Base teórica: O avanço no conhecimento e a introdução de tecnologias mais sofisticadas para o cuidado do paciente crítico trouxeram importante incremento na sobrevida deste grande grupo de pacientes. Por outro lado, existe um estrato de pacientes que sobrevivem à condição crítica aguda, porém permanecem dependentes de algum tipo de suporte de manutenção da vida por longos períodos. A doença crítica crônica (DCC) como é conhecida, apesar de descrita desde a década de 80, ainda não possui um critério de definição claro, levando a divergências nos resultados de estudos e prejudicando o avanço em pesquisas que investigam estratégias de tratamento. Objetivo: Avaliar a sobrevida e fatores associados à DCC em uma população de pacientes críticos comparando dois critérios de diagnóstico desta condição. Metodologia: Coorte histórica com avaliação de variáveis clínicas e desfechos durante a internação hospitalar em uma população de doentes críticos de uma única unidade de tratamento intensivo (UTI). Os pacientes foram alocados em três grupos, dois com critérios de DCC definidos por ≥14 ou ≥21 dias de ventilação mecânica (VM) e um terceiro grupo de pacientes críticos agudos (< 14 dias de VM). Recrutamento e alocação foram feitos através de um banco de dados institucional e dos registros hospitalares das internações ocorridas de janeiro de 2007 a dezembro de 2010. Resultados: No período analisado ocorreram 3.023 internações na UTI, 2.783 apresentavam os critérios de inclusão e compuseram a análise final. Em relação ao tempo de VM, 163 pacientes apresentaram ≥14 dias e 89 ≥21 dias. A mortalidade hospitalar e na UTI foi inferior no grupo de pacientes críticos agudos quando comparado com os dois grupos de DCC (≥14 e ≥21 dias de VM) (16.3% versus 55.8% e 58.4% p<0.001; 10.6% versus 47.3% e 53.9% p<0.001 respectivamente). Quando comparados os dois grupos de DCC (≥14 e ≥21 dias de VM), não houve diferença estatisticamente significativa para mortalidade hospitalar e na UTI (57.2% versus 58.4% p=0.5; 39.2% versus 53.9% p=0.18 respectivamente). O pequeno número de pacientes em cada grupo pode ter limitado o poder das análises. Ambos os grupos de DCC tiveram escores de gravidade mais altos, desenvolveram mais complicações na UTI, apresentaram maior tempo de internação hospitalar e mortalidade quando comparados aos críticos agudos. Conclusão: O estudo não mostrou diferença estatisticamente significativa quanto às características e desfechos clínicos entre as duas definições de DCC. Por outro lado, mostrou que os dois grupos de DCC apresentaram desfechos piores quando comparados com os pacientes críticos agudos. Estes resultados justificam o uso do critério de ≥14 dias de VM para a identificação mais precoce dos doentes críticos crônicos. / Theoretical basis: Progress in knowledge and the introduction of more advanced technologies for critical patient care brought about an important increase in the survival of this large group of patients. On the other side, there exists a subset of patients who survive their acute critical illness, but they remain dependent on some kind of life support for long periods. Despite being described since the 1980s, the chronic critical illness (CCI) has still not been clearly defined. This situation led to divergent studies’ results and jeopardized the progress in research focused on treatment strategies for CCI. Objective: To assess the survival and CCI-associated factors in a population of critically ill patients comparing two diagnostic criteria of this condition. Methodology: Historical cohort study assessing clinical variables and outcomes during hospital stay, in a population of critically ill patients of a single intensive care unit (ICU). The patients were divided into three groups, two of these with different criteria of CCI, defined by ≥14 or ≥21 days of mechanical ventilation (MV), and a third group with acutely critically ill patients (less than 14 days of MV). The recruitment and allocation were carried out through an institutional database and medical records of admissions occurred from January 1, 2007 to December 31, 2010. Results: In the study period 3,023 ICU admissions occurred, 2,783 met the inclusion criteria and made part of the final analysis. As far as MV days are concerned, 163 patients had ≥14 days and 89 ≥21 days. Hospital and ICU mortality were lower in the group of acutely critically ill patients compared with the two CCI groups (≥14 days and ≥21 MV days) (16.3% versus 55.8% and 58.4% p<0.001; 10.6% versus 47.3% and 53.9% p<0.001 respectively). The comparative analysis between the two CCI groups (≥14 days and ≥21 MV days, respectively) was not statistically significant for hospital and ICU mortality (57.2% versus 58.4% p=0.5; 39.2% versus 53.9% p=0.18, respectively). The small number of patients in the two groups may have limited the power of analyzes. Both CCI groups had higher severity scores, developed more ICU complications, showed higher hospital length of stay and mortality when compared with the acutely critically ill patients. Conclusion: This study did not show significant difference between the two CCI definitions regarding characteristics and clinical outcomes. However, it showed that both groups had worse outcomes when compared with the acutely critically ill patients. This result justifies the use of the CCI criteria of ≥14 days of MV for earlier identification of this subset of patients.

Base teórica: O avanço no conhecimento e a introdução de tecnologias mais sofisticadas para o cuidado do paciente crítico trouxeram importante incremento na sobrevida deste grande grupo de pacientes. Por outro lado, existe um estrato de pacientes que sobrevivem à condição crítica aguda, porém permanecem dependentes de algum tipo de suporte de manutenção da vida por longos períodos. A doença crítica crônica (DCC) como é conhecida, apesar de descrita desde a década de 80, ainda não possui um critério de definição claro, levando a divergências nos resultados de estudos e prejudicando o avanço em pesquisas que investigam estratégias de tratamento. Objetivo: Avaliar a sobrevida e fatores associados à DCC em uma população de pacientes críticos comparando dois critérios de diagnóstico desta condição. Metodologia: Coorte histórica com avaliação de variáveis clínicas e desfechos durante a internação hospitalar em uma população de doentes críticos de uma única unidade de tratamento intensivo (UTI). Os pacientes foram alocados em três grupos, dois com critérios de DCC definidos por ≥14 ou ≥21 dias de ventilação mecânica (VM) e um terceiro grupo de pacientes críticos agudos (< 14 dias de VM). Recrutamento e alocação foram feitos através de um banco de dados institucional e dos registros hospitalares das internações ocorridas de janeiro de 2007 a dezembro de 2010. Resultados: No período analisado ocorreram 3.023 internações na UTI, 2.783 apresentavam os critérios de inclusão e compuseram a análise final. Em relação ao tempo de VM, 163 pacientes apresentaram ≥14 dias e 89 ≥21 dias. A mortalidade hospitalar e na UTI foi inferior no grupo de pacientes críticos agudos quando comparado com os dois grupos de DCC (≥14 e ≥21 dias de VM) (16.3% versus 55.8% e 58.4% p<0.001; 10.6% versus 47.3% e 53.9% p<0.001 respectivamente). Quando comparados os dois grupos de DCC (≥14 e ≥21 dias de VM), não houve diferença estatisticamente significativa para mortalidade hospitalar e na UTI (57.2% versus 58.4% p=0.5; 39.2% versus 53.9% p=0.18 respectivamente). O pequeno número de pacientes em cada grupo pode ter limitado o poder das análises. Ambos os grupos de DCC tiveram escores de gravidade mais altos, desenvolveram mais complicações na UTI, apresentaram maior tempo de internação hospitalar e mortalidade quando comparados aos críticos agudos. Conclusão: O estudo não mostrou diferença estatisticamente significativa quanto às características e desfechos clínicos entre as duas definições de DCC. Por outro lado, mostrou que os dois grupos de DCC apresentaram desfechos piores quando comparados com os pacientes críticos agudos. Estes resultados justificam o uso do critério de ≥14 dias de VM para a identificação mais precoce dos doentes críticos crônicos. / Theoretical basis: Progress in knowledge and the introduction of more advanced technologies for critical patient care brought about an important increase in the survival of this large group of patients. On the other side, there exists a subset of patients who survive their acute critical illness, but they remain dependent on some kind of life support for long periods. Despite being described since the 1980s, the chronic critical illness (CCI) has still not been clearly defined. This situation led to divergent studies’ results and jeopardized the progress in research focused on treatment strategies for CCI. Objective: To assess the survival and CCI-associated factors in a population of critically ill patients comparing two diagnostic criteria of this condition. Methodology: Historical cohort study assessing clinical variables and outcomes during hospital stay, in a population of critically ill patients of a single intensive care unit (ICU). The patients were divided into three groups, two of these with different criteria of CCI, defined by ≥14 or ≥21 days of mechanical ventilation (MV), and a third group with acutely critically ill patients (less than 14 days of MV). The recruitment and allocation were carried out through an institutional database and medical records of admissions occurred from January 1, 2007 to December 31, 2010. Results: In the study period 3,023 ICU admissions occurred, 2,783 met the inclusion criteria and made part of the final analysis. As far as MV days are concerned, 163 patients had ≥14 days and 89 ≥21 days. Hospital and ICU mortality were lower in the group of acutely critically ill patients compared with the two CCI groups (≥14 days and ≥21 MV days) (16.3% versus 55.8% and 58.4% p<0.001; 10.6% versus 47.3% and 53.9% p<0.001 respectively). The comparative analysis between the two CCI groups (≥14 days and ≥21 MV days, respectively) was not statistically significant for hospital and ICU mortality (57.2% versus 58.4% p=0.5; 39.2% versus 53.9% p=0.18, respectively). The small number of patients in the two groups may have limited the power of analyzes. Both CCI groups had higher severity scores, developed more ICU complications, showed higher hospital length of stay and mortality when compared with the acutely critically ill patients. Conclusion: This study did not show significant difference between the two CCI definitions regarding characteristics and clinical outcomes. However, it showed that both groups had worse outcomes when compared with the acutely critically ill patients. This result justifies the use of the CCI criteria of ≥14 days of MV for earlier identification of this subset of patients.

No description available.

Critically ill patients often exhibit abnormal glycaemia that can lead to severe complications and potentially death. In critically ill adults, hyperglycaemia is a common problem that has been associated with increased morbidity and mortality. In contrast, critically ill infants often suffer from hypoglycaemia, which may cause seizures and permanent brain injury. Further complicating the matter, both of these conditions are diagnosed by blood glucose (BG) measurements, often taken several hours apart, and, as a result, these conditions can remain poorly managed or go completely undetected. Emerging ‘continuous’ glucose monitoring (CGM) devices with 1-5 minute measurement intervals have the potential to resolve many issues associated with conventional intermittent BG monitoring. The objective of this research was to investigate and develop methods and models to optimise the clinical use of CGM devices in critically ill patients. For critically ill adults, an in-silico study was conducted to quantify the potential benefits of introducing CGM devices into the intensive care unit (ICU). Mathematical models of CGM error characteristics were implemented with existing, clinically validated, models of the insulin-glucose regulatory system, to simulate the behaviour of CGM devices in critically ill patients. An alarm algorithm was also incorporated to provide a warning at the onset of predicted hypoglycaemia, allowing a virtual dextrose intervention to be administered as a preventative measure. The results of the in-silico study showed a potential reduction in nurse workload of approximately 75% and a significant reduction in hypoglycaemia, while also providing insight into the optimal rescue dose size and resulting dynamics of glucose recovery. During 2012, ten patients were recruited into a pilot clinical trial of CGM devices in critical care with a primary goal of assessing the reliability of CGM devices in this environment, with a specific interest in the effects of CGM device type and sensor site on sensor glucose (SG) data. Results showed the mean absolute relative difference of SG data across the cohort was between 12-24% and CGM devices were capable of monitoring some patients with a high degree of accuracy. However, certain illnesses, drugs and therapies can potentially affect sensor performance, and one particular set of results suggested severe oedema may have affected sensor performance. A novel and first of its kind metric, the Trend Compass was developed and used to assesses trend accuracy of SG in a mathematically precise fashion without approximation, and, importantly, does so independent of glucose level or sensor bias, unlike any other such metrics. In this analysis, the trend accuracy between CGM devices was typically good. A recent hypothesis suggesting that glucose complexity is associated with mortality was also investigated using the clinical CGM data. The results showed that complexity results from detrended fluctuation analysis (DFA) were influenced far more by CGM device type than patient outcome. In addition, the location of CGM sensors had no significant effect on complexity results in this data set. Thus, while this emerging analytical method has shown positive results in the literature, this analysis indicates that those results may be misleading given the impact of technology outweighing that of physiology. This particular result helps to further delineate the range of potential applications and insight that CGM devices might offer in this clinical scenario. In critically ill infants, CGM devices were used to investigate hypoglycaemia during the first 48 hours after birth. More than 50 CGM data sets were obtained from several studies of CGM in infants at risk of hypoglycaemia at the Waikato hospital neonatal ICU (NICU). In light of concerns regarding CGM accuracy, particularly during the first few hours of monitoring and/or at low BG levels, an alternative, novel calibration scheme was developed to increase the reliability of SG data. The recalibration algorithm maximised the value of very accurate calibration BG measurements from a blood gas analyser (BGA), by forcing SG data to pass through these calibration BG measurements. Recalibration increased all metrics of hypoglycaemia (number, duration, severity and hypoglycaemic index) as the factory CGM calibration was found to be reporting higher values at low BG levels due to its least squares calibration approach based on the assumption of a less accurate calibration glucose meter. Thus, this research defined new calibration methods to directly optimise the use of CGM devices in this clinical environment, where accurate reference BG measurements are available. Furthermore, this work showed that metrics such as duration or area under curve were far more robust to error than the typically used counted-incidence metrics, indicating how clinical assessment may have to change when using these devices. The impact of errors in calibration measurements on metrics used to classify hypoglycaemia was also assessed. Across the cohort, measurement error, particularly measurement bias, had a larger effect on hypoglycaemia metrics than delays in entering calibration measurements. However, for patients with highly variable glycaemia, timing error can have a significantly larger impact on output SG data than measurement error. Unusual episodes of hypoglycaemia could be successfully identified using a stochastic model, based on kernel density estimation, providing another level of information to aid decision making when assessing hypoglycaemia. Using the developed algorithms/tools, with CGM data from 161 infants, the incidence of hypoglycaemia was assessed and compared to results determined using BG measurements alone. Results from BG measurements showed that ~17% of BG measurements identified hypoglycaemia and over 80% of episodes occurred in the first day after birth. However, with concurrent BG and SG data available, the SG data consistently identified hypoglycaemia at a higher rate suggesting the BG measurements were not capturing some episodes. Duration of hypoglycaemia in SG data varied from 0-10+%, but was typically in the range 4-6%. Hypoglycaemia occurred most frequently on the first day after birth and an optimal measurement protocol for at risk infants would likely involve CGM for the first week after birth with frequent intermittent BG measurements for the first day. Overall, CGM devices have the potential to increase the understanding of certain glycaemic abnormalities and aid in the diagnosis/treatment of other conditions in critically ill patients. This research has used a range of prospective and retrospective clinical studies to develop methods to further optimise the use of CGM devices within the critically ill clinical environment, as well as delineating where they are less useful or less robust. These latter results clearly define areas where clinical practice needs to adapt when using these devices, as well as areas where device makers could target technological improvements for best effect. Although further investigations are required before these devices are regularly implemented in day-to-day clinical practice, as an observational tool they are capable of providing useful information that is not currently available with conventional intermittent BG monitoring.

Bakgrund: Redan på 1970-talet uppmärksammades närståendes situation inom vården, och trots att det har skett en ökning kring familjerelaterad forskning under de senaste 20 åren finns det fortfarande brister inom familjerelaterad omvårdnad Syfte: Syftet med studien var att beskriva närståendes upplevda behov av stöd från sjuksköterskan när en anhörig drabbas av allvarlig sjukdom eller skada. Metod: Den studie som genomfördes var en litteraturstudie, den inkluderar 10 artiklar varav 8 var kvalitativa och 2 var kvantitativa. Sökningar gjordes i Cinahl, PubMed och DiVA. Innehållet analyserades och kategorier identifierades. Resultat: Två huvudkategorier och tre underkategorier identifierades. Första huvudkategorin var närståendes behov, med underkategori betydelsen av kommunikation i vården med de närstående samt återhämtning. Den andra huvudkategorin var stöd som finns att tillgå, med underkategorierna närståendes delaktighet i vården. Slutsats: Studien visar på att närstående upplever ett stort behov av få vara delaktiga i vården kring patienten, framförallt genom att få information. Att göra närstående delaktiga kan minska den upplevda stressen vilket kan leda till ett ökat förtroende för vården. / Background: Already in the 1970’s were significant others situation in the healthcare highlighted, and although there has been an increase on family-related research over the past 20 years, there are still gaps in family-related care. Aim: The aim was to describe significant others experience of needs from the nurse, when a patient suffer from a serious illness or injury. Method: The study was conducted as a literature review, which included 10 articles of which 8 were qualitative and 2 were quantitative. Searches were made in Cinahl, PubMed and DiVA. The content was analyzed and themes were identified. Result: Two main themes and three subthemes were identified. The first main theme was the significant other’s needs, with the first subtheme being the meaning of communication in healthcare with the significant other and the second subtheme being recovery. The second main theme was available support, with the subtheme being significant others participation in care. Conclusion: The study implies that significant others felt a need to be involved in health care around the patient, especially by getting information. To involve the significant other can reduce the stress experience, which in turn can raise the trust in health care.

BACKGROUND: Agitation is a common complication in the intensive care unit (ICU) manifested in behavior and actions that range from simple apprehension or anxiety to frankly combative behavior.5 Agitation is associated with significant adverse outcomes.1-3 Studies report up to 71% of ICU patients have some degree of agitation during their ICU stay and that agitation is observed 32% of the time.3;4 Potential causes of agitation in critically ill patients are numerous; however, data about factors that predict agitation are limited. OBJECTIVE: The specific aim of this study was to identify predictors of agitation on admission to the ICU as well as within 24 hours prior to the first agitation event. DESIGN: Retrospective medical record review. SETTING: Two adult critical care units, Medical Respiratory ICU (MRICU) and Surgical Trauma ICU (STICU) in an urban university medical center. SUBJECTS: A convenience sample of 200 critically ill adult patients, all older than 18 years of age, consecutively admitted to a MRICU and STICU, admitted for longer than 24 hours, over a two month period. METHODS: Risk factors for agitation were identified from literature review as well as from expert consultation. Data were collected during the first 5 days of ICU stay. Agitation was identified using the documented Richmond Agitation-Sedation Scale or notation of “agitation” in the medical record. RESULTS: Of the sample 56.5% were male, 51.5% Euro-American, with mean age 55.5 years (±16.4). Independent predictors of agitation on admission to the ICU were: past medical history of illicit substance use, height, both the Sequential Organ Failure Assessment respiratory and central nervous system subscores, and use of restraints. Predictors of agitation within 24 hours prior to the first agitation event were: percent of hours using restraints, percent of hours using mechanical ventilation, number of genitourinary catheters, and blood pH and albumin. CONCLUSIONS: Use of these empirically based data may allow care providers to identify those at risk as well as predict agitation. Elimination or reduction of agitation in the ICU would improve patient safety and reduce hospitalization resulting in significant savings to healthcare. Reference List (1) Woods JC, Mion LC, Connor JT et al. Severe agitation among ventilated medical intensive care unit patients: frequency, characteristics and outcomes. Intensive Care Med 2004;30:1066-1072. (2) Jaber S, Chanques G, Altairac C et al. A prospective study of agitation in a medical-surgical ICU: incidence, risk factors, and outcomes. Chest 2005;128:2749-2757. (3) Fraser GL, Prato BS, Riker RR, Berthiaume D, Wilkins ML. Frequency, severity, and treatment of agitation in young versus elderly patients in the ICU. Pharmacotherapy 2000;20:75-82. (4) Gardner K, Sessler CN, Grap MJ. Clinical factors associated with agitation. Am J Crit Care 2006;15:330-331. (5) Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 1999;27:1325-1329.

O presente estudo é resultado de uma pesquisa de revisão integrativa, cujo objetivo geral é sintetizar a contribuição de pesquisas nacionais e internacionais referentes à hipotermia não induzida em pacientes graves e as possíveis complicações desencadeadas no período pós-operatório. O material do estudo foi constituído de artigos publicados nos periódicos nacionais e internacionais, no período de 2001 a 2011 e indexados nas seguintes bases de dados: CINAHL, EMBASE, LILACS, PUBMED e SCIELO e por Teses catalogadas no sistema DEDALUS no mesmo período. Os artigos selecionados totalizam 17 Artigos e 02 Teses. Estes artigos e Teses foram catalogados e chamados de A e T respectivamente. Foram elaborados três formulários: o formulário A, composto pelos seguintes itens: identificação dos artigos, autores, título da pesquisa, fonte e origem, já o formulário B, contém itens que detalham os artigos encontrados, isto é, tipo de estudo, finalidades/objetivos, descrição do estudo, resultados obtidos e conclusões, e o formulário C, que contém a identificação das teses, autor, título da pesquisa, ano de publicação e local. Realizadas as análises, foram encontradas as seguintes complicações mais frequentes causadas pela hipotermia não induzida: cardiovascular (vasoconstrição periférica, isquemia miocárdica, hipertensão arterial, taquicardia e trombose venosa profunda); coagulopatia (diminuição da coagulação em 10% e ativação plaquetária); infecção da ferida operatória (diminuição da circulação sanguínea nos tecidos); imunológica (aumento da incidência de infecção no local cirúrgico); alterações hidroeletrolíticas (hipocalemia, hipomagnesemia e hipofosfatemia); alteração na eliminação dos medicamentos (diminuição da circulação sanguínea e dificuldade de eliminação dos fármacos); tremor; úlcera por pressão (diminuição da circulação sanguínea e diminuição da perfusão periférica); dificuldade respiratória; alterações endócrino-metabólicas (diminuição de corticoides e da insulina, aumento da resistência periférica a insulina e do hormônio tireotrófico, hiperglicemia e hipoglicemia); aumento do tempo de recuperação. Apesar do conhecimento teórico sobre a hipotermia e suas complicações, surge um questionamento: o que nos leva a subestimar a hipotermia não induzida? / The present study is the result of an integrative research review whose objective is to summarize the contributions of national and international research related to non-induced hypothermia in critically ill patients and the possible complications triggered in the postoperative period. The study material consists of articles published in national and international journals indexed in the following databases: CINAHL, EMBASE, LILACS, PUBMED and SCIELO in the period between 2001 and 2011 and of theses cataloged in the DEDALUS database in the same period. The selected material totaled 17 articles and 02 theses. They were cataloged and named A and T respectively. Three forms were created: A, B and C. Form A contains items which detail the identification of the article, its authors, title, source and origin; Form B details the study type, its purposes/objectives, description, results and conclusions; and Form C contains the identification of the thesis, its author, title, publication year and location. Having performed the analyzes, we found the following most frequent postoperative complications caused by non-induced hypothermia: cardiovascular problems (peripheral vasoconstriction, myocardial ischemia, hypertension, tachycardia and deep vein thrombosis); coagulopathy (10% decrease in coagulation and platelet activation); wound infections (decrease in blood flow to tissues); immunological complications (increase in incidence of surgical site infections); electrolyte changes (hypokalemia, hypomagnesaemia and hypophosphatemia); changes in the elimination of drugs (decrease in blood flow and difficulty of removing drugs); trembling; pressure ulcers (decrease in blood flow and decrease in peripheral perfusion); breathing difficulty; endocrine-metabolic changes (decrease of corticosteroids and of insulin, increase of peripheral resistance to insulin and thyroid stimulating hormone, hyperglycemia and hypoglycemia); and increase in recovery time. Despite the theoretical knowledge of hypothermia and its complications, a question arises: what makes us underestimate the non-induced hypothermia?

The purpose of this study was to test the effect of the expressive writing and the expressive talking interventions on uncertainty and coping processes in Thai family members of patients in a coma, and to examine changes in positive emotion, negative emotion, and cognitive process word-use over three days. A quasi-experimental pretest-posttest, three group design was conducted with 45 Thai family members of patients in a coma who were in the intensive care units (ICU) at a hospital in Thailand. Three ICUs were randomly assigned into groups: the expressive writing, the expressive talking, and the control group. Participants of the expressive writing group (n = 15) were asked to write about their thoughts and feelings following standard guidance for expressive writing, those of the expressive talking group (n = 15) were interviewed with questions guided by the story path approach, whereas those of the control group (n = 15) did not receive any specific interventions. Participants completed the Thai version of the Mishel Uncertainty in Illness Scale-Family Member Form and the Thai version of the revised version of the Ways of Coping Scale before and after the interventions. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

Indonesia is a developing country with diversity in cultures, religions and landscape. The country has the fourth biggest population in the world, spread over the world’s largest archipelagic country with more than 18 000 islands. Health care is slowly improving but still there is a problem in reaching people due to the cultural, financial and political situation. This study asks nurses how they can promote hope in patients that are critically ill, cared for in an intensive care unit in Indonesia. The intensive care unit patient is often very sick, sedated, intubated, monitored with many interventions and unable to communicate with the world other than through interpreted signs to and from the nurse. It is possible that it is difficult for the patient to address what or who helps him/her to develop any kind of hope in this situation. Five specialized intensive care nurses from two different intensive care wards were interviewed according to a qualitative approach with open-ended questions. The respondents each had more than 10 years of experience and consisted of both females and males. The interviews were transcribed verbatim and analyzed according to a content analysis (Lundman &amp; Hällgren Granheim, 2008), with categories and sub categories as a result. The interviews showed that the nurses influence hope by using much interaction with both the patient and the family. The factors of family and religion showed however an interesting and very important role in how the nurses could reach the patient and his/her subjective wish for hopes. There is literature that supports the findings in the study but still the result can be discussed, as it was a single researcher with a small number of respondents using an interpreter. / Program: Specialistsjuksköterskeutbildning med inriktning mot intensivvård

Då någon drabbas av allvarlig sjukdom eller skada som hotar livet påverkas inte bara den sjuke utan också alla i den sjukes närhet. Att som närstående vara barn i denna situation kan vara oerhört traumatiskt. För att vi som vårdpersonal ska kunna hjälpa och stötta barnen och familjen behövs kunskap om hur barn upplever denna situation och vilka behov som finns hos dem. Syftet med studien är att beskriva barns upplevelse av att vara närstående till en svårt sjuk person. Med svår sjukdom/skada valdes i denna uppsats någon som vårdas på en intensivvårdsavdelning eller drabbats av cancersjukdom. Metoden som använts är litteraturstudie av vårdvetenskapliga kvalitativa artiklar där barnens upplevelse tydligt framkommer. I resultatet framgår det att barnen upplever oro och osäkerhet över vad som händer, förändrat vardagsliv, otrygghet och utanförskap. Dessa känslor och upplevelser har samlats under tre teman: Berätta för mig, Jag vill att det ska vara som vanligt och Ser ni mig? Med kunskap om barns upplevelser och känslor när någon närstående drabbats av svår sjukdom/skada kan vi som vårdpersonal informera och stötta barn och föräldrar för att möjliggöra en situation där barnen känner delaktighet och trygghet. Studien visar på vikten av att barnen är välinformerade om vad som hänt och hur sjukdomen/skadan utvecklar sig, att vardagen fortsätter i möjligaste mån med trygga rutiner och att barnen får känna delaktighet och blir sedda. Studien visar på hur viktigt det är att vi som vårdpersonal ser och informerar de närstående barnen med tanke på ålder, utveckling och erfarenhet och uppmuntrar och stöttar föräldrarna till att göra barnen delaktiga. / Program: Fristående kurs