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Recently, there has been increasing recognition of the threat of fatigue on safety. Nursing has been slow to recognize this threat. Workplace napping is a fatigue management strategy that is used in some nursing workplaces, although often hidden. This feminist interpretive phenomenological study explored the lived experience of night shift fatigue and the use of workplace napping among critical care nurses. An understanding of the meaning of night shift fatigue, the concern for safety as embodied by fear, was illuminated by exploring the phenomenological commonalities within the nurses’ historical, social and cultural world. Five main themes were identified within this overarching understanding. There is a need to recognize oppressive constraints, and share the responsibility for managing fatigue among individuals, professions and organizations. In education, practice and research, nurses must be supported through validated evidence-informed strategies to manage what is a normal consequence of shift work, thus leading to enhanced safety for both the patient and nurse.

Thesis (Ph. D.)--University of Virginia, 1989. / Includes bibliographical references (leaves 131-143). Also available online through Digital Dissertations.

Thesis (M.S.)--University of Wisconsin--Madison, 1986. / Typescript. Thesis approval page has authors' names reversed. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 195-201).

Like your average morning alarm, hospital alarms are specifically designed to elicit cognitive distress via auditory stimulation. They sound continuously, beckoning hospital staff to investigate the source of their call, day and night. As a result, caregivers become desensitized and begin to ignore the seemingly constant stimulus. However, ignoring these pleas for help can lead to adverse patient outcomes as the true alarms are indistinguishable from the false. In this study, we will review literature from the last five years to examine how alarm fatigue in nurses leads to detrimental patient outcomes and how we can begin to reduce the incidence of alarm fatigue. For example, when telemetry leads are improperly applied or lose their adherence, they are more sensitive to patient movements and can cause alterations on the recorded cardiac strips, creating the illusion that a patient is having an arrhythmia when, in reality, the patient is fine. This phenomenon causes alarms to chime, requiring the nurse to rush into the room to check on the patient and turn off the alarm. This can occur multiple times a shift, causing the nurse to become overwhelmed, to ignore the alarm, or to become distracted from their other duties due to the constant alarm response. This situation can easily be avoided by proper preparation of skin at the attachment site and the replacement of leads and pulse oximeters with disposable versions that can be changed daily. The aim of this study is to provide a multifaceted approach to identify ways to reduce the amount of alarm fatigue in an acute care setting in order to improve patient outcomes and consequently increase both patient and nurse satisfaction.

<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)

Injury is a global health problem and in the United States is the leading cause of death for persons aged 1 – 44 years. The primary causes of trauma related death are head injury and hemorrhage; hemorrhagic shock is difficult to recognize in the first hours after trauma. Identification of specific and optimal criteria upon which to base effective triage decisions for trauma patients has been an elusive goal for decades. The purpose of this dissertation was to identify measures available in the prehospital phase of care and in the Emergency Department that should be included for a more comprehensive definition of the trauma patient who will require trauma center care to better allocate trauma care and resources available. The first paper is a critical review of early physiologic markers of occult tissue hypoperfuson in which we examine markers of cardiovascular function and markers of tissue perfusion. In this review, we found surrogate measures of tissue perfusion include shock index as a measure of hemodynamic stability and acid-base indicators as measures of tissue oxygenation. This review guides the variable selection for the research study. The second paper is a report of a study conducted to examine shock index calculated from the first available prehospital vital signs and first available emergency department vital signs as a predictor of mortality within 48-hours in trauma compared to the Injury Severity Score. Shock index can be calculated in real-time during the course of treatment and provides continuous input into the ever changing condition of the patient. Injury severity score is calculated once, at the time of hospital discharge and is used primarily as a marker for comparison of injury severity in research and quality measures of trauma care. The study consisted of 516,156 trauma patient data reported to the National Trauma Data Bank (NTDB) in 2009. The results revealed SI as calculated in both the pre-hospital phase of care by Emergency Medical Services and in the Emergency Department to be significant independent predictors of mortality within forty-eight hours from trauma injuries. The third paper is a report of a study conducted to examine potential markers of occult tissue hypoperfusion within forty-eight hours of injury. The variables included four major variable categories, physiologic measures, anatomic measures, injury severity and presence of reported comorbid illness. The variable most predictive of death from trauma related injuries within forty-eight hours was the need for intubation. The findings from this dissertation provide further evidence of the value of multiple physiologic markers in early recognition of occult tissue hypoperfusion. Data from neither the review of the literature nor the two data-based studies are sufficient to identify a brief, accurate, easily used clinical instrument. Further work is needed to develop a clinically useful instrument to identify the occult tissue hypoperfusion in the trauma patient.

Thesis (M.S.)--University of Wisconsin--Madison, 1982. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 79-82).

Background: More than 200,000 children are admitted annually to Pediatric Intensive Care Units (PICUs) in the US. Research has shown young children can provide insight into their hospitalization experiences; child reports rather than parental reports are critical to understanding the child’s experience. Information relating to children’s perceptions while still in the PICU is scarce. Aims: The purpose of this qualitative study was to investigate school age children’s and adolescents’ perceptions of PICU while in the PICU; changes in perceptions after transfer to the General Care Unit (GCU); differences in perceptions of school age children/adolescents and those with more invasive procedures. Methods: Interviews were conducted in PICU within 24-48 hours of admission and 24-48 hours after transfer to GCU. Data on demographics, clinical care and number/types of procedures were obtained. Results: Participants were 7 school age children, 13 adolescents; 10 Hispanic; 13 males. Five overarching themes: Coping Strategies, Environmental Factors, Stressors, Procedures/Medications, and Information. Children emphasized the importance of peer support and visitation; adolescents relied strongly on social media and texting. Parent visits sometimes were more stressful than peer visits. Video games, TV, visitors, and eating were diversional activities. In the PICU, they wanted windows to see outside and interesting things to see on the ceiling above them. Children expressed anticipatory fear of shots and procedures, frustration with lab work, and overwhelming PICU equipment. Number of child responses was higher in PICU (927) than GCU (593); the largest difference was in Environmental Factors. Variations between school age children and adolescents were primarily in Coping Strategies, especially in social support. Number of GCU procedures were the same (8 children) or greater (2 children) than PICU procedures. Discussion: Admission to PICU is a very stressful event. Perceptions from children while still in PICU found information not previously found in the literature. Longitudinal studies to identify children’s perceptions regarding PICU hospitalization and post-discharge outcomes are needed.

Patients receiving mechanical ventilation endure high levels of stress and anxiety due to the invasiveness of the procedure. These critically ill patients are often uncomfortable as a result of their serious conditions and the high-intensity environments in which they are placed. Health care workers heavily sedate these patients to minimize pain and induce a state of relaxation. However, sedatives are known for their wide-ranging, and often deleterious, side effects. Music therapy is an intervention that has been studied in a variety of hospital settings to determine any potential beneficial effects on patients. Many studies have demonstrated a relationship between music therapy and decreased anxiety levels. This thesis reviewed studies on outcomes of music therapy on anxiety in mechanically-ventilated patients. A total of 10 studies that addressed the use of music to decrease anxiety in ventilated patients were analyzed and incorporated into the literature review. The articles were selected from a variety of databases on EBSCOhost, including MEDLINE, PsycINFO, ScienceDirect, and CINAHL. The literature review provides positive evidence for the support of music therapy to help alleviate anxiety in mechanically-ventilated patients.