The importance of nurse residency programs is addressed in the literature; however, a review of residency program outcomes and effectiveness is needed. Guided by Roy's adaptation model and Deming's plan-do-check-act model, the purpose of this quality improvement project was to assess the current state of a longstanding critical care nurse residency program in meeting organizational goals and objectives and to recommend modifications to the program related to external factors, internal challenges, and educational deficits of nurses entering the program. A review of the evidence-based literature and feedback from focus groups of leadership stakeholders were used to develop recommendations for residency program improvement. Using qualitative analysis of the focus group data, three common themes emerged related to external factors: financial resources, patient acuity, and generational differences that influence nurse satisfaction with the residency program. Three additional themes emerged related to organizational barriers to satisfaction with the program: preceptor availability and development, limited training hours due to productivity standards, and leader time to support novice nurses. Reality shock when starting to practice in the high acuity critical care area was the most frequently reported educational deficit among new nurses. Recommendations for program improvement included obtaining feedback from residency program participants and preceptors, initiating preceptor development pathways, reinstituting a dedicated cost center for nurse residents' training, and using competency assessment tools to customize training plans for residency program participants. This project has the potential for social change by increasing job satisfaction and retention of new nurses and improving health outcomes in critical care patients.

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.

Post Intensive Care Syndrome-Family (PICS-F) refers to acute and chronic psychological effects of critical illness on family members of patients in intensive care units (ICU). Evidence about the increase and persistence of PICS-F warrants the need for prevention interventions. This study evaluated the feasibility of providing Sensation Awareness Focused Training (SĀF-T) during the ICU stay for spouses of mechanically ventilated patients. Methods: A randomized controlled trial of SĀF-T versus a control group was conducted (n=10) to assess safety, acceptability, feasibility, and effect size of the intervention on PICS-F symptoms. Symptoms assessed as outcome measures included stress, anxiety, depression, posttraumatic stress disorder, and sleep efficiency. Those randomly assigned to SĀF-T received one session daily over 3-days in the ICU. Repeated measures (day 1, day 3, day 30, and day 90) of PICS-F symptoms in both groups were analyzed. Results: Mean age was 58 ± 12 years; 70% were female. Feasibility success criteria were met in weekly recruitment (8 ± 3.5), enrollment rate (67%), SĀF-T acceptability (100% of doses received, no adverse events) with significantly lower post SĀF-T stress levels (p<.05) compared to pre SĀF-T stress levels, ActiWatch acceptability rate (90% agreed to wear, no adverse events) with no significant difference in sleep efficiency between groups (p>.05), and repeated measures completion rate (>90%). Conclusions: This study provided guidance for modifications to protocol outcome measures and evidence of a large effect size, which will inform a larger clinical trial to assess the effectiveness of the SĀF-T intervention in reducing PICS-F.

This thesis covers research around the Medical Emergency Team (MET) system, describing its development, evaluation and other related research that evolved as a result of the MET concept. The basic problem that prompted development of the MET system was related to the inadequate care given to the seriously ill in acute hospitals. This thesis contains background research on some of the reasons why a MET system may be useful, including the limited skills and knowledge of medical training and the sort of acute problems encountered in a hospital at night. Research then describes how the MET system works, including published data on when and how often the team is called, the type of patient the team is called to, the interventions performed by the team, and the outcome of patients on whom a MET was called. At the same time research was being performed around outcome indicators used to measure the effectiveness of the MET system, resulting in the use of cardiac arrests, deaths and unanticipated admission to the Intensive Care Unit (ICU) as common end-points for research in this area. Further research demonstrated that potentially preventable antecedents were common before serious illness The thesis then concentrates on how effective the MET system was in reducing death and serious adverse events. The first study compared a hospital where a MET system had been implemented to two control hospitals and found there was a reduction in admissions to the ICU but after adjustment, not for deaths and cardiac arrests. The second study used a cluster randomised methodology, enrolling 23 hospitals across Australia, comparing the three end-points described above. The study found no difference between both groups. It did highlight some interesting areas around the importance of effective implementation in determining the effectiveness of systems in health. Other publications have described the importance of developing effective ways of caring for the seriously ill outside traditional areas such as ICUs. The MET system, or variations on it, is now implemented in many hospitals in Australia and around the world and there have been two international MET conferences held in North America and international guidelines on the MET concept established.

Includes bibliographical references. / 1 v. (various paging) : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (D.Nurs.)--University of Adelaide, Dept. of Clinical Nursing, 2002

<p>The aim of this study was to learn how students in specialist nurse education with direction towards nurse anaesthetist experienced tutorial given during their specialist placement.  The chosen method of the study was qualitative interview with phenomenological approach. Twelve nurse anaesthetist students were interviewed about their experiences during their placement at operation wards. The interviews were transcribed and analyzed according to Giorgios (1985) analyze method. The result showed that the students considered that a well functioned tutorial was essential for a successful clinic placement. The tutorial considered as satisfactory if the student and the tutor managed to have good communication and a good relation with each other. The students self-confidence could sometimes feel reduced when they experienced that the position as a student collided with their former profession identity as a nurse. Many different categories of students compete of the space around the patient, the student considered that fact as an obstacle in their education. Through confirmation on a regular bases and feedback from the tutor the student could gain self-confident, and thereafter gain the ability to perform independent. The students experienced mixed feelings at the prospect of their upcoming profession and the view of themselves as future tutors.Conclusion: The students' experience of tutoring during specialist nurse education with direction towards nurse anaesthetist shows that tutorial of good quality is essential to a successful clinic placement.</p><p> </p><p>Keywords: nursing instructors, clinical educators, nurse education, critical care, confirming, students, experience.<strong> </strong></p> / <p>Syftet med denna studie var att undersöka vilka upplevelser studenter i specialistsjuksköterskeutbildningen med inriktning anestesisjukvård hade av handledning under verksamhetsförlagd utbildning, VFU. Som metod valdes kvalitativ intervju med fenomenologisk ansats. Tolv studenter i specialistsjuksköterskeutbildningen med inriktning anestesisjukvård intervjuades om sina upplevelser av handledning under VFU. Intervjuerna transkriberades och analyserades enligt Giorgios (1985) analysmetod. Resultatet visade att studenterna ansåg att välfungerande handledning var viktig för en lyckad klinisk utbildning. Handledningen upplevdes som tillfredsställande om student och handledare lyckades få en bra kommunikation och god relation till varandra. Självförtroendet kunde stundtals upplevas som nedsatt då studenterna upplevde att rollen som student ofta kolliderade med den tidigare yrkesidentiteten som sjuksköterska. Många studentkategorier konkurrerar om utrymmet runt patienten, och studenterna upplevde det som hindrande i utbildningen. Genom regelbunden bekräftelse och feedback från handledaren kunde studenterna tillägna sig självförtroende, och därmed öka förmågan till självständigt arbete. Studenterna upplevde blandade känslor inför sin kommande ansvarsfulla yrkesroll och utsikten att själva i framtiden fungera som handledare. Slutsats: Studenters upplevelser av handledning under specialistsjuksköterskeutbildningen med inriktning anestesisjukvård visar att handledning av god kvalitet har stor betydelse för en lyckad klinisk utbildning.</p>

Relatives may experience a difficult and demanding situation when the patient is critically ill. During the period in the intensive care unit (ICU), the relatives may be subject to strong emotions of an existential nature, and the situation may involve several stressors as a result of changed roles, responsibilities and routines. These emotional stress experiences may result in weakened mental and physical functioning on the part of the relatives. During the patient’s rehabilitation at home the relatives are expected to provide care-giving assistance, which may lead to a further deterioration in their already weakened mental and physical functioning. The general aim of the thesis was to develop a theoretical understanding of coping approaches and social support experiences of relatives of critically ill patients, both in the ICU and at home. In order to gain an understanding of these areas it was deemed important to search for knowledge by means of qualitative methods, using grounded theory methodology, simultaneous concept analysis and qualitative content analysis. A total of 32 relatives of critical care patients participated in the studies. The findings of study I revealed that relatives of critically ill patients coped with their situation by alleviating, recycling, mastering or excluding their feelings during the ICU stay. The critical factors behind their choice of coping approach were their social circumstances, previous experiences of care and/or caring and how they apprehended the situation. In study II, during the patients’ recovery period at home, the relatives coped with their situation by accepting, volunteering, sacrificing or modulating. The critical factors in this period were the physical and psychological state of the relatives, previous experiences of care and/or caring and the psychological condition of the patient. A coping model was developed in study III, based on the coping concepts generated in studies I and II. In this model, the characteristics of each coping approach were systematised into different determinants in order to highlight the inherent process. The analysis of the relationship between the various coping approaches revealed differences in adaptation to the stressful situation. In terms of coping effectiveness, adaptation was associated with social support and health outcome. In the extended version of the coping model, with its dual perspective of the maladaptive-adaptive coping continuum and the weak-strong social support continuum, the degree of effectiveness of each coping approach was illustrated in relation to the others as well as to social support. In study IV and its Addition, a theoretical understanding of the phenomenon of what relatives experienced as supportive was developed. Support was perceived as empowerment by means of internal and external resources in the form of trusting oneself, encountering charity and encountering professionalism. The sense of empowerment permitted the relatives to experience their situation as safer and easier to control. The three support dimensions with their components and characteristics were illustrated in the empowerment model. These four studies have developed knowledge that may provide healthcare professionals with an understanding of the coping approaches and social support experiences of relatives during the critically ill patient’s ICU stay and recovery period at home. The association revealed between coping effectiveness, social support and health outcomes may draw attention to the relatives’ situation as well as to the possibility of enabling relatives to endure the patient’s entire illness and recovery period by enhancing the factors that promote effective coping. The three models may together form the basis for the development of a support programme for relatives of critically ill patients that encompasses the whole course of illness and recovery, which means that both institutional and community-based care would be involved.

Att handleda specialistsjuksköterskestudenter ställer höga krav på handledaren eftersom de handleder en sjuksköterska med yrkeserfarenhet. Studenten har hamnat i ett helt nytt sammanhang och befinner sig återigen på novisstadiet. Handledningen kan utmanas på flera sätt, både positivt och negativt, i den unika intensivvårdsmiljön. Syftet var att beskriva faktorer av betydelse för studenter och handledare vid handledningen under den verksamhetsförlagda utbildningen i specialistsjuksköterskeutbildningen med inriktning intensivvård. Litteraturstudien består av 8 kvalitativa artiklar som analyserats utifrån syftet och mynnat ut i två huvudteman: handledning - faktorer av betydelse för studenterna samt handledning - faktorer av betydelse för handledarna. Resultatet visade att tidigare kunskaper och förmågor inte kunde appliceras inom intensivvård men att utmaningar och ansvar som anpassades efter förmåga fick studenten att växa. Socialisering in i teamet var betydelsefull för utvecklingen. Handledarna upplevde rollen som viktig och betydelsefull men erfor att tidsbrist och bristande stöd från teamet innebar ett hinder. Handledaren tillsammans med övriga teamet har ett stort ansvar i att möjliggöra en gynnsam lärandemiljö. Det är viktigt med motiverade handledare som är tillgängliga för studenten och reflekterande i sitt förhållningssätt. Det magra sökresultatet i denna litteraturstudie indikerar att fortsatta studier om handledning av specialistsjuksköterskestudenter inom intensivvård behövs. En empirisk studie kunde undersöka möjligheter och hinder i handledningsprocessen. Dessutom vore det intressant att utforska hur övriga teamet upplever handledningen av specialistsjuksköterskestudenter inom intensivvård. / Precepting postgraduate nursing students is a high demanding task, the   student is a registered nurse with her own experiences. Furthermore, the   students have found themselves in a new context, again a novice nurse. The   precepting can face several challenges, positive and negative, in the unique   setting of the critical care unit. For that reason, the aim was to describe   significant factors for students and preceptors during the clinical education   of the postgraduate critical care nurse education program. This review   consists of 8 qualitative articles, analyzed according to the purpose, and   resulted in two main themes: significant factors for the students and significant   factors for the preceptors. The findings revealed that prior knowledge   and skills was not applicable in the critical care unit, but student progress   was made possible by appropriate challenges and responsibilities. The   socialization and to be a part of the team was important for student   progress. The preceptors found their role important and meaningful, but lack   of time and support could be an obstacle. To be reflective, motivated and   available was important characteristics. Preceptors, and members of the team,   are responsible of provide a positive learning environment. The few articles   in this review indicate that further studies needs to be conducted to explore   the conditions and the process of precepting postgraduate nursing students in   the critical care unit. Furthermore would it be interesting to exam how the   other team members experience the precepting process.

Bakgrund: Patienter inlagda på sjukhus behöver näringstillförsel för att kunna återhämta sig. Enteral nutrition är troligen att föredra framför parenteral nutrition, och bör sättas in så tidigt som möjligt. Enteral nutrition kan administreras på olika sätt. Den kan ges intermittent och innehålla nattvila, eller ges kontinuerligt för att undvika plötsliga sänkningar i blodsockernivåer. En oönskad komplikation är lösa avföringar hos patienten. Frågan är om administrationsformen av enteral nutrition kan påverka frekvensen av diarré. Syfte: Att med hjälp av en registerstudie jämföra antal lösa avföringar per dygn mellan två olika administrationsformer av enteral nutrition: intermittent med nattvila jämfört med kontinuerlig tillförsel över hela dygnet. Metod: En kvantitativ retrospektiv registerstudie har genomförts på totalt 50 intensivvårdspatienter med traumatisk skallskada vid Norrlands Universitetssjukhus. Journaler från 2007 till 2012 har använts i studien. Resultat: Ingen signifikant skillnad kunde påvisas mellan grupperna i antal lösa avföringar per dygn, p=0.5. Däremot visade denna studie att de patienter som fick intermittent enteral nutrition fick signifikant större mängd enteral nutrition (699±249 ml) per dygn jämfört med patienter som fick sin enterala nutrition kontinuerligt (505±278 ml/dygn), p = 0.008. Slutsats: Resultatet från studien visar att antalet lösa avföringar inte verkar bero på administreringsformen av enteral nutrition. Mängden tillförd enteral nutrition skiljer sig dock statistiskt signifikant varav betydelsen av det borde studeras vidare för att avgöra vilken administreringsform som är att föredra. / Background: Patients admitted to hospital need nutrition to recover. Enteral nutrition is probably preferable to parenteral nutrition should be initiated as early as possible. Enteral nutrition may be administered in various ways, it can be intermittent and include night rest, or given continuously to avoid abrupt reductions in blood sugar levels. An unwanted complication is loose stools of the patient. The question is whether the form of administration of enteral nutrition can affect the frequency of diarrhea. Aim: With the help of a retrospective registry study comparing number of loose stools per day between two different forms of administration of enteral nutrition: intermittent with night sleep compared with continuous supply throughout the day. Method: A quantitative retrospective registry study has been carried out on a total of 50 ICU patients with traumatic head injury at Norrlands University Hospital. Records from 2007 to 2012 were used in the study. Results: No significant difference was detected between the groups in the number of diarrhea per day, p = 0.5. However, this study demonstrated that patients receiving intermittent enteral nutrition was significantly greater amount of enteral nutrition (699 ± 249 ml) per day compared with patients who received their enteral nutrition continuously (505 ± 278 mL / day), p = 0008. Conclusion: The results from the study show that the number of loose stools do not seem to depend on the form of administration of enteral nutrition. Quantities of enteral nutrition differ statistically significantly significance of which it should be further studied to determine which form of administration is preferred.

Background Nurses complete tasks during patient care to promote the recovery, or to maintain the health, of patients. These tasks can be routine or non-routine to the nurse. Non-routine tasks are characterized by unfamiliarity, requiring nurses to seek additional information from a variety of sources to effectively complete the tasks. Nurses’ perception of their problem-solving skills, as characterized by the attributes of personal control, problem-solving confidence, and avoidance-approach style, influences how information is sought. Objectives/Research Questions Guided by the information-seeking behaviour model, this study was designed to: (1) examine how the non-routineness of the task affects nurses’ information-seeking behaviour and the use of accumulated knowledge; and, (2) explore nurses’ perception of their problem-solving abilities. Methods An exploratory cross-sectional survey design was used. A random sample of critical care nurses who worked in a hospital setting were selected from the College of Nurses of Ontario (CNO) research participant database. Multiple regression analysis was used to examine the proposed relationships. Results Avoidance-approach style and, problem-solving confidence did not have a significant relationship with nurses’ information-seeking behaviour. None of the variables explained use of accumulated knowledge (F = 0.902, p > 0.05). Previous training (p = 0.008), Non-routineness of the task (p = 0.018), and Personal control (p = 0.040) had a positive relationship with information-seeking behaviour (Adjusted R2 = 0.136). Implications The study results provide evidence that problem-solving ability, and in particular the attribute of personal control, influences nurses’ information-seeking behaviour during the completion of nursing tasks. They reveal how information is sought from resources, and what specific information resources are necessary to promote access to, and use of, evidence-based information. The results also help direct efforts towards training nurses in issues related to problem-solving and information-seeking by targeting the development of personal control and retrieving evidence-based information.