Introdução: As lesões de pele representam um grande desafio para os profissionais de saúde que prestam cuidados a pacientes críticos, especialmente os com alterações cardiopneumológicas, pois é frequente ocorrências de úlceras por pressão e de lesões por fricção nessa clientela com aumento de custos no tratamento e do tempo de internação além de desconforto e impacto negativo sobre a qualidade do serviço prestado e de vida dos pacientes. Objetivos: Este estudo objetivou identificar e analisar os coeficientes de incidência de úlceras por pressão e lesões por fricção e os fatores de risco para o seu desenvolvimento em pacientes de Unidade de Terapia Intensiva (UTI) Cardiopneumológica. Métodos: Trata-se de um estudo de coorte, prospectivo, cuja coleta de dados ocorreu durante os meses de novembro de 2013 a fevereiro de 2014, com censura de uma semana. O estudo foi realizado em uma UTI destinado a pacientes com doenças cardíacas e pulmonares de um hospital de grande porte na cidade de São Paulo, após aprovação dos Comitês de Ética em Pesquisa (CEP) da Escola de Enfermagem da Universidade de São Paulo e da instituição, de acordo com protocolo número 20780713.4.0000.5392, com parecer consubstanciado publicado na Plataforma Brasil em 24/10/2013. Participaram da amostra 370 pacientes maiores de 18 anos, que não apresentavam úlceras por pressão e lesões por fricção na admissão, que aceitaram participar do estudo (assinando o Termo de Consentimento Livre e Esclarecido) e que estavam na unidade há menos de 24 horas. Para análise dos dados foram utilizadas análises univariadas e a Classification And Regression Tree (CART). Resultados: Incidências globais de 10,80%, 7,02% e 2,16%, respectivamente para úlceras por pressão, lesões por fricção e ambas as lesões simultaneamente foram encontradas nos pacientes críticos. Diferentes fatores de risco foram encontrados, conforme o tipo de lesão, sendo o tempo de permanência na UTI igual ou superior a 9,5 dias e idade igual ou superior a 42,5 anos comuns para as úlceras por pressão e lesões simultâneas. Além desses, raça branca; uso de superfícies de suporte e número de artefatos invasivos na admissão; e uso de transfusão sanguínea foram fatores constatados respectivamente para as úlceras por pressão, lesões por fricção e lesões simultâneas Conclusão: Os coeficientes de incidência e os fatores de risco constatados assemelham-se a alguns estudos da literatura, somente para as úlceras por pressão. Para as lesões por fricção e lesões simultâneas, não foram encontrados estudos desenvolvidos junto a pacientes críticos, sendo, no entanto, corroborados alguns dos fatores de risco descritos em grupos e cenários distintos como idosos residentes em instituições de longa permanência e pacientes crônicos hospitalizados. O estudo contribui, portanto, para os conhecimentos relacionados à epidemiologia dessas lesões, recomendando-se a replicação de seus métodos, principalmente para as lesões por fricção em pacientes hospitalizados, isoladamente ou em associação com as úlceras por pressão. Por outro lado, ao favorecerem a maior compreensão do panorama dessas lesões em pacientes cardiopneumológicos críticos, os resultados obtidos poderão favorecer o planejamento de cuidados preventivos específicos para essa clientela / Introduction: Skin lesions represent a major challenge for health professionals who care for critical patients cardiopneumologics. In clinical practice, have been frequent occurrences of pressure ulcers and skin tears, by rubbing with increased costs in treatment, prolonged hospitalization, in addition to discomfort and negative impact on the quality of service and the quality of life of patients.Goal: This study aimed to identify and analyze the rate of incidence of pressure ulcers and skin tears and the risk factors for its development in patients in the Intensive Care Unit(ICU) Cardiopneumologic. Methods: This study is a prospective cohort which data collection occurred during the months of November 2013 to February 2014, with censorship of a week. The study was conducted in a Surgical Intensive Care Unit Cardiopneumologic of a large hospital in the city of São Paulo, after approval of the Ethics Committee (EC) of the School of Nursing, University of São Paulo and the institution in accordance with protocol number 20780713.4.0000.5392 with sound embodied the EC Platform published in Brazil on 10/24/2013. A sample of 370 patients older than 18 years who did not have any injuries mentioned (pressure ulcers and skin tears) on admission, and who agreed to participate (by signing the Instrument of Consent) and who were in the unit for less than 24 hours. For data analysis were used univariate analyzes and the Classification And Regression Tree (CART). Results: overall incidences of 10.80%, 7,02% and 2.16% respectively for pressure ulcers, skin tears and both lesions simultaneously were found in critically ill patients. Different risk factors were found, depending on the type of injury, and length of stay in ICU less than 9,5 days old and less than 42,5 years common for pressure ulcers and concurrent injuries. Besides these, the white race; Use of support surfaces and the number of invasive devices in entry; and use of blood transfusion were observed factors respectively for pressure ulcers, skin tears and simultaneous injuries Conclusion: The incidence and risk factors observed are similar to some studies in the literature, only for pressure ulcers. For skin tears and simultaneous lesions, no studies have not found together developed the critical patients, however, corroborated some of the risk factors described in groups and different scenarios as seniors residents in long-term hospitalized chronic patients and institutions. The study therefore contributes to the knowledge regarding the epidemiology of these types of injuries, recommending that replication of their methods, especially for lesions friction in acute inpatients and critics, alone or in combination with pressure ulcers. On the other hand, by favoring a greater understanding of these lesions panorama critical cardiopneumologics patients, the results will may facilitate the planning of specific preventive care for these clients

Class of 2012 Abstract / Specific Aims: The purpose of this study is to evaluate and compare clinical outcomes and cost involved with use of poractant versus beractant for the treatment of respiratory distress syndrome (RDS) in a level III, neonatal intensive care unit (NICU) within an academic medical center. Methods: This retrospective cohort study included patients if they were admitted to the NICU for RDS between April 1, 2010 to November 30, 2010 and December 1, 2010 to June 30, 2011 treated with beractant and poractant respectively. Patients were excluded from the study if they were greater than 35 weeks gestational age and survived less than 48 hours. This is a review and the information needed from the patients was submitted in a data extraction form. Data collected included demographic variables (age, birthweight, birth length, gender, and race/ ethnicity), FiO2 measurement, mechanical ventilation time, length of hospitalization in the NICU, the incidence complications in the first 28 days, number of doses given, use of the nasal CPAP, concurrent complications or comorbidites such as pulmonary hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosis, intraventricular hemorrhage, and retinopathy of maturity. Main Results: Data from 27 neonates in beractant and 13 in poractant groups were collected. The FiO2 measurements in both groups were generally similar. However, FiO2 was consistently lower in the poractant group. (p = 0.044 from a runs statistical test) Conclusions: The FiO2 measurement is poractant group was lower compared with beractant group, however the difference was noted to be not statistically significant.

The role of information technology within health care is getting more central and prominent. The purpose of this change is both to make the health care more efficient and to heighten patient safety. This exploratory case study of four care units aims to provide a glimpse into the clinical work of nurses, and to indentify and describe their communication and information needs. The analytical framework used in this study is distributed cognition and the research method used is cognitive ethnography. The study provides a peek into the complex system of health care, and how the central artifacts such as patient records, whiteboards and different alarm systems are used in this context. The result of the study describes the current work practices and information flows in the studied care units. From these results general system design implications are made.

Background: Preventable medical error accounts for approximately 98,000 deaths in the hospital setting each year. A proposed solution to decreasing medical error encompasses the development of a culture of safety. Safety culture has been defined as a common set of values and beliefs that are shared by individuals within an organization that influence their actions and behaviors. In 2015, the safety culture of Registered Nurses (RN) and Patient Care Technicians (PCT) who regularly worked in the Intensive Care Unit (ICU) and Cardiovascular Intensive Care Unit (CVICU) at Flagstaff Medical Center (FMC) was assessed using the Hospital Survey on Patient Safety Culture. This survey functioned as a needs assessment and demonstrated that ICU/CVICU staff had negative reactions to safety culture and error reporting on eight of twelve composites tested. Based off these results, the Incident Decision Tree (IDT) was selected as an intervention to help improve the areas identified in the needs assessment. Purpose: The aims of this quality improvement project included: 1) Development of a protocol for IDT use by ICU/CVICU managers; 2) Implementing the IDT; and 3) Administering a post IDT implementation survey. Methods: The IDT was implemented during a 4-week period in the ICU/CVICU at FMC. During this time, managers used the IDT when processing reported error. Post implementation, an online survey was administered over the course of two weeks to ICU/CVICU managers and unit based RNs and PCTs to reassess their perceptions on the IDT, error reporting, and safety culture. Results: During the implementation period, 23 errors were reported in the ICU/CVICU at FMC with management utilizing the IDT a total of 12 times. Analysis of the reportable data demonstrated that of the 12 incidents, seven were attributed to system failures. The remaining five incidents were processed using the “foresight test.” Conclusions: Results from the post implementation survey demonstrated that ICU/CVICU staff felt the IDT contributed to a non-punitive environment. Staff also reported the IDT helped to increase communication after an error occurred. Lastly, the majority of staff felt the IDT increased transparency in the error reporting process.

Syftet med studien var att beskriva hur närstående till intensivvårdspatienter upplevde en intensivvårdsavdelning (IVA) med fokus på delaktighet och omvårdnad. I studien intervjuades fem närstående. Intervjuerna analyserades med hjälp av en förenklad variant av meningskodning och tre kategorier som beskrev de närståendes upplevelser av IVA utvecklades. Kategorierna benämndes: "Första intrycket av IVA", Att leva med osäkerhet" och "Att vara delaktig". De närstående upplevde ett inre kaos när deras anhörig vårdades på IVA och använde sig av olika copingstrategier. De närstående beskrev intensivvårdssjuksköterskornas omvårdnad och bemötande på ett positivt sätt men vissa upplevde att läkare och kurator var frånvarande. Den största oron handlade om hur patienten skulle återhämta sig och hur framtiden skulle bli. Att få vara delaktig på IVA var ingen självklarhet och några anhöriga hade själva krävt att få vara med. / The aim of this study was to describe the experience of the close relatives of patients in an intensive care unit (ICU) with focus on participation and nursing care. In the study five persons who were close relatives were interviewed. The analysis of the interviews was done with a simplified version of code-of-meaning and three categories that showed experiences of importance of the relatives in the ICU emerged. The categories were called: "The first impression of the ICU", "To live with uncertainty" and "To be involved". The close relatives of the patient experienced inner chaos when the patient was in the ICU and they used different coping strategies. The close relatives of the patients described the nursing care provided by the intensive care nurses and the way they had been treated in a positive way but some lacked contact with physicians or a counselor. Their biggest concern was whether the patient would recover and how their future would turn out to be. It was not obvious for the close relatives to bee involved in the care of the patient, some felt they have had to demand it.

Lidande utgör ett hot mot hela människan som ej kan undflys. Patientens lidande påverkar vårdaren. Det skapar ett eget lidande i sjuksköterskan som inte kan lindra patientens lidande eller till och med orsakar ytterligare lidande. Också anhörigas lidande påverkar intensivvårdssjuksköterskan. Syftet med uppsatsen var att beskriva hur intensivvårdssjuksköterskor upplevde att vårda patienter med svårt lidande. En deskriptiv, semistrukturerad intervjuundersökning genomfördes med tre intensivvårdssjuksköterskor och tolkades medelst innehållsanalys. Resultat: Temat Lidandet genomsyrar sjuksköterskans värld identifierades och handlade om hur sjuksköterskan måste hantera sitt eget lidande likväl som patientens och anhörigas. Temat var uppbyggt av tre kategorier. Lidandets former beskrev det lidande informanterna mötte på intensivvårdsavdelningen. Lidandets samspel beskrev hur positiva och negativa känslor väcktes i samarbetet med lidande patienter, anhöriga och kollegor. Att göra den andres lidande till sitt eget beskrev sjuksköterskans personliga, ofta negativa, känsloupplevelser som aktualiserades vid mötet med stort lidande. / Suffering is an unavoidable threat to the individual as a whole. Suffering of patient and relatives affects the nurse, and creates a personal suffering when incapable of relieving the patients suffering, or inflicting even more. The purpose of this study was to describe how ICU nurses experienced caring for suffering patients. A descriptive, semi-structured interview study was conducted on ICU nurses and interpreted by content analysis. Result: The theme Suffering permeates the nurse’s world was identified and described how the suffering of patient, relatives and self had to be handled by the nurse. The theme consisted of three categories. The manifestation of suffering described how suffering in the ICU is perceived. The interaction of suffering described how cooperating with suffering patients, relatives and colleagues caused negative and positive emotions. Integrating suffering of the other described often negative personal emotions of the nurse evoked when encountering suffering. / <p>2010 felaktigt årtal titelsida</p>

This thesis presents the development and evaluation of a computerized physician-parent decision support tool for a neonatal intensive care unit (NICU), known as Physician and Parent Decision Support (PPADS). The NICU is a specialized hospital unit that treats very-ill neonates. Many difficult care decisions are made daily for this vulnerable population. The PPADS tool aims to augment current NICU decision-making by helping parents and physicians make more informed decisions, improving physician-parent communication, increasing parent decision-making satisfaction, decreasing conflict, and increasing decision efficiency. The development of the PPADS tool followed a five-step methodology: assessing the clinical environment, establishing the design criteria, developing the system design, implementing the system, and performing usability testing. Usability testing of the PPADS tool was performed on neonatologists and on parents of neonates who have graduated (survived) from a tertiary level NICU. The usability testing demonstrated the usefulness and ease of use of the tool.

Thesis advisor: Jane M. Flanagan / Purpose: The purpose of this study was to explore nurses’ experiences of Watson’s Theory of Human Caring Caritas Process Three: Cultivation of One’s Own Spiritual Practices and Transpersonal Self, Beyond Ego-Self. Background: There is currently an inadequacy of spiritual care provided to patients and families in the ICU despite a significant articulated need. Nurses report discomfort with and a lack of preparation in providing spiritual care competently. Nurses with strong personal spiritual development are more likely to report comfort with spiritual caregiving and provide spiritual care. Watson’s Theory of Human Caring Caritas Process Three; Cultivation of One’s Own Spiritual Practice and Transpersonal Self, Going Beyond Ego-Self makes explicit the primacy of relationship between nurse spiritual development and transpersonal spiritual nursing care. However, the nature of spiritual development of nurses in the ICU remains unknown. Methods: A qualitative descriptive methodology with directed content analysis applying Watson’s Caritas Process Three was used to analyze data for this study. Results: Ten ICU Nurses provided evidence of the experience of Caritas Process Three. Five themes were identified in the analysis of data: Caritas nurses vary in their ability to move beyond ego-self, Personal spiritual practices serve as a barrier and/or facilitator to nurses’ ability to provide spiritual care, Critical illness as experienced by patients and families provided the opportunity for nurses to explore spirituality with other, The care environment serves as a barrier and/or facilitator to nurses’ personal spiritual growth, and Cultivation of spiritual practice and spiritual identity is integral to a life-long process of consciousness evolution. Conclusions: The findings of this study extend and inform Caritas Process Three of Watson’s Theory of Human Caring. Nurses in this study provide evidence for the primacy of personal spiritual development for the delivery of spiritual and transpersonal care for patients in the ICU. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第22779号 / 工博第4778号 / 新制||工||1747(附属図書館) / 京都大学大学院工学研究科電気工学専攻 / (主査)教授 土居 伸二, 教授 萩原 朋道, 教授 小林 哲生, 教授 古谷 栄光 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

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.