Troponin elevations are frequent during critical illness and associated with higher short-term mortality. Whether troponin elevations in that population independently confer a worse prognosis remains a matter of debate and how to manage patients with troponin elevations in the intensive care unit is unknown. Myocardial injury after noncardiac surgery is a well-defined entity, but can the same criteria be applied in patients who transition in the intensive care unit? Most patients present a troponin elevation early after coronary artery bypass surgery. How should a myocardial infarction be defined in these patients? This thesis comprises 7 chapters that inform these knowledge gaps. Chapter 1 is an introduction providing the rationale for conducting each of the included studies. Chapter 2 reports on the PROTROPIC pilot study evaluating the feasibility of a larger study to assess whether troponin elevations in critical illness independently predict mortality. Chapter 3 presents the use of secondary cardiovascular prevention medications and cardiac risk stratification in the PROTROPIC pilot study participants. Chapter 4 is a systematic review and meta-analysis of randomized controlled trials evaluating the efficacy and safety of statins in critically ill patients. Chapter 5 describes patients admitted to the intensive care unit after noncardiac surgery in the VISION cohort. This substudy also evaluates whether admission to the intensive care unit modifies the prognosis associated with myocardial injury after noncardiac surgery. Chapter 6 evaluates the prevalence and prognosis associated with different definitions of myocardial infarction after coronary artery bypass grafting using data from the CORONARY trial. Finally, Chapter 7 discusses the conclusion, limitation, and implications of the research presented in this PhD thesis. / Thesis / Doctor of Science (PhD)

In the setting of the critical care unit, the nurse is caring for the critically ill patients and is the care giver who is present at the bedside for 24 hours. The nurse comes into contact with all other disciplines attending to the patient and is thus often the common link in the multidisciplinary team. It is therefore essential that there is effective collaboration between the physician and the nursing practitioner.With the world-wide shortage of skilled nurses worsening, it is imperative that we look at a means of retaining our current nursing personnel and attracting new nurses into the profession. Many studies examining the relationship between a healthy work environment and the retention of nurses have rated collaboration as a key aspect. The setting for this study was five critical care units within the private health care sector. The study investigated both nurses’ and physicians’ attitudes towards collaboration in critical care units, as well as identifying factors which facilitate and constrain effective physician-nurse collaboration. Recommendations for enhancing collaboration within the critical care unit were explored. In this study a non-experimental descriptive design was be used. The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration, a 15 statement Likert scale, was utilized to collect data from both the nurses and the physicians. The data was analysed using factor analysis and descriptive statistics. The results showed that nurses had a slightly more positive attitude toward collaboration as compared to the physicians, however the difference in the overall scores was not statistically significant.

A research report submitted to the Faculty of Health Science, University of Witwatersrand, Johannesburg ,in partial fulfillment of the requirements for the degree of Master of Science in Nursing, September, 2013 / Background: Despite many advances on evidence-based practice (EBP), nursing is still not based on evidence. Trained intensive care unit (ICU) nurses may be the key to EBP in the ICU. Purpose: To describe the knowledge, attitudes and practices of trained ICU nurses on EBP at an academic hospital in Gauteng. Design: Mixed methods sequential explanatory. Method: Data were collected from trained ICU nurses who were purposely selected using a validated tool (Upton & Upton, 2006) to obtain the quantitative results on their knowledge, attitudes and practices on EBP (n=100) and then followed up with 12 expert trained ICU nurses in two focus groups to explore the quantitative results in more depth. The quantitative and qualitative findings were then combined at discussion of results. Results: From the quantitative results, the majority of the nurses selected the best category: 81.0% on knowledge towards EBP, 75.0% on attitudes towards EBP and 75.0% on practices towards EBP. The qualitative results identified three categories: perceptions, challenges and suggestions. The trained ICU nurses were knowledgeable in their understanding of EBP but lacked knowledge in the skills of accessing evidence. Welcoming attitudes towards EBP were displayed but admitted to their practices being partly evidence-based due to challenges that included resistance to change, confusion of evidence, lack of resources, time and autonomy. The instrument was found to be reliable and valid with a Cronbach’s alpha of 0.94 for the entire questionnaire and the study increased its validity in the South African context. This study indicates that although trained ICU nurses are knowledgeable about EBP, they are still lacking in skills regarding EBP. Even though the trained ICU nurses have welcoming attitudes towards EBP, their practices towards EBP are not fully evidence-based due to the identified challenges. This study therefore suggests capacity building of the trained ICU nurses as well as development of their EBP skills to support EBP.

Thesis (Ph. D.)--University of Queensland, 2002. / Includes bibliographical references.

Thesis (M Nursing)--Montana State University--Bozeman, 2008. / Typescript. Chairperson, Graduate Committee: Susan Luparell. Includes bibliographical references (leaves 62-67).

Thesis (M.S.)--University of Wisconsin-Madison, 1993. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 36-38).

The purpose of this thesis was to conduct a systematic review of studies on critical care nurses’ job satisfaction. Specific research questions addressed were: 1) What are the conceptual definitions and theories of job satisfaction that are used in studies of critical care nurses?; 2) What instruments have been used to quantitatively measure and operationally define job satisfaction among critical care nurses?; 3) What is the level of job satisfaction among critical care nurses?; and 4) What factors are correlated to critical care nurses’ job satisfaction? Sixty-one studies were identified from five electronic databases. Definitions and theories of job satisfaction were inconsistent or absent in the literature. Forty-two different quantitative measures of job satisfaction were identified. The weighted mean job satisfaction score for critical care nurses was 56% and demonstrated a cyclical trend over time. Operating room and other (labour and delivery, pediatric, and neonatal) critical care, and undefined critical care nurses reported lower levels of job satisfaction compared to emergency and mixed critical care nurses. The following factors showed positive significant relationships to critical care nurses’ job satisfaction in four or more studies: shift worked, autonomy, personnel resources and staffing, and teamwork and cohesion. One factor, job stress showed a positive and negative significant relationship to critical care nurses’ job satisfaction depending on the study. Only one factor explored in the included studies (burnout emotional exhaustion) showed a negative significant relationship with job satisfaction. These factors hold promise as targets for critical care nurse job satisfaction interventions.

<p>With the increasing demand on the health-care system and increasing human resource shortages, the delivery of critical care services is facing a crisis. Although funding is being provided to increase the number of critical care beds to meet the physical demands, the supply of qualified registered nurses (RNs) is decreasing. To increase the required staff, new graduate RNs are being hired into critical care units more than ever before. The influx of newly graduated RNs has been deemed controversial as it is viewed that new graduates are unable to engage in complex decision-making or complete the technical skills required in critical care.</p> <p>The research objective of this study was to explore the experiences of new graduate RNs entering a critical care unit and to gain an understanding of the barriers and facilitators present when transitioning to the unit. Semi-structured interviews with eleven participants were conducted with new graduates from four critical care units within two major teaching hospitals in Southwestern Ontario. A qualitative descriptive design described by Sandelowski (2000) was used for this research study. The findings describe the experiences of new graduates including the emotional experience, the times of transition, becoming a professional, embracing team support and learning to feel comfortable within the unit.</p> <p>These findings will be of interest to a broad audience including nursing students, new graduates, hospital managers and administrators, educators and policy makers. It is anticipated that these results will help inform organizational policy and programs and will direct further research on this topic.</p> / Master of Science (MSc)

Bakgrund: Smärta är för intensivvårdspatienten en unik, subjektiv, obehaglig och flerdimensionell upplevelse. Intensivvårdssjuksköterskan har ett moraliskt ansvar att lindra patienternas smärta. Verbalt icke-kommunicerandepatienter kan inte skatta sin smärta med hjälp av Numeric Rating Scale (NRS). På en neurointensivvårdsavdelning (NIVA) i Stockholm har det beteendebaserade smärtskattningsverktyget- the Critical-Care Pain Observation Tool (CPOT), implementerats. Intensivvårdssjuksköterskorna på NIVA använder CPOT dagligen i sitt arbete. Som en del i implementeringsprocessen har denna enkätundersökning genomförts, med fokus på CPOT och dess användbarhet. Standarden ISO 9241-11 definierar begreppet användbarhet. Ledande komponenter i definitionen är – ändamålsenlighet och måluppfyllelse, effektivitet och tillfredsställelse. Syfte: Syftet med denna studie var att undersöka intensivvårdssjuksköterskors uppfattningar om användbarheten av the Critical-Care Pain Observation Tool – CPOT, hos verbalt icke kommunicerande patienter, på en neurointensivvårdsavdelning. Metod: Detta är en kvantitativ icke-experimentell tvärsnittsstudie. 32 intensivvårdssjuksköterskor har besvarat en enkät. Resultat och slutsats: Resultatet är en momentan mätning. Begreppet användbarhet har flera aspekter och resultatet kan tolkas på olika sätt. Intensivvårdssjuksköterskorna på NIVA har olika uppfattningar om CPOT och dess användbarhet. 84 % känner någon grad av tillfredsställelse med att använda CPOT på NIVA. De flesta uppfattar CPOT som effektiv. Respondenter har uttryckt svårigheter i att utföra smärtskattningar med hjälp av CPOT och delar av populationen ser brister i verktygets måluppfyllelse och ändamålsenlighet på NIVA. Klinisk betydelse: Implementeringsprocessen av CPOT på NIVA har en utvecklingspotential. Undersökningens resultat bör kunna användas vid fortsatt utvecklingsarbete i verksamheten. / Background: Pain for the intensive care patient is a unique, subjective, unpleasant and multidimensional experience. The critical care nurse has a moral duty to relieve the patient’s pain. Non-verbal communicative intensive care patients can´t self-report and score their pain using the Numerical Rating Scale (NRS). At a neurological intensive care unit (neuro-ICU) in Stockholm, one behavior based pain scale, the Critical-Care PainObservational Tool (CPOT), has been implemented. The critical care nurses at the neuro-ICU use CPOT daily in their work. As a part of to the implementation process one self-administered questionnaire has been conducted with focus on the concept usability. The European Standard ISO 9241-11 defines the concept usability. Main components in the definition are the attainment of goals, suitability, effectiveness and satisfaction. Purpose: The aim of this research was to investigate critical care nurses’ perceptions of the usability of the Critical-Care Pain Observation Tool – CPOT, for non-verbal communicative patients, at a neurological intensive care unit. Method: The investigation is a quantitative questionnaire-based cross-sectional survey. 32 critical care nurses answered a questionnaire. Results and conclusion: The result is a momentary measurement. The concept usability has various aspects and the result can be interpreted in different ways. The critical care nurses at the neuro-ICU express varying opinions about CPOT and its usability. 84 % experience some degree of satisfaction using CPOTat the neuro-ICU. The majority perceive CPOT as effective. The respondents have expressed difficulties in carrying out pain assessments with the CPOT at the neuro-ICU, and part of the population see deficiencies in the tools goal attainment and suitability at the neuro-ICU. Clinical Significance: The implementation process of CPOT at the neuro-ICU shows potential for further development of CPOT within the organization. The results of the investigation should be able to be used for further development.

Mechanically ventilated critically ill patients treated in the intensive care unit (ICU) require enteral feedings to maintain adequate nutrition during critical illness. Delivery of adequate enteral nutrition is also critical to the recovery of critically ill patients. Enteral nutrition has been shown to decrease length of time on the ventilator, decrease length of stay and ICU and decrease mortality. Despite all the evidence regarding the benefits of enteral nutrition, critically ill patients continue to receive less than their prescribed calories and protein. Nurses are in a unique position to influence the delivery of enteral nutrition. Nursing practices that contribute to underfeeding must be identified and corrected to ensure adequate delivery of nutrients is achieved. The purpose of the study was to describe the professional practice of critical care nurses regarding enteral feeding in mechanically ventilated critically ill patients. Several barriers were identified by the participants in the study that contributed to underfeeding including inconsistent practice regarding gastric residual volume, holding feeds when changing patient position and lack of a standardized protocol for enteral feeding. Also identified in the study was the idea that nurses do not see enteral feeding as a life-saving intervention. It is not the “sexy part” of what ICU nurses do. Enteral feeding guidelines need to be developed to include those interventions that are important to nursing practice in order to increase enteral feeding times and improve patient outcomes.