Bakgrund: Barn behöver få information anpassad för sin ålder. Enligt barnkonventionen har barn rätt att säga sin åsikt och att bli hörda. Om barn får besöka en svårt sjuk familjemedlem kan det påverka den sjuke positivt genom att hen känner mer hopp. Även barn kan påverkas genom att de känner mindre hopplöshet och skuldkänslor. Syfte: Att undersöka hur intensivvårdssjuksköterskan bemöter barn som är anhörig på en intensivvårdsavdelning. Metod: En integrativ litteraturstudie, sökningar gjorda i PubMed och CINAHL. Resultat: Utifrån syftet identifierades tre huvudteman: stöd till barn som besöker, anpassa mötet efter barns behov och intensivvårdssjuksköterskans attityder till barn som anhörig. Sex studier ingår i resultatet, studierna är av kvantitativ, kvalitativ och mixad metod. Konklusion: Intensivvårdssjuksköterskan behöver i bemötandet av barn engagera och bekräfta barnet genom att se till barnets individuella behov. Det kan göras genom att i mötet med barn informera, visa och engagera. Intensivvårdssjuksköterskans attityd till att bemöta barn kan påverka barns möjligheter att få komma på besök. Det finns attityder som underlättar för barn att få komma på besök medan andra attityder kan hindra barn som besökare.

Bakgrund: Många patienter som vårdas på intensivvårdsavdelning får en nedsatt verbal förmåga relaterat till mekanisk ventilation eller sederande läkemedel. Patienterna får på grund av detta svårt att kommunicera med intensivvårdssjuksköterskan vilket kan påverka deras vårdrelation. Syfte: Att undersöka det vetenskapliga underlaget för åtgärder som kan användas för att förbättra kommunikationen mellan intensivvårdssjuksköterskor och patienter med nedsatt verbal förmåga på intensivvårdsavdelning. Metod: En litteraturstudie med systematisk ansats som baserats på forskning med kvantitativ design. Sökning och urval av studier har gjorts med hjälp av PICO. De studier som svarade på litteraturstudiens syfte granskades sedan för risk för bias innan en narrativ analys användes för resultatet. Resultat: 17 artiklar inkluderades och efter analys framkom tre huvudteman: ‘utbildning inom kommunikationsåtgärder till intensivvårdspatienter med nedsatt verbal förmåga’, ‘elektroniska åtgärder och hjälpmedel för att förbättra kommunikationen’ och ‘icke-elektroniska åtgärder och hjälpmedel för att förbättra kommunikationen’. Till huvudteman om elektroniska åtgärder och icke-elektroniska åtgärder identifierades tre respektive två stycken subteman. Samtliga studier bedömdes ha måttlig eller hög risk för bias. Slutsats: Det vetenskapliga underlaget för åtgärder som kan användas för att förbättra kommunikationen mellan intensivvårdssjuksköterskor och patienter med nedsatt verbal förmåga är bristfälligt. Att utbilda intensivvårdssjuksköterskor inom kommunikationstekniker och hjälpmedel till dessa patienter samt användning av en kommunikationsbräda för att underlätta kommunikationen har påvisat statistiskt signifikanta förbättringar för patienterna.  Bristfälligt vetenskapligt stöd även för dessa två åtgärder leder dock till att det inte är möjligt att dra en definitiv slutsats utifrån denna litteraturstudies resultat. / Background: Many patients who receive care in the ICU suffer from a reduced verbal ability due to mechanical ventilation or sedation. It can also make it difficult for the patients to communicate with the intensive care nurse, which might affect the nurse-patient relationship. Aim: To explore the scientific basis for measures that can be used to improve the communication between the intensive care nurse and patients with reduced verbal ability in the ICU. Method: A literature study with systematic approach based on research with quantitative design. PICO was used for the search and selection of studies. The studies that answered this study's aim were then reviewed for risk of bias before a narrative analysis was used for the result. Results: 17 articles were included. Three main themes emerged after analysis: ‘training in communication measures for intensive care patients with a reduced verbal ability’, ‘electronic measures and aids to improve communication’ and ‘non-electronic measures and aids to improve communication’. The two last themes had three respectively two sub themes. All studies were assessed to have a moderate or high risk of bias. Conclusion: Training intensive care nurses in communication techniques and aids as well as the use of a communication board to facilitate communication has shown statistically significant improvements for patients with reduced verbal abilities in the ICU. Because of the poor quality of the included studies and the insufficient scientific basis it is however not possible to draw a definitive conclusion based on the results of this literature study.

Background: Critical Care Nurses (CCNs) frequently provide end of life (EOL) care in intensive care units (ICUs). Barriers to EOL care in ICUs exist and have been previously published, but qualitative reports from CCNs themselves remain scarce. Qualitative data exploring barriers faced during ICU EOL care may increase awareness of obstacles and help remove them. Objective: Excluding family experiences, what are the major themes recounted by CCNs when asked to share common obstacles experienced in providing ICU EOL care? Methods: Members of the American Association of Critical-Care Nurses were randomly surveyed and responses to a single qualitative question were used. Results: There were 104 participants who provided 146 responses reflecting EOL obstacles which were divided into 11 themes; 6 physician- related obstacles and 5 nursing-and-other related obstacles. Top three EOL ICU barrier themes were inadequate physician communication, physicians giving false hope and nursing-related obstacles. Conclusion: Poor physician communication is the main obstacle noted by CCNs during ICU EOL care followed by physicians giving false hope. Heavy patient workloads were also a major barrier in CCNs providing EOL care.

Health care professionals have begun to view family members as an integral part of the healing process and the well-being of patients in the intensive care unit. The needs of family members may be varied, and nurses must become attuned to the family members' needs and acquire skills to direct interventions toward identifying and meeting those needs. The aim of the research study was to explore and identify the perceptions of family members' needs and to ascertain if those needs were perceived as met or unmet by the family members of patients housed in the intensive care units. The hypothesis proposed that a gap exists between identified needs of family members visiting intensive care patients and their perceptions of needs as being met or unmet. Data analysis included quantitative and qualitative methods.

No description available.

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.

Bakgrund: Patienter som skrivs ut från intensivvårdsavdelningar står inför en stor psykisk påfrestning, där fragmenterade minnen, minnesluckor och mardrömmar gör det svårt att urskilja vad som verkligen hänt och inte. Dagböcker är en billig intervention och har visat på potentiellt terapeutiska fördelar, för en population som annars löper signifikant risk för psykisk ohälsa. Syfte: Syftet med detta arbete var att beskriva patienters upplevelser av en dagbok skriven under deras vårdtid på en intensivvårdsavdelning. Metod: En beskrivande litteraturöversikt med systematisk ansats. Resultat: Fem huvudkategorier identifierades: Att läsa om sig själv i en kritisk situation, Att pussla ihop sin egen berättelse, Vikten av kontinuitet, Skapa insikt för att gå vidare, & Tacksamhet till vården och närstående. Det var påfrestande att läsa dagboken i början, och många uttryckte en overklighetskänsla över innehållet. Dagboken hjälpte deltagarna att koppla ihop minnesfragment med verkliga händelser, och den var ett viktigt verktyg i att rekonstruera sin egen berättelse, däremot kunde brister i kontinuiteten sätta hinder för detta och vikten av kontinuerliga anteckningar betonades. Dagboken gav insikt i hur sjuk deltagarna varit, och gjorde det lättare att förstå varför återhämtningen var långsam. Genom att läsa sjuksköterskans och närståendes anteckningar fick deltagarna en ny förståelse och tacksamhet gentemot det stöd de haft under vårdtiden, och dagboken stod som bevis för att de alltid haft någon vid sin sida, även om de inte kommer ihåg det själva.  Slutsats: Dagboken upplevdes hjälpa den psykologiska återhämtningen och gjorde tiden på intensivvårdsavdelningen mer hanterbar, vilket gjorde det möjligt att gå vidare. / Background: Discharge from the intensive care unit comes with significant psychological strain, with fragmented memories, memory gaps, and nightmares makes it hard differentiating between actual and false memories. Diaries is a cheep intervention with potential therapeutic advantages, for a population which otherwise is at great risk of mental illness. Aim: The aim of this study was to describe patients’ experience of a diary written during their stay at the intensive care unit. Method: A descriptive literature review with a systematic approach. Results: Five main categories emerged: To read about oneself in a critical situation, To piece together ones own story, The importance of continuity, Creating insight to move on, & Gratitude towards care giver and relatives. It was hard reading the diary at first, and many described a feeling of unreality. The diary aided participants in connecting fragmented memories to events, and it was seen as a crucial tool in reconstructing ones story. Lack of continuity was a hindrance, and the importance of continuous notes was stressed. The diary gave insight into how ill the participants had been, which made it easier to understand why the recovery was slow. By reading notes by nurses and relatives, the participants gained understanding and gratitude towards the support they hade received, and the diary was evidence that they always hade someone bedside, even if they can’t remember it. Conclusion: The diary was perceived to aid the psychological recovery and made the intensive care experience more manageable, which made it possible to move on.

Bakgrund: Patientsäkerheten brister ibland i vården men är så viktig för den enskilda individens mående och tillfrisknande, begreppet innebär att patienter inte ska komma till skada eller att vårdåtgärder uteblir som patienten är i behov utav. Olika faktorer kan påverka att oförutsedda händelser inträffar som kan medföra en patientsäkerhetsrisk, för att dessa faktorer skall kunna uppmärksammas rapporteras händelser in som avvikelser av involverad personal. Det saknas studier gjorda på vilka områden som identifieras bland dessa avvikelser. Syfte: Syftet var att beskriva vilka typer av avvikelser som rapporterats in samt antal per år och analysera vilka områden som identifieras bland avvikelserna inom intensivvården för att främja patientsäkerheten. Metod: En registergranskning med tematisk analys av 212 avvikelser inrapporterade i sjukhusets interna avvikelsesystem. Resultat: Studien visar att de avvikelser som rapporterats till största del består av undvikbara vårdskador, 85 %, samt 15 % oundvikliga vårdskador. De områden som förekommer rör mestadels läkemedelsförseelser samt bristande följsamhet kring riktlinjer. Det är många olika faktorer som identifierats som potentiella orsaksområden men arbetsmiljö, kompetensbrist, den mänskliga faktorn samt organisatoriska faktorer är de återkommande områden som identifierats. Slutsats: Resultaten från denna studie visade att arbetsmiljö är en faktor som är starkt förknippad med patientsäkerhet. Majoriteten av alla negativa händelser som inträffar är undvikbara då det till största del är läkemedelsbetingade eller en brist på följsamhet av etablerade rutiner på avdelningen. De oundvikbara händelser som inträffat är till största del beroende på organisatoriska faktorer och därmed ej något som vårdpersonal hade kunnat förändra utgången av. / Background: Sometimes patient safety is lacking in care, but it is very important for the individuals care and recovery, the concept means that patients should not be harmed or lack nursing care that the patient is in need of. Various factors can affect the occurrence of unforeseen events that may be a patient safety risk, so for these factors to be noticed, events are reported as deviations of the staff involved, no studies have been done on what these deviations have for common areas. Purpose: The purpose was to describe which types of deviations that were reported over time and to analyze what common areas there is for the deviations reported in intensive care units to improve patient safety. Method: A registries study of 212 deviations from the hospitals internal deviation-database with a thematic analysis. Result: The deviations reported consists of avoidable medical errors, 85%, and 15% of unavoidable medical errors. The common areas that occur are drug misconducts and lack of adherence to guidelines. There are different factors that have been identified as potential causes, but the working environment, lack of competence, the human factor and organizational factors are the recurring areas identified. Conclusion: The working environment is a factor that is strongly associated with patient safety. The majority of all deviations that occur are avoidable as they are drug misconducts or lack of adherence to established guidelines on the department. The unavoidable medical errors occurred due to organizational factors and are therefore not something that healthcare personnel could have changed the outcome of.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: The role of the physiotherapist in the neonatal intensive care unit is unclear. How other neonatal healthcare professionals and physiotherapists themselves perceive their role in the management of neonates, their practice patterns and services, their role in the neonatal intensive care multidisciplinary team, their use of evidence-based practice and awareness of the profession in this setting has not been well explored. This information is lacking in the South African healthcare context as well. Therefore, the aim of the study was to explore and describe the perception of doctors, nurses and physiotherapists of the role of the physiotherapist in public and private sector neonatal intensive care units in South Africa. Methods: A qualitative exploratory research design was used. All medical practitioners (paediatricians and neonatologists), nurses and physiotherapists working in the neonatal intensive care units in two private sector and two public sector hospitals in the Cape Metropole region in the Western Cape South Africa who provided consent to participate were included. An inclusive (total population) sampling method was used where all healthcare professionals working in these units were invited to an individual face-to-face audiotaped interview using a semi-structured interview guide and conducted by the researcher at a time and place convenient to the participants following informed consent. Data was transcribed verbatim and analysed using both deductive and inductive thematic content analysis to develop codes, categories and themes. Trustworthiness was ensured by ensuring credibility, conformability, dependability and transferability of data. Ethics was obtained from the relevant Institutional Review Board. Results: Twenty-one healthcare professionals participated, including doctors (n=5), nurses (n=6) and physiotherapists (n=10). The mean age in years of the participants was 41+/–11 years with the physiotherapists having the lowest mean age. The participants had various years of general and neonatal intensive care experience and physiotherapists in specific only had basic undergraduate qualifications with minimal specialised training in neonatal intensive care. Five major themes emerged namely: i) the role of the physiotherapists in the management of the neonatal ICU patient, ii) practice patterns and services iii) teamwork iv) training and qualifications including evidence-based practice, v) awareness of and exposure to neonatal intensive care physiotherapy. Conclusion: Physiotherapists working in this neonatal intensive care setting need to promote their profession through education of other neonatal healthcare professionals in order to improve awareness, referral patterns and integration into the multidisciplinary team. Evidence-based practices and improving training and skills development in the area of neonatal physiotherapy can be further explored in this setting.

Studies have addressed the visitation needs of visitors and patients and the impact of visitation policies on nurses, but few studies compare the level of satisfaction between visitors and nurses when visitation policies change. The objectives of this study were to investigate whether a more liberal intensive care unit visitation policy satisfactorily met the needs and expectations of visitors and nurses. © 1999 Lippincott Williams and Wilkins, Inc.