Over the last three decades, there has been a growing body of literature that has described moral distress as a prominent issue that negatively affects critical care nurses. However, little focus has been given to how nurses cope and continue on in their practice despite the hardship that moral distress can cause. This study sought to reveal nurses’ strategies of coping with moral distress to allow for a better understanding of this aspect of critical care nurses’ experiences. This study adopted a qualitative design that used Thorne’s (2008) approach to interpretative description. Face-to-face, semi-structured interviews were conducted with seven critical care nurses employed within two ICUs of a tertiary care academic hospital. Interviews were analyzed using Aronson’s (1995) approach to thematic analysis. The experience of coping with moral distress had an overarching theme of being “like grass in the wind.” Four major themes were identified: Going Against What I Think is Best, Moral Distress- It’s Just Inherent in Our Job, It Just Felt Awful, and Dealing with It.

Orientador: Edineis de Brito Guirardello / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T09:38:22Z (GMT). No. of bitstreams: 1 Brito_CandidaMarciade_M.pdf: 2773732 bytes, checksum: 23c42c18538a8ff7fb4546d5bc319ad9 (MD5) Previous issue date: 2006 / Resumo: Nas Unidades de Cuidados Críticos (UCCs) o enfermeiro está exposto à múltiplas demandas de atenção inerentes ao ambiente de trabalho e que exigem um aumento da concentração para lidar com elas. Este estudo que se insere na linha de pesquisa Processo de Cuidar em Saúde e Enfermagem, teve como objetivos: 1) caracterizar os enfermeiros com relação às variáveis sociodemográficas e profissionais, 2) identificar à percepção da adequação do ambiente de trabalho pelos enfermeiros, 3) identificar as situações de demandas de atenção do enfermeiro em unidades de cuidados críticos, 4) Verificar se existem diferenças na percepção dessas demandas pelos enfermeiros das diferentes UCCs e em relação as variáveis sociodemográficas e profissionais e 5) Descrever as estratégias de enfrentamento apontadas pelos enfermeiros frente às fontes de demanda nas UCCs. Para a coleta de dados utilizou-se os instrumentos: Caracterização Sociodemográfica, Caracterização do Ambiente de Trabalho e Demandas de atenção de enfermeiro. Participaram do estudo 60 enfermeiros, de cinco UCCs de um hospital privado do município de São Paulo. A maioria era do sexo feminino, solteira e com curso de especialização. As situações de maiores demandas de atenção foram: ¿observar o sofrimento de um paciente¿, ¿cuidar de famílias com necessidades emocionais¿, ¿necessidade de dar orientação a família¿ e ¿alto nível de barulho na unidade¿. Na análise das demandas de atenção entre as variáveis sociodemográficas verificou-se diferenças estatisticamente significativas para: estado civil, turnos de trabalho, tempo de experiência profissional, tempo de trabalho na unidade e horas trabalhadas na semana. Ao comparar as situações de demanda julgadas pelos enfermeiros entre as UCCs, observou-se diferenças estatísticas para 11 situações. As estratégias de enfrentamento foram classificadas como independentes ao ambiente de trabalho e relacionadas ao mesmo. Confirmou-se a consistência interna do instrumento, com a=0,90. O conhecimento dessas situações permite aos enfermeiros e gerentes responsáveis por essas unidades na re-estruturação de estratégias de trabalho, visando minimizar o esforço dos profissionais no enfrentamento dessas demandas / Abstract: In the critical care units (CCUs), the nurse is exposed to multiple sources of demand of attention that require a higher level of concentration to deal with them. The aims of this study developed under the research field Caring Process in Nursing and Health were: 1) characterize the nurses with relation to the sociodemographic and professional variable, 2) to identify the perception of the adequacy of the environment of work for the nurses, 3) to identify the situations of demands of attention of the nurse in units of critical cares, 4) to verify if exist differences in the perception of these demands by nurses from the CCUs and in relation the sociodemographic and professional variables and 5) to describe the strategies pointed by nurses in order to deal with these sources of demands. For the collection was used the instruments: Sociodemographic characterization, Characterization of the Environment of Work and Demands of nurse attention. A total of 60 nurses from five CCUs of a private hospital in the city of São Paulo took part of this study. Most of the nurses were female, single and had some level of degree like specializacion in the area. The situations of higher demands of attention were: "to observe a patient suffering", "to take care of families with emotional needs", "necessity to give to orientation the family" and "high level of racket in the unit". The analysis showed some statistical differences in the sources of demands perceived by nurses and sociodemographic variables like marital status, shift work, time of professional experience, time of work in the unit and hours worked in the week. There were statistical differences for eleven situations in relation to the sources of demands judged by nurses. They also pointed out some strategies to deal with the sources of demand that were related to and others are independent to the work environment. It was confirmed internal consistency of the instrument, with a=0,90. The knowledge of these demands by nurses and managers will help them to stablish strategies in order to minimize these sources of demands in the workplace / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Introduction Paediatric Intensive Care has developed rapidly in recent years with a dramatic increase in survival rates. However, there are increasing concerns regarding the impact that admission to a Paediatric Intensive Care Unit (PICU) has on both the child and their family. Following discharge from PICU, children may be living with complex medical problems as well as dealing with the psychosocial impact that their illness has had on them and their family. Objectives To describe the long-term health outcomes of children admitted to a paediatric intensive care unit (PICU). Methods A full literature search was conducted including the databases; MEDLINE via PubMed, Cochrane Central Register of Controlled Trials, (CENTRAL), Scopus, Web of Science, CINAHL, ERIC, Health Source Nursing/Academic, APA PsycInfo. All studies including children under 18 admitted to a PICU were included. Primary outcome was short- and longerterm mortality. Secondary outcomes were neurodevelopment/cognition/school performance; physical function, psychological function/behaviour impact, quality of life outcomes and social/family implications. Studies focused on Neonatal Intensive Care Admission and articles with no English translation were excluded. Results One hundred and five articles were included in the analysis. Mortality in PICU ranged from 1.3% to 50%. Mortality in high income countries reduced over time but the data did not show the same trend for low- and middle-income countries. Higher income countries were found to have lower Standardised Mortality Rates (SMRs) than low- and middle-income countries. Children had an ongoing risk of death for up to 10 years following PICU admission. Children admitted to PICU also have more ongoing morbidity than their healthy counterparts with more cognitive/developmental problems, more functional health issues, poorer quality of life as well as increased psychological problems. Their parents also have an increased risk of Post Traumatic Stress Disorder (PTSD). Discussion Most of the studies identified are from high income countries and only include short-term follow up. More data is needed from low- and middle-income countries and over longer terms. The studies were markedly heterogenous and were all observational. Agreement is needed regarding which outcomes are most important to measure as well as standardised methods of assessing them. Further research is needed to identify the risk factors which cause children to have poorer outcomes as well as to identify predictive and modifiable factors which could be targeted in practice improvement initiatives.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22352号 / 医博第4593号 / 新制||医||1042(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 稲垣 暢也, 教授 森田 智視, 教授 柳田 素子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Magister Scientiae (Physiotherapy) - MSc(Physio) / The professional status of physiotherapists in Sudan is reported to be low even though the profession was established in Khartoum, Sudan in 1969. Intensive care units are operating in Khartoum, Sudan. Physiotherapists have been reported to be integral to the management of intensive care patients. Globally, the role of ICU physiotherapists in the management of ICU patients have been explored and described; however, this information is lacking for Khartoum, where the profession is still in its infancy. Therefore, this study aimed to explore and describe the physiotherapists’ perceptions of their role in the management of intensive care patients in Khartoum, Sudan. / 2022

Thesis advisor: Susan . Kelly-Weeder / Thesis advisor: Judith . Shindul-Rothschild / BACKGROUND: The influenza virus is uniquely capable of creating pandemic illness in our population. The unpredictability of pandemics necessitates plans that will allow registered nurses to expand current capacity to care for ill individuals. It has been documented that personnel resources, often nurses, are a limiting factor in the health care system’s ability to care for large influxes of patients. Prior research has shown that an outbreak of an infectious disease, such as influenza, may lead to healthcare workers (HCWs) intentionally staying out of work. The potential increase in patient demand coupled with a decrease in the number of critical care nurses reporting to work will strain the ability of healthcare systems to meet the needs of patients. To date, research has not studied critical care nurses’ intentions to report to work during a pandemic influenza. PURPOSE: The purpose of this study was to examine the percent of critical care nurses that intend to report to work during an influenza pandemic. Covariates that may influence CCNs intention to report included personal, professional, and employer characteristics. Additionally, the impact of threat (perceived susceptibility to influenza and perceived severity of an influenza pandemic) and efficacy (perceived self-efficacy and perceived efficacy of the overall response) on intentions were analyzed. METHODS: A cross-sectional and descriptive design was utilized. Participants were recruited through the American Association of Critical Care Nurses. The final sample totaled 245 critical care nurses from across the United States. The participants completed an adapted version of the Johns Hopkins Public Health Infrastructure Response Survey Tool (JH~PHIRST) as well as personal demographics and information on their primary employer. Data were analyzed using bivariate methods and logistic regression. RESULTS: This study found that nearly 87% of CCNs intend to report during a pandemic flu, but this number drops to 78% if severity of the pandemic is factored in and further declines to 63% if the CCNs are asked to work extra. Perceived self-efficacy is a primary factor in explaining CCNs intend to report to work. CCNs with high perceived self-efficacy were6.221 (95% CI: 2.638-14.673) times more likely to report than those with low perceived self-efficacy. Perceived self-efficacy continues to significantly impact intentions to report to work when the severity of the pandemic is considered as well as when CCNs are asked to work extra. CCNs with high perceived self-efficacy are consistently, significantly more likely to intend to report than those with low perceived self-efficacy. CONCLUSION: Perceived self-efficacy is related to CCN intentions to report to work during a pandemic flu emergency. Future research should examine methods for increasing CCN perceived self-efficacy, including professional, educational and employment factors. / Thesis (PhD) — Boston College, 2020. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

The overuse of antibiotics is a large problem in healthcare today, accelerating the development of microbial resistance to antibiotics. Antibiotic stewardship campaigns have been implemented to help clinicians curb their use. Procalcitonin is a serum peptide and marker of inflammation secreted in response to microbial toxins. For this reason it is more specific to bacterial infections than other markers of general inflammation , like Creactive protein. The population of patients with sepsis in the Intensive Care Unit is one in which extended durations of antibiotics are used. The FDA has approved use of procalcitonin to guide de-escalation of antibiotic therapy in critically ill patients with sepsis to avoid both antibiotic overuse and antibiotic related side effects. Review of current literature shows that procalcitonin is efficacious in reducing duration of antibiotic therapy in patients with sepsis in the ICU setting. This result, however, is not being observed in clinical practice. This discrepancy is due to the inappropriate use of procalcitonin that does not align with use outlined in randomized control trials. We propose a study to determine how procalcitonin is being used in clinical practice in four Boston area hospital Intensive Care Units. Through chart review, we will identify patients in the Intensive Care Unit with sepsis from 2013-2018 recording patient demographic information and patient characteristics. We will determine whether they had PCT measured during their stay, and if they did, whether or not discontinuation of antibiotics was in accordance with FDA’s proposed algorithm. We will aim to compare whether discontinuing antibiotic therapy in accordance with the FDA’s procalcitonin deescalation algorithm is associated with reduced duration of antibiotic therapy or incidence of Clostridium Difficile infection. In conducting this study, we hope to identify patterns of procalcitonin use in clinical practice and provide further evidence that using the algorithm to guide therapy can serve as an effective tool in reducing exposure to unnecessary antibiotics and the complications from their use.

No description available.

This qualitative descriptive research study was undertaken to describe the experiences of emergency nurses with critical incidents and identify strategies used to manage these situations in the emergency department setting. Critical incidents are events, such as death or serious injury, that cause a strong emotional reaction and may overwhelm a nurse‘s usual coping skills. Nineteen nurses who worked in one of two community-based emergency departments in Central Massachusetts were interviewed and asked to describe a critical incident they had experienced in their nursing career. Qualitative content analysis revealed two major themes: (1) critical incident experiences; and (2) aftermath; and five subthemes: (a) connections; (b) workplace culture; (c) responses; (d) lasting effects; and (e) strategies. Critical incidents were limited to events with children, patient deaths, and interactions with family; this differed from prior research in that no incidents were identified involving multiple casualties, violence, or mutilating injuries. Connections occurred when the patient was known to the nurse or reminded the nurse of self or family. Responses were the reactions of the participants to the critical incident and were physical, psychological, and spiritual in nature. The majority of study participants cried in response to a critical incident. Workplace culture, a subtheme not found in other studies, involved their perceptions of expected behavior in the emergency department and emphasized the influence of workplace culture on newer or inexperienced nurses. The theme of aftermath described the time period following critical incident. Lasting effects occurred in the form of vivid memories that were triggered by different stimuli. The subtheme, strategies, revealed that nurses desired, but lacked formal strategies to manage their reactions following a critical incident. Thus, they described the use of informal strategies such as talking to co-workers and family members. Implications of this study support the need for educational preparation and support of emergency nurses who deal with critical incidents in the workplace. Intervening during the critical incident experience and having follow-up strategies in place to prevent distress and enhance coping in the aftermath are important for well-being, practice, and patient care in the emergency setting.