoidable threat to the individual as a whole. Suffering of patient and relatives affects the nurse, and creates a personal suffering when incapable of relieving the patients suffering, or inflicting even more. The purpose of this study was to describe how ICU nurses experienced caring for suffering patients. A descriptive, semi-structured interview study was conducted on ICU nurses and interpreted by content analysis. Result: The theme Suffering permeates the nurse’s world was identified and described how the suffering of patient, relatives and self had to be handled by the nurse. The theme consisted of three categories. The manifestation of suffering described how suffering in the ICU is perceived. The interaction of suffering described how cooperating with suffering patients, relatives and colleagues caused negative and positive emotions. Integrating suffering of the other described often negative personal emotions of the nurse evoked when encountering suffering. / <p>2010 felaktigt årtal titelsida</p>

This thesis presents the development and evaluation of a computerized physician-parent decision support tool for a neonatal intensive care unit (NICU), known as Physician and Parent Decision Support (PPADS). The NICU is a specialized hospital unit that treats very-ill neonates. Many difficult care decisions are made daily for this vulnerable population. The PPADS tool aims to augment current NICU decision-making by helping parents and physicians make more informed decisions, improving physician-parent communication, increasing parent decision-making satisfaction, decreasing conflict, and increasing decision efficiency. The development of the PPADS tool followed a five-step methodology: assessing the clinical environment, establishing the design criteria, developing the system design, implementing the system, and performing usability testing. Usability testing of the PPADS tool was performed on neonatologists and on parents of neonates who have graduated (survived) from a tertiary level NICU. The usability testing demonstrated the usefulness and ease of use of the tool.

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第22779号 / 工博第4778号 / 新制||工||1747(附属図書館) / 京都大学大学院工学研究科電気工学専攻 / (主査)教授 土居 伸二, 教授 萩原 朋道, 教授 小林 哲生, 教授 古谷 栄光 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

Background: The withdrawal of invasive mechanical ventilation (MV) within the context of withdrawal of life-sustaining measures (WLSM) is common in the intensive care unit (ICU). The method by which invasive MV is withdrawn during WLSM remains an ongoing topic of discussion and research; two methods are terminal weaning (TW) and terminal extubation (TE). Aims: To statistically describe and compare the processes of TW and TE as undertaken in two ICUs. Study Design: A secondary data analysis using data from a longitudinal retrospective chart audit. Results: A total of 78 patient charts were included. MV was withdrawn in 88.5% of patients undergoing WLSM. TW was used in 62.3% of the cases while TE was used in 37.7%. Patients who underwent TW were on average younger, had a longer ICU stay, higher respiratory support requirements, a longer duration of invasive MV, and shorter period from first change in MV parameters to patient death. Conclusion: This study highlights the nuances and complexities within MV withdrawal and WLSM in the ICU.

The purpose of this research was to offer a description of the complexity of nurses’ medication administration practices in relationships with technology. The clinical situations and circumstances in which nurses administer medications today are comprised of rapidly changing technological initiatives that are intended to support safe, efficient care. Nurses’ medication administration practices are not immune to a rapidly changing technological health care environment. Research and literature has documented medication administration occurs in complex situations and nurses apply particular knowledge that supports decision-making and clinical practices for patient safety. Praxiographic methodology was used to describe deeply embedded knowledge and values that shape and guide contemporary nursing practice. Lack of attention to knowledge and values that shape and guide nursing practice and care, may contribute to the risk that those practices may be lost as nurses retire amongst a rapidly changing healthcare environment. A highly technical Neonatal Intensive Care Unit (NICU) was the location for the study. Participants included twelve NICU nurses and a pharmacist. The research findings included the significance of understanding NICU nurses’ use of local and universal maps to navigate the complexity of medication administration. Furthermore, the research documented NICU nurses’ medication administration practices as inseparable from technology. Further practice-based research is recommended to support the development of technologies that incorporate nurses’ medication administration practices. / Graduate

Bakgrund: Av de ca 110 000 – 120 000 barn som föds årligen i Sverige, behöver drygt tio procent vård på neonatalavdelning. Att amma sitt barn har väldokumenterade fördelar och är särskilt anpassat för det individuella barnets behov vilket ger fördelar både på fullgångna och prematurfödda barn. Syfte: Syftet med studien är att belysa faktorer vilka påverkar det amningsfrämjande arbetet på neonatalavdelningar. Metod: Allmän litteraturöversikt som innefattar totalt 16 vetenskapliga artiklar. Samtliga artiklar vilka inkluderats i resultatet har granskats enligt kvalitetsmall. Resultat: Amning och bröstmjölk väcker starka och blandade känslor hos vårdpersonalen. Vårdpersonal som genomgått någon form av utbildning inom området amning var generellt mer positivt inställda till att ge amningsstöd trots påverkan på arbetsbördan. Flaskmatning sågs som ett bekvämt alternativ även om bröstmjölkens fördelar var väl kända. Slutsats: I vilken utsträckning amningsstöd utförs och vilken kvalitet det har beror på stor del på vårdpersonalens egna upplevelser och känslor gällande amning. Då få studier fanns att tillgå är det en indikation på att vidare forskning inom området behövs. / Background: In Sweden, approximately 110,000 – 120,000 babies are born every year. More than ten percent of all newborn babies born in Sweden are in need of care in neonatal care units. Breastfeeding has well-documented benefits and is specifically tailored to the needs of the individual child, providing benefits for both full-term and premature born babies. Aim: The purpose of the study is to shed light on factors that affect breastfeeding work in neonatal wards. Method: General literature review. Including a total of 16 scientific articles. All articles included in the results have been reviewed according to the quality template.  Results: Breastfeeding and breast milk triggered strong and mixed feelings in the health care workers. Healthcare professionals who had undergone some form of training in the field of breastfeeding were generally more positive towards providing breastfeeding support despite the impact on the workload. Bottle feeding was seen as a convenient option although the benefits of breast milk were well known. Conclusion: The extent to which breastfeeding support is performed and the quality of it depends largely on the healthcare staff's own experiences and feelings regarding breastfeeding. Since few studies were available, it is an indication that further research in the field is needed.

Bakgrund: Delirium hos intensivvårdspatienten är ett komplext neuropsykiatriskt syndrom med fluktuerande karaktär som kan leda till sämre prognos och ökat vårdlidande för patienten. Dessutom leder tillståndet till ökade samhällskostnader. Genesen tros vara multifaktoriell där risk och utlösande faktorer kan påverka förekomsten. Farmakologiska åtgärder har hittills tillämpats med otillräcklig framgång varför även omvårdnadsåtgärder rekommenderas. Syfte: Att sammanställa evidens för omvårdnadsåtgärder som kan förebygga delirium hos patienten på intensivvårdsavdelningen. Metoden: Metoden utgjordes av en integrativ litteraturstudien för att kartlägga och sammanställa aktuell forskning om omvårdnadsåtgärder som kan förebygga delirium. Totalt 15 artiklar från CINAHL och PubMed inkluderades. Resultat: Utifrån de inkluderade artiklarnas resultat kunde preventiva omvårdnadsåtgärder identifieras vilka presenteras i fyra huvudkategorier; Involvera närstående, Kognitivt stimulera patienten, Fysiskt stimulera patienten och Främja patientens sömn. Konklusion: Det framkommer att intensivvårdssjuksköterskan med till synes enkla omvårdnadsåtgärder kan förebygga delirium hos patienten. Flertalet omvårdnadsåtgärder kan ses som kopplade till människans fundamentala omvårdnadsbehov som idag redan är implementerade i vården. En viktig del i intensivvårdssjuksköterskans preventiva arbete är således att identifiera faktorer som kan utlösa delirium, och ständigt arbeta strukturerat och medvetet genom sina omvårdnadshandlingar. För att möjliggöra det behövs ett personcenterat förhållningssätt med utgångspunkt i patientens resurser. / Background: Intensive care unit delirium is a complex neuropsychiatric syndrome with a fluctuating nature that can impair the prognosis and increase suffering for the patient. In addition, the permit leads to increased societal costs. The genesis is considered multifactorial where risk and triggering factors may affect the occurrence. Common experiences among healthcare professionals is that the condition can be difficult to identify, manage and treat. Pharmacological interventions implemented have resulted in insufficient success, therefore nursing interventions are also recommended. Aim: To compile evidence about nursing interventions to prevent intensive care delirium. Method: The method consisted of an integrative literature study to map and compile current research involving delirium. A total of 15 articles from CINAHL and PubMed were included. Results: Based on the results of the included articles, preventive interventions could be identified into four main categories; Involve next of kind to the patient, Cognitively stimulate the patient, Physically stimulate the patient and Promoting patients normal sleep cycle. Conclusion: It appears that the intensive care nurse, with seemingly simple nursing measures, can prevent delirium in the patient. Most nursing measures can be seen as linked to the person's fundamental nursing needs that are already implemented in healthcare today. An important part of the intensive care nurse's preventive work is to be able to identify factors triggering delirium, and continuing structured work in a conscious way through their nursing actions. To enable this, a person-centered approach based on the patient's resources is needed.

Objectives: To describe the characteristics of children who died and their modes of dying in a South African Paediatric Intensive Care Unit (PICU). Design: Retrospective review of data extracted from the Child Healthcare Problem Identification Programme (Child PIP)and the PICU summary system (admission and death records) on children of any age who died in the PICU between 01 January 2013 and 31 December 2017. Setting: Single-centre tertiary institution. Patients: All children who died during PICU admission were included. Measurements and Main Results: Four-hundred and fifty-one (54% male; median (IQR) age 7 (1-30) months) patients died in PICU on median (IQR) 3 (1-7) days after PICU admission; 103 (22.8%) had a cardiac arrest prior to PICU admission. Mode of death in 23.7% (n=107) was withdrawal of life sustaining therapies; 36.1% (n=163) died after limitation of life sustaining therapies; 22.0% (n=99) died after failed resuscitation and 17.3% (n=78) were diagnosed brain dead. Ultimately, 270 (60%) children died after the decision to limit or withdraw life sustaining therapies. There was no difference in the number of deaths during office and after-hours periods (45.5% vs. 54%; p = 0.07). Severe sepsis (21.9%) was the most common condition associated with death, followed by cardiac disease (18.6%).Ninety-four (20.8%) patients were readmitted to the PICU within the same year; 278 (61.6%) had complex chronic disorders. During the last phase of life, 75.0% (n=342) were on inotropes, 95.9% (n=428) were ventilated, 12.0% (n=45) received inhaled nitric oxide and 10.8% (n=46) renal replacement therapy. Only 1.5% (n=7) of children became organ donors and postmortems were done in 47.2% (n=213) of the patients. Conclusions: Most PICU deaths occurred after a decision to limit or withdraw life-sustaining therapy. Severe sepsis was the most common condition associated with death. Referral for organ donation was extremely rare.

Family-centered care (FCC) is considered the gold standard for care delivery in the Neonatal Intensive Care Unit (NICU). However, there are challenges with the implementation of FCC in practice and there is limited literature about how to tailor this approach for specialized NICU populations. To explore FCC for surgical neonates in the NICU, the concept was explored using Roger’s evolutionary concept analysis. Results illustrate that FCC in the NICU is a philosophy or care, rather than a set of interventions. The subsequent cross-sectional descriptive exploratory study showed that the surgical infants in our sample (n=11) received a limited amount of skin-to-skin care (median 0 mins/day) and parents reported challenges to being involved in their infant’s care. This thesis supports the challenges with the implementation of FCC in practice and both the need to consider multiple perspectives and the need for broader systemic change in order to support a FCC philosophy.

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.