Within the health care, many medical professionals know about the critical time restraints for provisions of care within their discipline, but do not know the term "The Golden Hour". The Golden Hour is a term indicating the universal time restraint found within every area of health care and more specifically, every area of nursing. The term and concept represented by it should be recognized to better the outcomes of our patients. Although the Golden Hour typically indicates a 60-minute period of time, various settings recognize shorter and longer periods during which specific actions must be taken to assure positive patient outcomes. To meet this aim, this thesis will review studies related to outcomes as associated with time critical interventions that could be categorized by "The Golden Hour". To meet the goal, a search of CINAHL, MEDLINE, PsychINFO, and ScienceDirect databases was conducted. Findings of the search revealed that while the term is not widely used, the concept of time sensitive care is found in many areas of Health Care and, specifically, within multiple sub-disciplines of nursing.

Family Presence During Resuscitation (FPDR) remains controversial and is not consistently implemented during resuscitation events or invasive procedures. Evidence has demonstrated positive outcomes produced by implementation of FPDR; such as, decreased rates of post-traumatic stress symptoms, decreased symptoms of anxiety, and depressive symptoms were not significantly different. Unfortunately, use of FPDR in the acute care setting is not widely accepted or readily implemented. The primary purpose of this integrative literature review is to evaluate the use of FPDR in the acute care setting. The secondary purpose is to evaluate the health care professional's level of perceived value associated with the outcome of having family present during resuscitation. A systematic literature search was conducted using multiple databases for relevant articles in the English language between 2006 to 2017, including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Elton B. Stephens Co. Host (Ebsco Host), Medical Literature On-line (Medline), Psychological Information Database (PsychINFO), and PubMed. Search terms included 'family presence during resuscitation', 'family presence', 'pediatrics', 'nurse perceptions', and 'perceptions'. Ten of the nineteen articles suggest the use of FPDR leads to positive outcomes such as decreased post-traumatic symptoms, and decreased anxiety for family members. The use of FPDR can enhance family members' understanding of resuscitation efforts and involves them in their loved one's care. This integrative review indicates the implementation of FPDR can provide benefits for family members of those undergoing CPR and invasive procedures; although the perceptions of the healthcare team remain the barrier to its use.

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Bakgrund: Vasoaktiva läkemedel är vanligt förekommande hjälpmedel inom intensivvården. Denna läkemedelskategori beskrivs som förstahandsval vid svår cirkulatorisk svikt. De har ett smalt terapeutiskt spektrum och utsätter patienter för potentiellt livshotande komplikationer samtidigt som de är nödvändiga för överlevnad. Att vara specialistsjuksköterska på en intensivvårdsavdelning innefattar avancerad vård och omvårdnad av kritiskt sjuka patienter. Här ställs höga krav gällande ansvar och kompetens inom en rad komplexa områden. I Sverige är det framför allt specialistsjuksköterskor som hanterar och administrerar vasoaktiva läkemedel efter ordination. Det kräver sakkunnighet inom det medicinska området gällande verkningsmekanism, interaktioner och biverkningar. Det erfordras även individuell skicklighet för att motsvara intensivvårdens kompetenskrav och inte riskera patientsäkerheten. Syfte: Syftet med denna studie var att beskriva intensivvårdssjuksköterskors erfarenheter av att vårda patienter som behandlas med vasoaktiva läkemedel. Metod: En kvalitativ intervjustudie har genomförts där data samlats in genom individuella, semistrukturerade intervjuer med 10 intensivvårdssjuksköterskor. Intervjuerna analyserades enligt en kvalitativ innehållsanalys med manifest ansats. Resultat: Analysen resulterade i fyra kategorier: att ha ett omvårdnadsperspektiv, att ha kliniskt handhavande, att ha en patientsäkerhetskultur och att upprätthålla klinisk kompetens. Det resulterade i ett gemensamt tema för samtliga kategorier: ett livslångt lärande. Lärande beskrivs som en dynamisk process vilket främst tillhandahålls genom klinisk praxis. Erfarenhet av att arbeta med cirkulatoriskt instabila patienter medför en trygghet och säkerhet i hanteringen av vasoaktiva läkemedel. Det leder också till att omvårdnaden och patientsäkerheten kan förbättras. Lärande beskrivs som ett eget och gemensamt ansvar för samtliga professioner. Slutsats: Det krävs att intensivvårdssjuksköterskan har teoretisk kunskap för att hantera vasoaktiva läkemedel. Det är dock genom kliniskt handhavande och praktisk erfarenhet som trygghet och skicklighet skapas.

El delirio es un estado disfuncional cerebral agudo que se presenta en pacientes críticos en unidades de cuidados intensivos (UCI), produce resultados clínicos desfavorables, mayor estancia y deterioro cognitivo a largo plazo. La participación de la familia, aún no es clara, pero podría desempeñar un papel importante en su prevención. El objetivo que guió esta revisión crítica, fue describir el efecto de las estrategias que incluyen a la familia en la prevención del delirio en el adulto critico de una UCI. La metodología que se empleó fue la Enfermería basada en la Evidencia (EBE), elaborándose el esquema PIS para plantear la pregunta clínica ¿Cómo es el efecto de las estrategias que incluyen a la familia en la prevención del delirio en el adulto crítico de una unidad de cuidados intensivos? Se realizó la búsqueda de evidencias en base de datos, encontrándose 244 artículos, considerándose 11, que cumplieron con los criterios de selección, sometiéndose a la lista de Gálvez Toro, finalmente se seleccionó uno, que se analizó con la guía de lectura crítica de CASPe para Revisión Sistemática. La revisión concluye que las intervenciones de tratamiento múltiple, especialmente involucradas en movilización temprana y participación familiar, deben incorporarse en la atención diaria de los pacientes en las UCI, porque son las más efectivas para la prevención del delirio, aunque no para su duración. Los resultados respondieron a la pregunta clínica y demuestran que la participación de la familia como intervención no farmacológica se recomienda para prevenir eficazmente el delirio en la UCI. / Delirium is an acute dysfunctional cerebral state that occurs in critically ill patients in intensive care units (ICUs). It can cause unfavorable clinical results, longer stays, and long-term cognitive impairment. Family involvement is not yet clear, but it could play an important role in its prevention. The objective of this critical review was to describe the effect of strategies that include the family in the prevention of delirium in the critically ill adult in an ICU. The methodology used was Evidence-Based Nursing (EBE), developing the PIS scheme to pose the clinical question: Which is the effect of strategies that include the family in the prevention of delirium in critically ill adults treated in the intensive care unit? The search for evidence in the database was carried out, finding 244 articles, considering 11 of them, which met the selection criteria, submitting to the Gálvez Toro list, finally one was selected, which was analyzed with the critical reading guide. of CASPe for Systematic Review. The review concludes that multiple treatment interventions, especially involving early mobilization and family involvement, should be incorporated into the daily care of patients in ICUs, because they are the most effective for delirium prevention, although not for its duration. The results answered the clinical question and demonstrate that family involvement as a non-pharmacological intervention is recommended to effectively prevent delirium in the ICU.

In-patient deterioration is a global phenomena and timely recognition and action improves outcome. Intensive care facilities are scarce and expensive and therefore patient care must be optimal. A retrospective health record analysis was used for this study. The findings indicated that nursing personnel do not recognize patient deterioration timeuously. However, the implementation of an outreach team and clinical markers training program improved the recognition of patient deterioration in general wards with three hours and 40 minutes. It is recommended to implement a comprehensive hospital program that addresses the basic knowledge and skills of general ward personnel to observe, recognize, assess and intervene to patients with clinical deterioration. Together with an extensive training program, a basic physiological parameters guideline to activate a team of experts to the bedside, such as an Outreach team, assist nursing personnel to recognize and manage those patients timeuously and ensure treatment in an appropriate level of care. / Health Studies / M. A. (Health studies)

Some innovations are termed ‘disruptive’, a designation that is normally applied to technology; examples include computers, digital cameras, and mobile phones. The term can also be applied to groups of workers, particularly if they are able to offer specific technical capabilities within a market at lower cost, but broadly equal and effective to that offered by traditional products or services. Paramedics could be described in this way and are a newly professionalised group, with distinctive capabilities in terms of responding to the needs of not just the acutely ill and injured, but increasingly those patients with undifferentiated non-life- threatening conditions, which increasingly make up the bulk of 999 call demand. The key to their transition from an artisan, skilled worker to professional status is the acquisition of certain ‘hallmarks’. Perhaps the most important of these is the completion of more prolonged education that affords the opportunity to graduate with enhanced decision-making and other clinical skills in order to meet the needs of the full spectrum of patients in the pre-hospital setting. Paramedics were surveyed to determine how they rated their ‘traditional’ preparation and to establish what their attitudes were to a more educationally based approach. Paramedics themselves proved to be realistic regarding shortcomings in established training and education systems, while also being strongly motivated to learn more within a higher education setting, particularly if this additional effort would result in being able to offer a wider range of care to their patients. During the study, major changes in the health care environment and the role of the Ambulance Service took place, leading to a requirement to undertake a second phase of research. This took the form of ‘Horizon Scanning’ in an attempt to detect ‘signals’, themes and trends in relation to newly emerging ‘competitors’ to the paramedic role. These included nursing, new practitioners and most critically, the rapidly emerging medical sub-speciality of pre-hospital care, staffed by medical personnel on a pattern found specifically in some European countries, sometimes termed the ‘Franco-German’ model/System (FGM/S). Hitherto, the model of provision in the UK had followed the ‘Anglo-American’ model/System (AAM/S), approach, with paramedics providing direct patient care in the field and medical staff largely involved in medical oversight, teaching, clinical governance and other higher level roles. As part of this research, the evidence base for change was examined and consideration given to the factors that might help clarify what the likely situation could be in 2030 in respect of ambulance services, pre-hospital care and paramedics. This future is uncertain, but factors have been identified that would militate in favour of one or other model prevailing, with close links established between educational preparation, system design, career structure and the continuance of the professionalisation process favouring paramedic progression. However, other factors, most specifically professional power, the absence of a clear evidence base and an apparent reluctance to clearly acknowledge this in some respects, lead to the conclusion that the future of pre-hospital care remains uncertain and contested, but also potentially amenable to a well-directed influencing strategy.

Thesis (MPhil (Curriculum Studies))--Stellenbosch University, 2008. / Background to the study: The Critical Care nursing programme at the Faculty of Health Sciences (Stellenbosch University) is a one-year programme. The practical component consists of practical procedures and case presentations. Students have limited time available in the clinical areas to reach competency in the practical skills. Students tend to use the majority of the clinical teaching time available to reach competency in these practical procedures, rather than discussing the patient and learning the skills to integrate and understand the patient’s condition and treatment, which they can acquire by doing case presentations. The end result of this misuse of clinical contact time is that some of the students, by the end of their programme, still have difficulty to integrate a patient’s diagnosis and treatment regime, although they have managed to complete the expected practical procedures. Summary of the work: A case study design was used. I wanted to investigate whether one could make use of simulation and the Clinical Skills Centre (CSC) to complete the majority of the practical procedures so that more time would be available in the clinical areas for the students to do case presentations. The study focuses on describing how the tutors and students involved experienced the use of simulation, as well as how it impacted on the available teaching time in the clinical areas. Conclusions and recommendations: Some of the most important issues that were highlighted in the study and needs to be mentioned are the following: · The students highly valued supervision by a Critical Care tutor when practising their skills in the CSC. · Students indicated that they valued the opportunity to practise some of the more risky procedures in simulation, because it presents no risk to patients. · Case presentations seem important to be added to the CSC’s practical sessions in order to attempt making the practical simulated scenarios even more realistic. · The teaching at the bedside in the clinical areas used to be done somewhat ad hoc. With the teaching in the CSC now being much more structured, this necessitates the teaching at the bedside to be revisited and to be structured to a certain extent. Summary of the results: The information obtained from the Critical Care tutors and the students indicated that these two groups were largely in agreement that simulation seems to be valuable and can effectively be used in a Critical Care nursing programme.

Att arbeta som nyutbildad intensivvårdssjuksköterska kan upplevas som väldigt krävande. Det krävs både specificerad kunskap om olika komplexa sjukdomstillstånd och att intensivvårdssjuksköterskan ska kunna hantera den högteknologiska miljön som en intensivvårdsavdelning utgör. När patienter vårdas på intensivvårdsavdelning förekommer olika intrahospitala transporter under vårdtiden, vilket medför ökade risker för patienterna. Tidigare studier visar att det förekommer ett högre antal oväntade händelser och en större otrygghet bland intensivvårdssjuksköterskor med kort arbetserfarenhet av intensivvård i samband med intrahospitala transporter. Syftet med detta examensarbete var att beskriva behov hos intensivvårdssjuksköterskor med mindre än fem års arbetserfarenhet för att känna sig trygga i samband med intrahospitala transporter av kritiskt sjuka patienter. Nio intensivvårdssjuksköterskor med <5 års arbetserfarenhet av intensivvård deltog i studien. Datainsamlingen genomfördes med semistrukturerade intervjuer, vilka sedan analyserades med en kvalitativ innehållsanalys. Analysen resulterade i tre kategorier: behov av att ha kompetent vårdpersonal med god samarbetsförmåga, behov av att ha en miljö som är anpassad för transporter och behov av att genomföra en omsorgsfull planering för att känna sig förberedd, vilka sedan resulterade i ett tema: behov av att känna kontroll över situationen med stöd från vårdteamet. Resultatet av denna studie visar vikten av att det implementeras en rutin vid intensivvårdsavdelningar för nyutbildade intensivvårdssjuksköterskor som tar anställning vid arbetsplatserna. Största vikten bör läggas på att intensivvårdssjuksköterskor ska omges av ett kompetent vårdteam med en tillåtande miljö, där det finns tid och möjlighet för god och individanpassad handledning.

Dissertation submitted in fulfillment of the requirements for the Degree in Masters of Technology: Nursing, Durban University of Technology, 2011. / Background Working in the intensive care unit can be traumatic for nursing personnel. Critical care nurses are faced with repeated exposure to death and dying as they are involved in caring for patients who are actively dying or who have been told that they have a terminal illness and are faced with the possibility of impending death. Critical care nurses relate in different ways to the phenomena of death and dying within their nursing profession and their scope of practice. These nurses often have a difficult time coping with the stress that comes with caring for those who are dying or relating to loved ones of those that are dying. Aim of the study The aim of the study was to explore the critical care nurse’s experiences of death and dying. Methodology A qualitative, descriptive phenomenological approach was used to guide the study. Four nurses were recruited and rich descriptions of their experiences were gained through individual face-to-face interviews. One broad question was asked: ‘What are your experiences regarding death and dying of your patients in ICU?’ iii Results The findings of this study revealed that issues such as communication, multicultural diversity, education and coping mechanisms relating to caring for the critically ill and dying patient are essential in nursing education and practice. Critical care nurses need to have support networks in place, not only to assist in providing care, but also for their own emotional support / M