[pt] Na atualidade, prevalece uma cultura pautada no ideal de consumo e bem-estar, onde o reconhecimento social está associado à ideia de sucesso e felicidade. Portanto, não convém ao sujeito falar sobre o seu sofrimento. Logo, se a morte gera sofrimento, ela deve ser silenciada. Tal olhar sobre a morte é atestado por Ariès (2003), que diz que na sociedade contemporânea falar sobre a morte é um tabu. O interdito da morte ingressou no processo de ensino-aprendizagem dos profissionais de saúde, sobretudo dos médicos. Esta interdição faz parte do processo civilizador moderno e está atrelada às conquistas do iluminismo científico, que criou socialmente a solidão dos moribundos e enlutados. Houve um enfraquecimento dos rituais públicos em torno da morte e, consequentemente, um fortalecimento da medicalização pela ciência. A morte passou a ser medicalizada, por meio de tecnologias, assim como o luto. Contudo, não há como negar a tristeza gerada pela morte de um familiar. Freud (1996j/1917) entoa a relevância do exame de realidade e o fator tempo. O autor aponta que é justamente entrando em contado com os sentimentos que envolvem a perda de um ente querido que se possibilita a elaboração do luto. Diante disso, o presente trabalho tem o objetivo de problematizar como a morte e o luto são retratados nos dias atuais e nas instituições hospitalares e seu impacto sobre as pessoas que vivenciam uma experiência de perda de um ente querido. A pesquisa consiste em um estudo teórico sobre o tema, pautado na bibliografia disponível sobre o assunto, tendo como eixo teórico principal a teoria psicanalítica. / [en] Today, a culture based on the ideal of consumption and well-being prevails, where social recognition is associated with the idea of success and happiness. Therefore, it is not convenient for the subject to talk about his suffering. If death generates suffering, it must be silenced. This look at death is attested by Ariès (2003), who says that in contemporary society talk about death is a taboo. The ban on death enters the teaching-learning process of health professionals, especially doctors. This interdiction is part of the modern civilizing process and linked to the achievements of scientific enlightenment that socially created the loneliness of the dying and mourning. There was a weakening of public rituals around death and, consequently, a strengthening of medicalization by science. Death became medical, through technologies, as well as the self. However, there is no denying a sadness generated by the death of a family member. Freud (1996j/1917) refers to the examination of reality and the time factor. The author points out that it is only entering the content with the feelings that involve the loss of a loved one that allows the elaboration of grief. Given this, the present work aims to problematize how death and grief are portrayed today and in hospital institutions and their impact on people who have an experience of losing a loved one . The research consists of a theoretical study on the subject, based on the available bibliography on the subject, with psychoanalytic theory as its main theoretical axis.

Patienter på IVA är utsatta för obehagliga upplevelser, både genom sjukdom, behandling och vårdmiljö. Närstående beskriver känslor av overklighet och skräck. Patienter minns drömmar, mardrömmar och faktiska händelser lång tid efter intensivvårdsvistelsen. Dagbok används på många IVA-avdelningar för att ge patienten ett underlag att bearbeta händelser och eventuella minnesluckor från vårdtiden. Syftet med litteraturstudien är att belysa betydelsen av dagbok för IVA-patienter och deras närstående. Studien grundas på nio utvalda och granskade artiklar. I analysen identifierades fem kategorier: kommunikation, trygghet, känslor, förståelse och acceptans samt värdefullt tids- och minnesdokument. / Patients at intensive care units are exposed for unpleasant experiences through illness, treatment and environment. The relatives describe feelings of unreality and fear. Patients remember dreams, nightmares and factual events a long time after discharge from intensive care. Diaries are used at many intensive care units, as a tool for understanding memories and loss of memories. The aim of this literature review is to illustrate the meaning of diaries for intensive care patients and their relatives. Nine articles were chosen and examined. Five categories were identified through the analyze: communication, security, feelings, understanding/accepting and a valuable document over time and memory.

[pt] A avaliação de desempenho no contexto da saúde é especialmente importante para Unidades de Terapia Intensiva (UTIs), que lidam com casos de alta complexidade. Este trabalho avalia 93 UTIs com uso de Análise Envoltória de Dados (DEA). Três modelos são propostos para aprofundar a análise em diferentes perspectivas: equipe médica, estrutura e capacidade. Este trabalho usa dados a nível de paciente para ajustar os resultados pelo case-mix da UTI, o que resulta em dois outputs: taxa de mortalidade ajustada (SMR) e taxa de uso de recurso ajustada (SRU). Análises estatísticas também são realizadas para mostrar a relação entre as variáveis. Médias dos valores de eficiência obtidos pelo DEA são calculados para variáveis categóricas não-discricionárias, mostrando que hospitais privados com fins lucrativos, em geral, têm melhores resultados de eficiência, e que grandes UTIs têm menores valores de SMR e SRU. / [en] Healthcare performance assessment is especially relevant for Intensive Care Units (ICUs), which deal with high complexity cases. This work evaluates 93 ICUs using Data Envelopment Analysis (DEA). Three models are proposed to broaden the analysis from different perspectives: staffing, structure, and capacity. It uses patient-level data to adjust outcomes to the ICU s case-mix, which results in two outputs: Standardized Mortality Rate (SMR) and Standardized Resource Use (SRU). Statistical analyses are also performed to show the relation of the variables. Average DEA efficiency scores are calculated for categorical non-discretionary variables, assessing that private for-profit hospitals, in general, have better efficiency results and that large ICUs have lower SMR and SRU.

Mobile chest radiography remains the most appropriate test for critical care patients with cardiorespiratory changes and with patients who have chest tubes and lines as a monitoring tool, and to detect complications related to their use. However, one of the most frequent issues recognized radiographically with patients in critical care is chest tubes and lines malposition. This can be related to technical quality reasons which can affect their appearance in the chest radiography. This research considers how the technical quality of the ICU/CCU chest radiography can impact upon the appearance of chest tubes/lines and how that appearance can impact on the decision making. Results show that the methods used in the chest phantom experiment to estimate the degree of angulation have a large effect upon the appearance of anatomical structures, but it does not have a particularly large effect upon the apparent changes of tube/line position central venous catheter and endotracheal tube (CVC, ETT). The study also shows that there was a little difference between the two image processing algorithms, apart from the visualisation of sharp reproduction of the trachea and proximal bronchi, which was significantly better using the standard algorithm compared to the inverted algorithm. The two methods used to estimate the degree of angulation and the apparent position of the CVC/ETT on 17 mobile chest radiographs provide limited useful information to the image interpreter in estimating the degree of angulation and degree of malpositioning of the tube and line.

Intensivvården är ett fält där patienter vårdas för livshotande tillstånd. Där, trots en snabb teknologisk utveckling, det inte alltid är möjligt att rädda patientens liv. De här patienterna avlider för det mesta på IVA eller annan avdelning på sjukhuset. Data från palliativa registret tyder dock på att patienter i hög utsträckning önskar dö i hemmet om det är möjligt. Möjligheten att överföra patienter från intensivvårdsavdelning (IVA) till hemmet finns i vissa delar av världen men betraktas i de flesta länder som något extraordinärt. I det aktuella examensarbetet utforskas tidigare forskning inom området. Syftet med examensarbetet var att övergripande sammanställa forskning kring hur överföring av intensivvårdade patienter till hemmet i livets slutskede beskrivs. Examensarbetet har genomförts som en integrativ sammanställning av alla återfunna studier publicerade de tio senaste åren i fyra stora databaser. Resultatet visar att perspektiv från patient, anhöriga och personal står i centrum. För patienter och anhöriga handlar beslutet om att utöva sin autonomi och på ett värdigt sätt avsluta sitt liv. Kultur är en viktig faktor. Hos personalen dominerade tankar om hur överföringen ska gå till och kring vilka patienter som var lämpliga att överföra. Arbetet visar att överföring hem från IVA sker i flera delar av världen och att de som har varit inblandade i stort är positivt inställda. Sjuksköterskan spelar en viktig roll i hela processen, från att stödja patientens autonoma förmåga, samordna resurser och även i genomförandet av själva transporten. / Intensive care is an area where patients are treated for life threatening conditions where, even if development is happening quickly, the patients’ lifes cannot always be saved. These patients usually die at the ICU or in other general hospital wards. Data from the Swedish palliative register shows that a large portion of patients would prefer to die at home. The possibility to transfer patients from the ICU to home before death exists as a practice in some parts of the world but is usually seen as something out of the ordinary. In this master thesis earlier published studies on this practice were explored. The purpose was to describe the existing research regarding transferring patients from the ICU home to die. The method has been an integrative review of all retrieved articles published in four big databases during the last ten years. The results showed that the perspectives of patients, relatives and personnel are central. For patients and their relatives, the question of personal autonomy and a dignified end of life are of importance. For ICU staff the views are dominated by more practical concerns regarding how a transfer can be made and which patients were suitable for the practice. Transfer home from the ICU to die is happening around the world and those that have been involved report positive experiences. The ICU nurse plays an important role in the whole process, from first identifying the patient’s autonomic capacity in order to make such a decision, to coordinating resources and preparation of the transfer, and even in performing the transfer.

Patients admitted to an adult intensive care unit (ICU) are at risk of developing an acute condition known as ICU delirium, which can impact patients’ length of hospital stay and increase short term and 6-month mortality. The cause of ICU delirium is multifactorial, and lack of quality sleep is a known risk factor. Patients’ sleep in the ICU is frequently interrupted by clinicians involved in their care and equipment alarms. Sleep hygiene interventions to minimize these interruptions for the patient are one strategy to reduce the risk of ICU delirium. Examples of sleep hygiene interventions include eye masks, earplugs, and grouping patient care to minimize nighttime interruptions. The primary purpose of this thesis was to review the available evidence on non-pharmacological sleeping interventions and how they can prevent the development of ICU delirium in adults hospitalized with a critical illness. A secondary aim of this thesis was to study the impact of non-pharmacological interventions on sleep quality. Seven studies conducted in critical care units were included in this scoping review, which examined how non-pharmacological sleep hygiene interventions impacted both the prevention of ICU delirium, and sleep quality. Study results were analyzed to determine their effectiveness in relation to the two outcome measures. Although this review identified many benefits of non-pharmacological sleep interventions, the results on which are most effective in preventing delirium and improving sleep quality are inconclusive. Future research needs to be done to evaluate which sleep-promoting intervention(s) will benefit critical care patients most in preventing or lowering their risk of delirium. The feasibility of both health care staff consistently and effectively executing the intervention(s) outside of research conditions, and patient compliance to the interventions needs to be further studied. Additionally, there is a need for future studies measuring sleep quality as a result of sleep promoting interventions to be measured by PSG rather than subjective written/oral reports in order to obtain objective, reliable results.

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In the intensive care unit, patients with crucial, life-threatening conditions are admitted and need constant monitoring. Here, the need for a quick and efficient decision support tool is the greatest. The use of machine learning has shown promising results in identifying patients at risk of different severe conditions in the intensive care unit and detection at an early stage is crucial in order to take preventive measures. This especially applies to conditions that can be hard to manage once developed, such as circulatory shock. In this master’s thesis, a machine learning modeling approach is suggested to detect and differentiate the onset of three types of circulatory shock – cardiogenic, hypovolemic and septic shock. Data was used from the open-source database MIMIC which represents thousands of patients from intensive care. The data was preprocessed and labels for the three shock types were created using ICD-9 codes combined with a proxy that is closely related to the condition – vasopressor. Different machine learning algorithms were then used for a static onset prediction as a base. The best performing models were also trained for a dynamic onset prediction in order to make predictions up to four hours ahead of onset. All models were evaluated using different evaluation metrics and at last, an interpretation method was used to enable a simpler interpretation of the results. The final results show that it is possible to detect and distinguish between the three types of shock, up to four hours ahead of onset. For future developments, further development and validation using more data should be the main focus before testing it in a clinical setting.