No description available.

No description available.

Myeloid-derived suppressor cells (MDSCs) numbers increase significantly in sepsis and are associated with high mortality rates. These myeloid cell precursors promote immunosuppression, especially in the late (post sepsis) stage. However, the mechanisms that underlie MDSC expansion and programming are not completely understood. To investigate these mechanisms, we used a cecal-ligation and puncture (CLP) mouse model of polymicrobial sepsis that progresses from an early/acute proinflammatory phase to a late/chronic immunosuppressive phase. Previous studies in our laboratory showed that microRNA (miR)-21 and miR-181b elevate levels of the transcription factor nuclear factor 1 (NFI-A) that promotes MDSC expansion. We report here that miR-21 and miR-181b regulate NFI-A expression via a post-transcriptional regulatory mechanism by recruiting RNA-binding proteins HuR and Ago1 to stabilize NFI-A mRNA, thus increasing its protein levels. Studies in our laboratory also showed that inflammatory mediator S100A9 accumulates in the nucleus in Gr1+CD11b+ myeloid precursors in the later phases of sepsis and is necessary for their expansion and programming into immunosuppressive MDSCs. We demonstrate here that nuclear S100A9 associates with specific transcription factors that activate miR-21 and miR-181b expressions. In our final manuscript, we uncover another layer of the mechanisms of MDSC expansion and programming. We found that long non-coding RNA (lncRNA) Hotairm1 binds to and recruits S100A9 to the nucleus to program Gr1+CD11b+ myeloid precursors into MDSCs in the later phases of sepsis. Together, our results reveal three regulatory layers involving NFI-A, S100A9 and Hotairm1 in the pathway leading to MDSCs development in sepsis and suggest that therapeutically targeting these molecular switches might improve sepsis survival.

The dependence of cardiac output measurement precision on ambient temperature and cardiac output stability was assessed by concurrent continuous and bolus thermodilution methods in postoperative cardiac surgery patients. The degree of agreement between the two methods was depended on room temperature (0.1 L/min for each degree below 25 degrees C). The agreement was also closer in trials where cardiac output was stable (< 10% variation). The continuous thermodilution method shows sufficient agreement with the bolus method for use in critical care; however, improved precision of cardiac output thermodilution measurements can be achieved by use of correction factors for cardiac instability and for ambient temperature.

The purpose was to examine the effect of a self-care educational intervention on nursing student resilience and thus the potential for compassion fatigue, depersonalization, burnout, depression, and inadequate self-care. A one-group pretest-posttest research design was applied to a convenience sample of 104 nursing students near the end of their last semester in a baccalaureate nursing program. The measurements were demographics, a psychometric resilience scale, program evaluation, and reflection question. The intervention was a standardized, intensive 30 min training program on the high degree of stress and burnout nurses face and the core self-care methods that can promote resilience to these hazards. The educational intervention had a strong positive effect on resilience scores (effect size of r=72%; p < 0.05). Eighty-six percent of the participants believed that the intervention increased their capabilities for self-care, especially in sleep, spending time outside, hydration, nutrition, and physical stretching exercises but not in journaling. Eighty-one percent stated that they would be likely to seek professional help if needed. Although this study must be repeated in other samples before it be implemented with full confidence, the standardized, high intensity, short duration, resilience training session can be recommended to nursing programs just prior to graduation and to hospitals for nurse orientation programs.

No description available.

Den svenska intensivvården drabbades 2020 av en svår kris när coronapandemin mångdubblade antalet svårt sjuka patienter i en redan hårt belastad verksamhet. För att hantera krisen behövde sjukvården ställa om till katastrofsjukvård. Syftet med denna uppsats är att ge en fördjupad bild av intensivvårdens kapacitetsökningsförmåga, katastrofomställning och anpassning under Covid -19. Ett intervjuresultat togs fram genom semistrukturerade intervjuer och med hjälp av PAR-modellen härleddes förutsättningarna för den katastrofomställning som genomfördes. Arbetet är en av de första studierna som undersöker coronapandemins effekter på intensivvården med en tydlig riskvetenskaplig metodik. Intervjuresultatet tolkades med hjälp av en kontextanpassad och tillämpad PAR-modell ochvisade att trots en oförberedd sjukvård och dåliga grundförutsättningar lyckas den undersökta verksamheten absorbera chocken och genomföra en katastrofomställning. Den anpassade sig till den grad att patienterna kunde få en kvalitativ vård tack vare stora uppoffringar och umbäranden från vårdpersonalen. / The Swedish intensive care was hit by a severe crisis when the corona pandemic 2020 multiplied the number of seriously ill patients in an already strained health care system. In order to cope with the crisis the healthcare system needed to undergo a surge and adapt to disaster medicine operations. The purpose of this essay was to give an in-depth picture of intensive care's medical surge capacity, transition to disaster medicine and adaptation during Covid -19 through semi-structured interviews. Using the PAR-model I derived the conditions for the disaster transition that was carried out. The work is one of the first studies with a clear risk science methodology that examines the effects of the corona pandemic on the intensive care. The result from the interviews was interpreted with the PARmodel that was adapted to the studies context and showed that despite an underprepared healthcare system and poor basic conditions, the investigated operations manage to absorb the shock and implement a transition to disaster medicine and adapt to the extent that patients could receive qualitative care thanks to great sacrifices and hardship of the healthcare staff.

Le développement de la compétence à poser un jugement clinique est essentiel pour l’ensemble des infirmières de soins critiques afin qu’elles offrent des soins sécuritaires et de qualité. Pour ce faire, l’American Association of Critical Care Nurses (2019) recommande l’intégration d’activités d’apprentissage coopératif au sein des programmes de formation continue. Ces activités seraient bénéfiques pour les infirmières novices, mais les connaissances sur le processus d’apprentissage à l’occasion de ces activités et leur apport pour les infirmières expertes demeurent limitées. Présentée sous forme de manuscrit, cette étude qualitative descriptive avait pour but d’explorer, selon la perspective d’infirmières expertes en soins critiques, la contribution d’activités d’apprentissage coopératif à leur compétence à poser un jugement clinique. Elle visait à comprendre le processus et les caractéristiques de ces activités d’apprentissage. Le cadre de référence combinait le modèle du jugement clinique de Tanner (2006) et le modèle d’apprentissage coopératif de Slavin (2014). Des entrevues semi-dirigées ont été réalisées auprès de sept expertes en soins critiques ayant fait l’expérience d’activités d’apprentissage coopératif avec des infirmiers et des infirmières de différents niveaux de développement. L’analyse des données s’est inspirée de l’analyse thématique de Braun et Clarke (2006). L’analyse des données a révélé quatre thèmes. Les deux premiers correspondent aux caractéristiques des activités soit « l’établissement d’un environnement sécuritaire favorise la participation » et « l’hétérogénéité du groupe d’apprenants favorise les échanges ». Les deux autres correspondent aux mécanismes lors des activités : « comparer son raisonnement clinique afin de le remettre en question et prendre conscience de ses automatismes » et « expliquer son raisonnement clinique pour faire l’état de ses connaissances et les approfondir ». À la lumière de ces résultats, des recommandations ont été élaborées afin d’améliorer les programmes de formation continue offerts aux infirmières, dont les expertes, et du fait même, contribuer au développement de leur compétence à poser un jugement clinique. / The development of clinical judgment is essential for all critical care nurses to provide safe and quality care. To this end, the American Association of Critical Care Nurses (2019) recommends incorporating cooperative learning activities in continuing education programs. These activities would be beneficial for novice nurses, but evidence regarding the learning process in these activities and their benefits for expert nurses remains limited. Presented as a manuscript, the purpose of this descriptive qualitative study was to explore, from perspective of expert critical care nurses, the contribution of cooperative learning activities to their clinical judgment competency. Specifically, it aimed to understand the process and characteristics of these activities. The study was based on a framework combining Tanner’s (2006) clinical judgment model and Slavin’s (2014) model of cooperative learning. Semi-structured interviews were conducted with seven expert critical care nurses who had experienced cooperative learning activities with nurses of different levels of development. Data analysis was based on Braun and Clarke’s (2006) thematic analysis. Data analysis revealed four themes. The first two correspond to the characteristics of cooperative learning activities, namely « establishing a safe environment fosters participation » and « the heterogeneity of the group of learners fosters exchanges. » The other two reflect the mechanisms operating within the discussion during cooperative learning activities. These themes are « comparing one’s clinical reasoning to question it and become aware of one’s automatisms, » and « explaining one’s clinical reasoning to review and deepen one’s knowledge. » In the light of these results, recommendations are made to improve continuing education programs offered to nurses, including experts, and thereby contribute to the development of their clinical judgment.

Limited research exists about the experiences of nurses’ caring for patients during the COVID-19 pandemic post hoc. To understand nurses’ realities of caring for patients with COVID-19, I aimed to understand the lived experience of nurses caring for patients with COVID-19 in the United States. A qualitative design with a hermeneutic phenomenological methodology was used. Sixteen participants were recruited via purposive sampling, augmented with snowball sampling. Data were collected through unstructured interviews and were analyzed using Braun and Clarke’s Reflexive Thematic Analysis. Nurses’ experiences of caring for patients with COVID-19 in the U.S. were consolidated into four themes: “a living hell”; “rationing patient safety”; “mental aftermath of the war zone”; and “post-pandemic pride”. Nurses provided patient care amidst challenging environments of limited to no resources, with extensive, large-scale critically ill patients, and patient deaths. Due to overwhelming patient care demands, nurses were unable to provide safe patient care to everyone in need, resulting in patient deterioration and death. These experiences caused nurses to endure maladaptive mental effects, such as compassion fatigue and moral suffering, which can threaten the safety of patients. Despite these undesirable results, nurses continued to provide patient care and expressed feelings of pride in the profession of nursing for surviving the COVID-19 pandemic. However, this study demonstrates the persistent impacts on nurses’ abilities to provide safe care after the crisis years. Support for nurses is recommended to preserve patient safety.

La période de transition des infirmières et infirmiers nouvellement diplômés (IND) dans la pratique clinique est marquée par des défis individuels, émotionnels et professionnels. Ces défis peuvent contribuer à un épuisement professionnel et ainsi augmenter le taux d’attrition des IND dans les unités de soins. La mise en place d’un programme de résidence en soins infirmiers permet de répondre à ces défis et entraîne donc des répercussions positives au niveau individuel, professionnel et institutionnel. Toutefois, aucune revue des écrits ne recense les programmes de résidence en soins infirmiers pour les IND débutant dans le secteur des soins intensifs. Le but de cette revue de la portée est donc d’identifier et de décrire la structure des programmes de résidence en soins infirmiers pour les IND dans les unités des soins intensifs. Cette revue de la portée réalisée selon la méthode du Joanna Briggs Institute a recensé un total de 241 références, dont huit ont été retenues. L’extraction des données a été réalisée en suivant le modèle de structure de programme de résidence en soins infirmiers de Chant et Westendorf (2019) comprenant sept concepts-clés (cadre de référence, objectifs initiaux, préceptorat, mentorat, composantes didactiques, durée, immersion clinique). Quatre constats provenant des résultats obtenus ont pu être tirés et discutés: une grande disparité dans la structure des programmes de résidence, un besoin d’encadrer davantage le développement des compétences des IND par des cadres de référence et des principes pédagogiques, la nécessité de répondre aux besoins de transition des IND et le besoin de prendre en compte les ressources disponibles. Ces constats illustrent la pertinence de l’implication des formateurs et des gestionnaires pour répondre aux besoins de transition des IND sur les unités de soins intensifs. / The period of transition of new graduate nurses (NGN) into clinical practice is marked by individual, emotional and professional challenges. These challenges can contribute to a burnout and increase turnover rates for care units. The implementation of a nurse residency program for NGN transitioning into practice can address these challenges and lead to positive repercussions at individual, professional and institutional levels. The purpose of this scoping review is to identify and describe the structure of nursing residency programs for NGN in intensive care units. This scoping review using the Joanna Briggs Institute method identified a total of 241 references, of which eight were retained. The extraction followed Chant and Westendorf's (2019) structure model using seven key concepts (framework/models, defined outcomes, preceptorship, mentorship, didactic components, program length, clinical immersion). Four findings were drawn and discussed from the results obtained: a wide disparity in the structure of residency programs, a need for more guidance in the development of NGN competencies by using frameworks and pedagogical principles, the necessity to answer to the transition needs of NGN, and the need to consider the available resources. These findings highlighted the relevance of the involvement of trainers and managers to help NGN transition into intensive care units.