No description available.

By taking advantage of the increasing amount of available electronic health data, applications of machine learning in the intensive care unit have the potential to improve medical diagnostics and risk stratification. This thesis proposes an approach for early onset prediction of pneumothorax with such technique, using time series data extracted from a clinical database. The prevalence of pneumothorax among patients is identified through ICD-9 codes, and labels for the onset are obtained by relying on proxies closely related to the condition. Both simple algorithms and deep learning networks are used in a sliding window-based prediction framework, and the importance of each feature is measured with weighted Shapley values. The results proved the feasibility of this approach using Long Short-Term Memory models, although the number of false positives is noticeably high. Mechanical ventilation was the most contributing feature for the outcome. In future work, the focus should be on addressing the large class imbalance that prevails, along with considering more well-founded methods of target labeling.

In the intensive care unit, patients with crucial, life-threatening conditions are admitted and need constant monitoring. Here, the need for a quick and efficient decision support tool is the greatest. The use of machine learning has shown promising results in identifying patients at risk of different severe conditions in the intensive care unit and detection at an early stage is crucial in order to take preventive measures. This especially applies to conditions that can be hard to manage once developed, such as circulatory shock. In this master’s thesis, a machine learning modeling approach is suggested to detect and differentiate the onset of three types of circulatory shock – cardiogenic, hypovolemic and septic shock. Data was used from the open-source database MIMIC which represents thousands of patients from intensive care. The data was preprocessed and labels for the three shock types were created using ICD-9 codes combined with a proxy that is closely related to the condition – vasopressor. Different machine learning algorithms were then used for a static onset prediction as a base. The best performing models were also trained for a dynamic onset prediction in order to make predictions up to four hours ahead of onset. All models were evaluated using different evaluation metrics and at last, an interpretation method was used to enable a simpler interpretation of the results. The final results show that it is possible to detect and distinguish between the three types of shock, up to four hours ahead of onset. For future developments, further development and validation using more data should be the main focus before testing it in a clinical setting.

Introduktion: Akut konfusion är ett tillstånd som karakteriseras av akut kognitiv svikt och drabbar upp till 80% av kritiskt sjuka patienter på intensivvårdsavdelningar.  Tillståndet skapar ett lidande hos patienten och ger även negativa konsekvenser för anhöriga, vården och samhället. Behandlingen består i första hand av omvårdnadsåtgärder vilket ställer höga krav på sjuksköterskans kompetens.  Syfte: Syftet med studien var att beskriva vuxna patienters upplevelser av akut konfusion på intensivvårdsavdelning.  Metod: Allmän litteraturstudie med kvalitativ ansats. Tretton kvalitativa artiklar söktes i databaserna PubMed, CINAHL samt i metaanalysers referenslistor. Kvalitetsgranskningen utfördes med kvalitetsgranskningsmall från SBU. Resultatanalysen genomfördes med Forsberg & Wengströms analysmodell.  Resultat: I resultatet identifierades fem teman: upplevelser av sjuksköterskans och närståendes förhållningssätt och bemötande, upplevelser av perceptionsstörningar, upplevelser av att vara vilsen i tid och rum, upplevelser av skiftande sinnesstämning samt upplevelser av agitation och paranoia.  Slutsats: Patienternas upplevelser av akut konfusion beskrevs som ett lidande. De framkom att patienterna nyttjade olika copingstrategier för att hantera tillståndet. Genom att ha kunskap om detta kan sjuksköterskan vara ett stöd i att lindra patientens lidande. Patienters upplevelser behöver studeras ytterligare så sjukvårdspersonal kan utbildas vidare i ämnet och på så sätt erbjuda en god vård för denna patientgrupp. / Introduction: Acute confusion is a condition characterized by an acute cognitive failure and affects up to 80% of the severely ill patients in intensive care units. The condition contributes to suffering for the patient and also generates negative consequences for relatives, healthcare and society. The treatment is primarily nursing measures which makes high demands on nurses competence.  Aim: The aim of the study was to describe the adult patient's experience of acute confusion in the intensive care unit.  Method: A general literature study with a qualitative approach. Thirteen qualitative studies were found in the databases PubMed, CINAHL and through metaanalyzes references. The quality review was done implementing the quality review template from SBU. The result analysis was carried out using Forsberg and Wengströms analysis model.  Results: The result identified five themes: experiences of the nurse and relatives approach and reception, experiences of perception disorders, experiences of being disoriented in time and space, experiences of mood swings, and also experiences of agitation and paranoia.  Conclusion: Patients' experiences of acute confusion was described as a suffering. Patients used different coping strategies to manage their condition. With knowledge about the condition the nurse can be a support in easing the patients suffering. Patients' experiences need to be studied further so healthcare professionals can be educated about the subject and offer good care för this patient group.

Yes / Aim and Objectives: To explore fathers' views and experiences of providing Kangaroo Care (KC) to their baby cared for in a Neonatal Intensive Care Unit (NICU). Kangaroo Care has been known to improve the health outcome for preterm, low birth weight and medically vulnerable term infants and achieve the optimal perinatal health wellbeing for parents and infants. Historically, mothers are considered as the dominant KC providers, whereas fathers are spectators and have been overlooked. Little is known about the fathers' perspectives in providing KC in NICUs. Methods: Individual semi-structured interviews were conducted with 10 fathers who delivered KC to their baby when in the NICU. Data were analysed using Braun and Clarke's six-phase thematical framework. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was followed to report this qualitative study. Findings: Fathers in this study identified they were passing a silent language of love and connecting with their baby by the act of KC in a challenging environment. Three themes emerged: ‘Positive psychological connection’, ‘Embracing father-infant Kangaroo Care’ and ‘Challenges to father-infant Kangaroo Care’. Conclusion: The findings of this study show KC enhances the bonding and attachment between fathers and infants. The conceptualisation of the paternal role in caregiving to a newborn is evolving as a contemporary practice. Further research is warranted to confirm or refute the study findings. Policies and facilities should be modified to include father–infant KC within the fields of neonatal care. Relevance to Clinical Practice: It is important for nurses and other health professionals to support and enable fathers to give KC. Father–infant KC is recommended in neonatal care settings. / Open access publishing facilitated by University of South Australia, as part of the Wiley - University of South Australia agreement via the Council of Australian University Librarians.

Yes / . Kangaroo care (KC) has been used widely in neonatal care to promote bonding/attachment and neurodevelopment for preterm and term infants. However, current literature suggests that research mainly focuses on infants' and mothers' experiences. The role of fathers in caring for their infant/child is changing and evolving in many countries around the globe. Yet little is known about fathers' experiences of KC in neonatal units. This review, therefore, aims to scope the current evidence of Father-infant KC (Father KC) in Neonatal Intensive Care Units (NICUs). Research question. What impact does KC have upon fathers when their baby is cared for in NIUCs? Search method. A scoping review was conducted and guided by the framework of Arksey and O'Malley (2005). The data sources consisted of Medline, Embase, America Psychological Association (APA) PsycInfo, Emcare, Cochrane Central, Web of Science, Google Scholar and ProQuest. The study inclusion criteria were: (1) studies involving fathers who had experience of KC with their baby whilst in Neonatal Intensive Care Units (NICUs), and other neonatal care settings, such as Special Care Baby Nursery (SCBU), delivery/labour room and postnatal ward; (2) literature published from 2000 to 2020; (3) primary studies including qualitative, quantitative, and mixed methods studies; (4) studies published in English. Results. The total number of studies identified were 13. Seven studies were qualitative and six were quantitative. None were mixed methods. Studies reported several positive KC benefits on fathers, such as reduced stress, promotion of paternal role and enhanced father-infant bond. It was highlighted that KC could be time-consuming for fathers and challenging to practise when balancing work and family life commitments. Conclusion. This review provides evidence that KC practice has health and wellbeing benefits for fathers and infants in NICUs and other relevant neonatal care settings, The findings of this review support the justification to promote Father KC in NICU environments, and guide policies to include father involvement. Implementing Father KC in NICU settings will assist fathers to care and connect with their baby. Further research is needed to explore how to facilitate and evaluate KC education for fathers from diverse s and cultures.

Background: NICU experiences pose significant challenges for parents, especially immigrants, necessitating comprehensive support. South Asian immigrants, comprising 25% of Canada's visible minority population, face unique adversities related to gender roles, hindering access to essential health services and integration. Coupled with unfavourable social determinants of health (SDoH), these challenges worsen issues like inadequate prenatal care, education, and nutrition, predictors of adverse maternal and neonatal health outcomes. Existing studies lack insight into the specific experiences of South Asian immigrant mothers in the NICU. This study investigates these experiences. Methods: Using a qualitative descriptive approach, we recruited four participants for semi-structured interviews, supplemented by a demographic questionnaire and participant observation. Qualitative content analysis was employed for data analysis. Findings: Four key themes were identified from the interviews: (1) Seeking Understanding, (2) Cultural Influence on NICU Experience, (3) Motherhood Journey, and (4) Circle of Care. Implications: This study fills a gap in NICU research for South Asian immigrant women, providing a foundation for future nursing research and practice. It underscores the importance of communication and preparation for discharge delays to ease parental concerns. Additionally, it emphasizes culturally sensitive care practices and encourages further exploration of cultural influences on hospital experiences. Insights from this study can benefit other ethno-racial immigrant groups. / Thesis / Master of Science in Nursing (MSN) / Existing research offers insights into the general challenges and distress often associated with mothers' experiences in the NICU. However, there is little evidence to understand the specific experiences of South Asian immigrant mothers within this context. The objective of this thesis is to describe and understand the experiences in the NICU reported by this population. Employing a qualitative description methodology, this study engaged four eligible participants. Data collection entailed semi-structured interviews alongside a demographic questionnaire. Employing qualitative content analysis, four overarching themes were identified: (1) Seeking to Understand, (2) The Impact of South Asian Culture on the NICU Experience, (3) Becoming a Mother One Step at a Time, and (4) Circle of Care.

Sammanfattning Bakgrund: Miljön på intensivvårdsavdelningar (IVA) är högteknologisk. Patienter som vårdas inom intensivvården övervakas ständigt av personal och medicinteknisk utrustning. Omvårdnadsåtgärder och undersökningar behöver utföras oavsett tid på dygnet. Personalens närvaro påverkade patienternas sömn och apparatur låter dygnet runt. Vid utebliven sömn och minskad REM-sömn ökar riskerna för negativa effekter som nedsatt immunförsvar och delirium. Det behövs ökad kunskap för hur patienterna upplever sin sömn på IVA för att kunna främja förutsättningarna för sömn, hälsa och välbefinnande.  Syfte: Syftet med studien var att belysa hur patienter som vårdats på intensivvårdsavdelning upplever sin sömn under vårdtiden.  Metod: En kvalitativ systematisk litteraturstudie baserad på 11 vetenskapliga artiklar. Analysen genomfördes med Bettany-Saltikov och McSherry (2016) analysmetod.  Resultat: I resultatet framkom det att patienterna upplevde att sömnen påverkades av IVA-miljön. Många upplevde svårigheter att somna, men också att de väcktes flera gånger. Patienterna kände sig fast mellan sömn och vakenhet, vilket skapade mycket ångest och oro. De upplevde vårdmiljön som skrämmande och kunde känna sig ensamma och övergivna vilket försämrade sömnkvaliteten ytterligare. För att känna trygghet behövde patienterna kontinuerligt kommunicera med vårdpersonal och känna deras närvaro. Det skapade förutsättningar för god sömn.  Slutsats: Aspekter i den fysiska och psykiska miljön spelade stor roll för att intensivvårds patienterna skulle få goda förutsättningar för tillräcklig sömn. Intensivvårdssjuksköterskan kan genom lyhördhet och ökad kunskap uppmärksamma hur viktig den yttre miljön samt existentiella faktorer är för att patienten ska kunna uppnå god sömn på IVA.

Unplanned extubation is premature removal of endotracheal tube, is an adverse event; which can either, be accidental during a nursing procedure or self deliberate by the patient. The AACN Synergy Model for Patient Care was used as conceptual model for this study. A retrospective descriptive design revealed that over a period of two years, 327 patients admitted to the intensive care unit require intubation of which 40.4% were self-deliberate extubation and 59.4% accidental extubation. Of the accidental extubated patients, 29.8% had physical restrains, 57.6% received sedation, 43.9% had analgesic infusion and 38.9% were on neuromuscular blockade. A means Glasco Coma Scale was 9.4 and 56% of the patients were reported as being. Most patients (89.9%) required re-intubation. The findings also revealed that 49.1% of the nurses who cared for the patients when the extubation occured had one patient at the time. Also, 84.2% of nurses had 0-6 years of nursing experience and 74% of nurses had less than five years of ICU experience. / Health Studies / M.A. (Health Studies)

The aim: was to describe and compare a group of experts and critical care nurses' agreement in detecting delirium in intubated, ventilator treated patients with sedation / analgesia, before and after an in house training intervention with the instrument Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Method: A quasi-experimental study, one group pretest - posttest design. A convenience sample of 17 critical care nurses in a general intensive care unit included. To detect delirium the instrument CAM-ICU was used, 21 paired tests before and 22 after an educational intervention. Main Results: The results showed that after an in house training intervention sensitivity and kappa coefficient improved of the characteristic 1 "acute onset and fluctuating course," an improvement that was significant. In other features, and overall values were signs of numerical improvement and deterioration in sensitivity, specificity and kappa coefficient but no significant change. Conclusion: Implementing a new instrument for detecting delirium in clinical practice requires education and follow-up. A small sample of critical care nurses with varying ability to use the new instrument and the fact that patients' status may change rapidly making it difficult to draw any conclusions from this study. It is clear, however, that education and follow-up is needed when new care routines are introduced, and that further studies are needed to clarify whether the CAM-ICU is a valit and reliable instrument to use in clinical practice. / Syftet var att beskriva och jämföra en expertgrupp och intensivvårdssjuksköterskors överensstämmelse i att detektera delirium hos intuberade, respiratorbehandlade patienter med sedering/analgesi, före och efter en utbildningsintervention med instrumentet Confusion assessment method for the intensive care unit (CAM-ICU). Metod: En kvasiexperimentell studie, en grupps pretest – posttest design. Ett bekvämlighetsurval på en allmän intensivvårdsavdelning där inkluderades 17 intensivvårdssjuksköterskor. För att detektera delirium användes instrumentet CAM-ICU, 21 parmätningarna före och 22 efter en utbildningsintervention. Huvudresultat: Resultatet visade att efter utbildningsinterventionen förbättrades sensitiviteten och kappa koefficienten i kännetecken 1 ”akut insättande eller fluktuerande förlopp”, en förbättring som var signifikant. I övriga kännetecken och totalvärden fanns tecken på numerär förbättring och försämring i sensitivitet, specificitet och kappakoefficient men ingen signifikant förändring. Slutsats: Att implementera ett nytt instrument för att detektera delirium i klinisk verksamhet kräver utbildning och uppföljning. Ett litet sample av intensivvårdssjuksköterskor med varierad förmåga att använda det nya instrumentet samt det faktum att patienters status hastigt kan förändras gör det svårt att dra några slutsatser av denna studie. Klart är dock att utbildning och uppföljning behövs när nya vårdrutiner införs, och att ytterligare studier behövs för att klargöra om CAM-ICU är ett valit och reliabelt instrument att använda i klinisk verksamhet.