This descriptive exploratory study was designed to determine the perceived importance of selected needs of family members of critically ill brain-injured patients. In addition, the personal/demographic factors which may have influenced the needs of these family members were investigated, as well as the reasons family members perceived these needs as important or unimportant. A convenience sample of one family member for each of 15 critically ill brain-injured patients was selected from two tertiary care hospitals and the community. Family members were interviewed using a pre-determined interview guide and asked to verbally rate 20 need statements on a four-point Likert-type scale. Generally, family members perceived all 20 needs to be important. However, the importance of each need was influenced by the family members' personal/demographic factors. No significant statistical relationship was found between personal/demographic factors and the family members' perceptions of the importance of selected needs. However, the findings of the study suggest that family members relate their needs to their present experience, and thus individual assessment of family members' needs is crucial. / Applied Science, Faculty of / Nursing, School of / Graduate

The purpose of this study was to describe critical care nurses' perceptions of their experiences with nursing quality assurance activities. Using an exploratory, descriptive design, data were collected in a survey, utilizing a self-administered questionnaire. A convenience sample of critical care nurses, who are members of the Canadian Association of Critical Care Nurses, was used. The results showed that these particular nurses knew what comprised the components of a nursing quality assurance program, however, their participation in these activities was low. In addition, the majority identified that the primary purpose of nursing quality assurance activities was to meet the accreditation requirements of the hospital. Finally, the results also identified that all of this particular group of nurses felt that nursing quality assurance activities involved them, and the majority felt that these activities were part of their professional responsibilities. / Applied Science, Faculty of / Nursing, School of / Graduate

Orientador: Salomon Soriano Ordinola Rojas / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T12:57:10Z (GMT). No. of bitstreams: 1 Morais_ElaineAparecidaSilva_M.pdf: 1537327 bytes, checksum: 2392dd8e8cc4fd0b2f4b6b4d33c92183 (MD5) Previous issue date: 2014 / Resumo: Introdução: A qualidade da assistência à saúde tem sido foco de discussões e consequentemente de elaboração e implantação de programas que visam à melhoria dos serviços. Não é possível somente propagar a existência da qualidade, é necessário, portanto evidenciá-la por meio de indicadores confiáveis. O propósito deste estudo é desenvolver indicadores para avaliação do cuidado a pacientes críticos neurológicos. Método: Estudo de desenvolvimento metodológico de elaboração e validação de indicadores de avaliação em saúde com teor investigativo dos métodos de obtenção, organização e análise de dados, validação de instrumentos e técnicas de pesquisas. Foi desenvolvido a partir da escolha do ponto do cuidado ao paciente crítico neurológico. O processo de validação se deu através da metodologia de validação opinativa, onde sete experts participaram da análise dos conteúdos através de um manual operacional. Resultados: O parecer dos experts compreendeu a análise e julgamento do Manual Operacional dos indicadores propostos; do conteúdo de cada item de avaliação. Os resultados indicaram que todos foram considerados válidos em relação ao percentual de concordância ( Content Validity Index ¿ CVI) e em relação a representatividade da medida e a clareza dos itens de verificação. Conclusão: Considerando ¿ se os resultados obtidos no estudo é possível o estabelecimento de indicadores confiáveis para avaliação do cuidado proposto e estabelecer a qualidade do serviço prestado. A metodologia de validação possibilita uma alternativa para tornar medidas de avaliação seguras. A partir de pressupostos teóricos dos indicadores, sua aplicação subsidiará o controle da qualidade assistencial à medida que colabora com a elaboração de um plano de intervenção / Abstract: Introduction: The quality of health care has been the focus of discussions and consequently of the development and implementation of programs aimed at improving services. You can not only propagate the existence of quality, it is therefore necessary to evidence it through reliable indicators. The purpose of this study is to develop indicators for assessing the neurological critical care patients. Method: a study that implicates a methodological development and validation of indicators of health evaluation with investigative content methods of obtaining, organizing and analyzing data, validation of tools and research techniques. It was developed from the point of choice of the critical neurological patient care. The validation process was done through the opinionated validation methodology, where seven experts participated in the analysis of content through an operating manual. Results: The opinion of experts included analysis and judgment of the Operational Manual of the proposed indicators, the content of each assessment item. The results indicated that all were considered valid if compared to the percentage of agreement (Content Validity Index - CVI) and to the relative measure of the representativeness and clarity of check items. Conclusion: Considering the results obtained in the study, it is possible to establish reliable indicators for evaluation of care and establish the proposed quality of service. The validation methodology provides an alternative to making reliable assessment measures. From theoretical prerequisites of the indicators to application control, it will support the quality of care while collaborates with the development of an intervention plan / Mestrado / Fisiopatologia Cirúrgica / Mestra em Ciências

Myeloid-derived suppressor cells (MDSC) expand during sepsis, suppress both innate and adaptive immunity, and promote chronic immunosuppression, which characterizes the late/chronic phase of sepsis. We previously reported that the transcription factors Stat3 and C/EBPb synergize to induces the expression of microRNA (miR)-21 and miR-181b to promote MDSC expansion in a mouse model of polymicrobial sepsis that progresses from an early/acute proinflammatory phase to a late/chronic immunosuppressive stage. We also showed that Gr1+CD11b+ cells, the precursors of MDSCs, from mice genetically deficient in the inflammatory protein S100A9 lack miR-21 or miR-181b in late sepsis, and are not immunosuppressive. In the present study, we show that S100A9 induces miR-21 and miR-181b during the late sepsis phase. We find that S100A9 associates with and stabilizes the Stat3-C/EBPb protein complex that activates the miRNA promoters. Reconstituting Gr1+CD11b+ cells from the S100A9 knockout mice with late sepsis with S100A9 protein restores the Stat3-C/EBPb protein complex and miRNA expressions, and switches the Gr1+CD11b+ cells into the immunosuppressive, MDSC phenotype. Importantly, we find that this process requires IL-10 mediated signaling, which induces S100A9 translocation from the cytosol to the nucleus. These results demonstrate that S100A9 promotes MDSC expansion and immunosuppression in late/chronic sepsis by inducing the expression of miR-21 and miR-181b.

The objectives of this thesis are : 1) To provide a review of the literature on the significance, pathogenesis, diagnosis and management of secondary infections in the Intensive Care Unit. 2) To present the findings of a study of the technique of selective parenteral and enteral antisepsis regimen (SPEAR) in the patient population of the Respiratory ICU at Groote Schuur Hospital, aimed at reducing the incidence of secondary infection and, further to evaluate the study in terms of the effect of SPEAR on the incidence of secondary infection and its influence on the mortality due to secondary infection. 3) To present the findings of the effect of SPEAR on patient bacterial colonisation in the ICU, and to evaluate its longterm influence on the microbial flora of the ICU.

PURPOSE: The purpose of this qualitative descriptive study was to describe critical care nurses’ experiences of moral challenges, moral distress, and moral resilience during the COVID-19 pandemic. The specific aims of this study were to: 1. Describe the moral challenges experienced by ICU nurses. 2. Describe moral resilience in terms of integrity, buoyancy, moral efficacy, self-regulation, and self-stewardship among ICU nurses (from Rushton’s framework). 3. Explore the relationship between moral distress and moral resilience to advance the concept of moral resilience in the face of the COVID-19 pandemic. FRAMEWORK: This study was undergirded by an adaptation of Rushton’s conceptual framework of moral concepts. DESIGN: A qualitative descriptive design was used. Participants were recruited between January to May 2021, and a semi-structured interview guide was utilized to interview participants. RESULTS: 17 participants were interviewed for the study. Participants described the four themes of moral challenges: death and dying, pain and suffering, being alone, and being helpless and not in control. Moral resilience was described as: integrity, buoyancy, moral efficacy, self-regulation, self-stewardship, and self-perception. The relationship between moral distress and moral resilience was described as iterative and fluid. CONCLUSION: The findings of the study provided a new domain of moral resilience called self-perception and a revised adaptation of the conceptual framework for moral resilience.

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.

Bakgrund: I slutet av 2019 spreds sjukdomen Covid-19 och i mars 2020 deklarerades det som en pandemi. Sjukdomen resulterade i en stor mängd intensivvårdskrävande patienter vilket krävde stora resurser från hälso- och sjukvården. Historiskt har omfattande epidemier under 1900-talet påverkat vården på liknande sätt och sjuksköterskor som har arbetat under dessa har upplevt en stor arbetsbelastning vilket påverkat deras mående. Syfte: Att beskriva intensivvårdssjuksköterskors upplevelser och erfarenheter av att arbeta med intensivvårdskrävande patienter drabbade av Covid-19 under år 2020. Metod: Intensivvårdssjuksköterskor från tre intensivvårdsavdelningar i Mellansverige intervjuades i fokusgrupper angående deras upplevelser av att vårda patienter med Covid-19. Intervjuerna transkriberades och analyserades enligt Krueger och Caseys (2015) konstant jämförande metod. Resultat: Resultatet sammanställdes till 5 kategorier och 15 koder. Kategorierna var Personliga uppfattningar, Pandemins påverkan på vården, Relationen med patient och närstående, Arbetsgivarens hantering och Yrkets framtid. Konklusion: Intensivvårdssjuksköterskorna upplevde en ansträngd arbetssituation, där stress och utmaningar av att arbeta i skyddsutrustning var utmärkande. Arbetsbelastningen upplevdes leda till en hotad patientsäkerhet. Sjuksköterskorna upplevde en bristfällig beredskap inom organisationen. De saknade konkret klinisk information samt stöd från arbetsgivaren. För- och nackdelar av att inte ha närstående närvarande på avdelningen diskuterades och slutligen uttryckte sjuksköterskorna en oro inför framtiden. / Background: At the end of 2019, Covid-19 disease took spread and in March 2020 it was declared as a pandemic. The disease claimed large resources from the health care system. Epidemics during the 20th century have affected the health care system in a similar way and nurses working during these conditions have experienced a great workload, which affected their well-being. Aim: To describe the Critical Care Nurses [CCN] experiences working with patients suffering from Covid-19 during the year of 2020. Method: CCN from three critical care units in Sweden were interviewed in focusgroups regarding their experiences of caring for patients with Covid-19. The interviews were transcribed and analyzed according to Krueger and Casey's (2015) constant comparative method. Results: The results were compiled into 5 categories and 15 codes. The categories were Personal perceptions, The pandemic's impact on care, The relationship with the patient and their relatives, The management by the employer and The future for the profession. Conclusion: CCNs experienced a strained working situation, where stress and challenges of working in protective gear were characteristic. This led to a perceived endangered patient safety. The nurses experienced a lack of preparedness within the organization, they lacked information and support from their employer. Impacts of not having the patient's relatives present were discussed and finally the nurses expressed concern about the future.

The public’s demand for competent and safe health care obligates the profession to meet the challenges of high quality care with current knowledge and skills. The maintenance of competence and the participation in continuous professional development (CPD) has firmly been established as a professional standard with the purpose of ensuring the safety of the public. The enhancement and maintenance of knowledge and skills can be obtained through participation in CPD programmes. Despite the importance of CPD, not many critical care nurse practitioners avail themselves of the opportunity to attend CPD programmes. The overall aim of this research was to reach consensus regarding the reasons for the unsatisfactory attendance of a CPD programme developed for critical care units in a private hospital in Gauteng. A consensus methodology was used to involve the critical care nurse practitioners in planning and prioritising strategies for a future continuous professional development programme. Using the nominal group technique the critical care nurse practitioners reflected on their experience related to the current CPD programme and provided inputs and ranked priorities. Fourteen critical care nurse practitioners participated in the nominal group session. Consensus was reached regarding five priorities that should be implemented as strategies to enhance attendance of future CPD programmes. In rank order these priorities were communication, continuous professional development, clinical training, time constraints and financial implications. A central theme “attitude” was included as attitude has a powerful effect on all of the above mentioned priorities. In conclusion the study focussed on identifying and discussing the reasons for unsatisfactory attendance of a CPD programme. Based on the reasons identified priorities were set and strategies were collaboratively developed to enhance future attendance of a CPD programme. / Dissertation (MCur)--University of Pretoria, 2013. / gm2015 / Nursing Science / MCur / Unrestricted

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