The literature suggests that informed consent documents (ICDs) are not well understood by research participants. The patient decision aid model may suggest improvements for the informed consent process, particularly in the critical care setting (ICU) because of patient capacity issues. Our goal was to evaluate the extent to which existing ICDs used in ICU research adhere to standards and recommendations for high quality informed consent. Eighteen items from recommendations specific to ICU trials were added to a previously developed ICD evaluation tool. A sample of ICU trials was identified from clinicaltrials.gov database and the investigators contacted for their trial ICD. Conformity to the recommendations was variable. Some information are found routinely in consent documents for critical care research and some are not. Efforts should aim to establish tools for measuring decision quality in the ICU with the goal of facilitating and helping patients and surrogates work through trial participation decisions.

The purpose of the study was to explore and describe the lived experiences of neophyte professional nurses working in ICU during their first year post graduation with the aim to discover strategies to support the nurse in critical care unit. An explorative, descriptive, interpretative qualitative design was conducted to uncover the nurse’s experiences. A purposive sampling was used which is based on belief that the researcher’s knowledge about the population can be used to hand pick sample elements. Data was collected through in-depth unstructured interviews and written narratives. Collaizi’s method of data analysis was used. The study findings revealed that neophyte professional nurses experienced difficulties and challenges in adjusting to the unit because of lack of mentors emanating from the shortage of staff. Nurses experienced mixed feelings regarding the relationship with colleagues in terms of support received. / Health Studies / M.A. (Health Studies)

Nonvocal alert patients in the intensive care unit setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. A novel communication tool, the Manually-Operated Communication System (MOCS), was developed for use in intensive care settings for patients unable to speak due to mechanical ventilation. It is a speech-generating device designed for patients whose limited manual dexterity precludes legible writing. In a single-arm device feasibility trial, 14 participants (11 with tracheostomies, 2 with endotracheal tubes, and 1 recently extubated) used MOCS. Participants, family members, and observing nurses were interviewed whenever possible. Interviews included a modified version of the System Usability Scale (SUS) as well as open-ended questions; a qualitative immersion/crystallization approach was used to evaluate these responses. Participants with a tracheostomy and their family members/care providers rated MOCS on the SUS questions as consistently “excellent” (average rating across all groups was 84 +/- 17; all subgroups also rated the device highly). Through a qualitative interview process, these stakeholders expressed support for the use of MOCS in the ICU. Based on these data, MOCS has the potential to improve communication for nonvocal patients with limited manual dexterity.

BACKGROUND Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored. OBJECTIVES To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year retrospective study of all patients undergoing VAD-TAH surgery at a large academic university medical center. METHODS The preferred reporting items for systematic reviews and meta-analyses or PRISMA statement guided this systematic review. Quality of evidence was determined using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Two reviewers independently appraised manuscripts matching the eligibility criteria for study inclusion. Four databases including PubMed, CINAHL, Web of Science, Google Scholar, and hand searches of journals based on reference lists from included studies were utilized. Initial results of this primary search revealed zero studies that met inclusion and this search methodology was confirmed by medical librarian consultation. Therefore, a follow up retrospective study was necessary to identify incidence of PI in the VAD-TAH population. However, a secondary search, dropping keywords of VAD-TAH and instead focusing on studies of on-pump cardiac surgery and mixed surgical studies where cardiac surgery patients were included, was conducted to establish variables to guide a retrospective study of all VAD-TAH surgeries between 2010-2018. The retrospective study evaluated the incidence of pressure ulcers by case, patient and incidence density for each of the respective 1000 patient days during the study period. Univariate statistics are reported by four different VAD-TAH devices. Variables significant in bivariate analysis were entered in a stepwise logistic regression model. RESULTS In the systematic review, 312 articles were identified from the databases with eight additional articles from hand searches. Following abstract review, 208 were excluded for not meeting inclusion criteria or study quality metrics. 77 articles were read in full, with 61 excluded, leaving 16 articles for inclusion. 31 risk factors were identified for PI development in on-pump cardiac surgery patients with 11 risk factors which were identified as significant in multivariate analysis for inclusion in the retrospective study.

Bakgrund: Donation efter primär hjärnskada (DBD) har utförts i Sverige sedan 1981 och ärden vanligaste formen av donation. Donation efter cirkulationsstillestånd (DCD) infördes iSverige 2020 och ökar i omfattning. I länder där DCD redan är etablerat beskrivskunskapsnivån som låg i förhållande till DBD vilket leder till en känsla av otrygghet hosvårdpersonalen.Syfte: Att kartlägga hur intensivvårdssjuksköterskans skattar sina kunskaper och erfarenheter ivården av potentiella donatorer över 18 år enligt DCD processen.Metod: Enkätundersökning med kvantitativ design genomfördes. Enkäten skickades ut till 11intensivvårdsavdelningar i Sverige.Resultat: Består av svar från 58 respondenter. Majoriteten av respondenterna har fått teoretiskoch praktisk utbildning i att vårda en potentiell donator i DCD processen. Över 50% svararockså att de fått utbildning i att stödja donatorns närstående. Samband finns mellan kunskapoch utbildning men även mellan utbildning och skattad trygghet.Konklusion: Tydliga samband ses i studien mellan utbildning och kunskap. Kunskapen i sintur visar tydliga samband med intensivvårdssjuksköterskans skattade erfarenhet av trygghet ivården av den potentiella donatorn men även erfarenheten av att stödja/bemöta och besvarafrågor från närstående. Utbildningen är en viktig faktor för att förberedaintensivvårdssjuksköterskan i vården av en DCD. / Background: Donation after brain death (DBD) has been performed in Sweden since 1981 andis the most common type of donation. Donation after circulatory death (DCD) was introducedin Sweden in 2020 and is increasing in scope. In countries where DCD already is establishedthe level of knowledge is described as low in relation to DBD which leads to a feeling ofinsecurity of healthcare professionals.Purpose: To map how intensive care nurses estimate their knowledge and experiences in thecare of potential donors over the age of 18 according to the DCD-process.Method: Survey study with a quantitative design. The Survey was sent to eleven intensive careunits in Sweden.Result: Consist of answers from 58 respondents. The majority of the respondents receivedtheoretical and practical education in the care of a potential donor in the DCD process. Morethan 50% also received education to support the donors’ relatives. Correlations were shownbetween knowledge and education but also between education and a feeling of security.Conclusion: A clear correlation is seen in the study between education and knowledge.Knowledge in turn shows correlation to the intensive care nurse ́s valued experience in the careof a potential donor but also to the experience of supporting and answering questions from itskin. Education is an important factor to prepare the intensive care nurses in the care of a DCD.

Burnout is reflected in pathological emotional depletion and maladaptive detachment that is a secondary result of exposure prolonged occupational stress. It is comprised of three dimensions, namely, emotional exhaustion, depersonalization and reduced personal accomplishment. It is becoming increasingly recognized as one of the most serious occupational hazards for nurses who work in critical care units. The objectives of this study are to assess the prevalence of burnout among a sample of nurses who worked in the critical care units in a particular hospital in Kenya, to analyze factors that contributed to the development of burnout and to identify measures for the mitigation of burnout. For this study, the researcher utilized a mixed methods research design in two phases. Phase one assessed the prevalence of burnout in nurses working in the critical care units by making use of the Maslach Burnout Inventory – Human Services Survey. Focus groups discussions were then held in Phase two to investigate the factors that the nurses perceived as the main causes of burnout and to solicit their ideas about it could be mitigated. Convenience sampling and purposive sampling were used in the two phases of the study respectively. / Health Studies / M.A. (Health Studies)

The purpose of this study was to explore and describe the knowledge that a cohort of 40 intensive care unit nurses had of evidence-based practice. It was assumed that they lacked the knowledge to locate, evaluate understand and apply research findings. Quantitative, non-experimental descriptive research was conducted to explore their knowledge and to formulate recommendations for promoting it. Data collection involved administering a structured questionnaire administered to the cohort in an intensive care unit. The findings revealed that, although they were familiar with the basic concept of evidence-based practice, they were reluctant and lacked the skills to adopt it in their practice. It is recommended that they be trained and empowered to develop research expertise from within their own ranks. Finally it is recommended that nursing management should play a more proactive role in identifying cost-effective strategies in overcoming barriers to finding, promoting and integrating evidence-based practice / Health Studies / M.A. (Health Studies)

Background: Critical care is a relatively young speciality with its intention to treat critical illness equally all around the world. Patients admitted to ICUs receive advanced treatments in order to save lives, however some patients will pass away during critical care, which put family members in great physical and emotional distress. It is important to support family needs and keep core principles of palliative care in mind in order for patients and family members to cope with current situation. The need for palliative care is greater than ever, but in most parts of the world it is poorly developed. Brazil struggles with several challenges regarding implementation of a palliative approach within ICU settings. Aim: the aim was to explore nurses’ experiences of palliative care, focusing on family involvement in Brazilian ICUs. Method: semi-structured interviews were analysed using content analysis. Five female nurses were included from one public and one private hospital in the city of Rio de Janeiro, with an average ICU working experience of nine years. Results: three main categories were identified describing nurses’ experiences of palliative care and family involvement: to care for a dignified death, to promote family involvement and areas for future improvement. Discussion: the results reveal that the nurses, even though lack of professional training, believe that palliative care is important for both patient and their family members at the EOL. Brazilian nurses also face several challenges in order to perform palliative care successfully within ICUs. They struggle with strict visiting policy and the perception of nurses being inferior to physicians. There is a wish for acknowledgement of the nursing profession during EOLC in Brazilian ICUs, since nurses spend most time at each patient’s bedside along with their family members.

This study focused on Registered Nurses (RNs) working in Acute Trust surgical wards in the context of their role development, role expansion and role extension. The study originated from concerns raised by RNs undertaking the surgical pathway of the BSc Hons in clinical nursing practice, who alerted me to their dissatisfaction with their working conditions and their role. This revelation was made at a time when modernization was cascading into Acute Trusts as a result of the NHS plan (DOH 2000); simultaneously the European Working Time Directive (EWTD) was being implemented, sequentially reducing Junior Doctor’s hours of work. NHS modernization and the EWTD were the two initiatives which led the researcher to the assumption that RNs working in surgical wards were the labour force who would be absorbing the additional workload brought about by these changes, because RNs are the only health professionals in acute surgical wards with twenty-four hour contact with, and responsibility for, ward-based surgical patient care. The study was conducted in one clinical directorate of an Acute Trust hospital, comprising six in-patient surgical wards and five specialist nursing services. The methodology was ethnography, where the researcher worked as an RN for fifteen months, collecting data through Spradley’s (1980) descriptive, selective and focused phases of fieldwork. Data was analysed using what Miles and Huberman (1994) refer to as a set of ‘choreographed / custom built’ techniques. The descriptive phase of fieldwork revealed an apparent ‘staffing illusion’ on the surgical wards and RNs were found to be under tremendous pressure to manage ‘patient throughput’, and an ever increasingly dependent case mix of surgical patients, within the existing, or if possible diminishing Senior / experienced RN labour force due to the emergent evidence of a ‘cycle of staff change’ with non-clinical managers backfilling Senior RN posts with Junior RNs. For Senior RNs this backdrop meant additional support and supervision demands on their role. To get through the workload many RNs held ‘dual roles’ to enable maintenance of the surgical services within the directorate. The selective phase of fieldwork re-focused the ethnographic lens on the RNs in the context of their role development, role expansion and role extension, from which six perspectives were found: 1) role development from Junior to Senior RN, 2) role expansion dependent on shift of the day, day of the week – the co-ordinator role, 3) role extension confusion and boundary disputes, 4) hidden [role expansion and extension] talents of surgical nurses, 5) role contraction – a feeling Nursing is going backwards, and finally, 6) ‘if only I could’ – role expansion aspirations of surgical RNs. The third phase of fieldwork, described by Spradley (1980) as the focused phase, was spent validating the findings and conducting the ethnographic interviews. The findings are interpreted locally [from the perspective of RN’s working within Rodin] as ‘working to full capacity’ through ‘doing more for more with less’, as a result of the RN with the surgical directorate being sandwiched between two agendas, that of Junior Doctors EWTD and NHS modernisation. Braverman’s skill substitution / degradation of skilled work thesis is then used as an interpretative framework to conclude the thesis, the outcome of which reports a ‘triple substitution’ agenda.

Social support is the collection of tangible and intangible experiences that surround people as they cope with daily stressors. High quality social support is important among patients with cardiovascular disease (CVD) because it has positive effects on social, psychological and physical well-being, and those with good social support cope better with the travails of CVD. Although there are many studies of social support in CVD, little work has been done on the topic of discrepancies between desired and received social support in the context of gender. The purpose of this dissertation was to determine if there are gender differences in the discrepancies between CVD patients’ desired and received social support. If gender differences exist in desired and received needs for social support, it is necessary to identify how these differences might affect rehospitalization and mortality rates. Three manuscripts are included in this dissertation: 1) a comprehensive review of the literature to examine gender differences in CVD patients’ perception of the concordance between desired and received social support and if gender differences in patients’ perception of concordance are associated with differences in health outcomes; 2) a secondary analysis of a cross-sectional observational study to determine whether there is a differential relationship between perceived social support and depression in African American and Caucasian patients with heart failure (HF), and 3) a longitudinal observational study to determine if the discrepancy between desired and received support for individuals hospitalized with an exacerbation of HF is associated all-cause event-free survival. I identified a gap in the literature regarding the differences in received and desired levels of social support between genders that warrants further investigation. In the secondary analysis, I found that race moderates the relationship between perceived social support and depressive symptoms. Higher levels of perceived social support were associated with lower levels of depressive symptoms among Caucasians who had higher levels of depression. Among African Americans, depression levels were lower and were unaffected by level of social support. In the longitudinal observational study, 157 participants identified desired and received support upon enrollment. The participants had follow-up at one- and three-month post discharge intervals to determine if they had experienced rehospitalization or mortality during the period. In unadjusted and adjusted analyses neither gender nor social support congruency score group were predictive of all-cause event-free survival. This finding belies the common belief that too much support will smother the patient, causing cardiac invalidism. Despite this, further research is needed to continue to evaluate ongoing discrepancies between genders of desired and received support and their impact on health outcomes. Further research is also needed to establish accuracy in more appropriately matching social support received with the social support desired.