The Intensive Care Unit, well known as ICU, is a specialized section of a hospital that provides comprehensive and continuous care (treatment and monitoring) for persons who are critically ill or in an unstable condition and who can benefit from treatment. The importance of this specific area of the hospital can be also understood from the amount and variety of the equipment that is installed inside. Therefore the Intensive Care Unit (ICU) should provide both continuous fault-free equipment operation and enhanced electrical safety for the patients and the medical staff. The main objective of the thesis is to study and design the electrical installation and the dedicated devices of a sample ICU, according to the latest European regulations and standards. In the first introductory chapter is described the main ICU medical equipment, patient modules, areas and utilities. The second chapter contains the Main Standards, Directives and Recommendations related to the building installing and testing of the ICU electrical installation and dedicated equipment. Chapter three described general the electrical safety in the ICU and the methods and means of protection against an Electrical shock. The next chapter reviews the methods and means of protection against an Equipment Malfunction and against Mains power failure. The fifth chapter is the design of a sample ICU Area including main power electrical installation and dedicated protection and monitoring devices. The last chapter includes the electrical safety tests of the installed system and dedicated devices and also the value limitations according to the European Standards and Regulations. / Η Μονάδα Εντατικής Θεραπείας, γνωστή ως ICU, είναι ένα εξειδικευμένο τμήμα του νοσοκομείου που παρέχει πλήρη και συνεχή φροντίδα (θεραπεία και παρακολούθηση) στα πρόσωπα που αντιμετωπίζουν κρίσιμα προβλήματα υγείας ή βρίσκονται σε μια ασταθή κατάσταση. Ο εξειδικευμένος εξοπλισμός της χωρίς καμία αμφιβολία μπορεί να επιφέρει πολύ θετικά αποτελέσματα στον ιατρικό τομέα Η λειτουργία και η σημασία της μονάδας, αναμφίβολα μπορούν να διαφανούν και από τον άριστο εξοπλισμό που διακατέχει. Είναι βέβαιο ότι μέσα από την συγκεκριμένη μονάδα θεραπείας μπορεί να δοθεί στον ασθενή η κατάλληλη σημασία έτσι ώστε να μπορεί να γιατρευτεί. Ο άρτια εξοπλισμός που υπάρχει μπορεί να επιφέρει άριστα αποτελέσματα. Συνεπώς, η Μονάδα Εντατικής Θεραπείας (ICU) πρέπει να συνεχίσει την απρόσκοπτη λειτουργία της και συνάμα την ενίσχυση του εξοπλισμού της, έτσι ώστε να υπάρχει ενισχυμένη ηλεκτρική ασφάλεια τόσο για τους ασθενείς όσο και για το ιατρικό προσωπικό. Ο κύριος στόχος της διατριβής είναι η μελέτη και ο σχεδιασμός της ηλεκτρικής εγκατάστασης και δείγμα των αποκλειστικών συσκευών της μονάδα, σύμφωνα με τις τελευταίες ευρωπαϊκές προδιαγραφές. Στο πρώτο εισαγωγικό κεφάλαιο, περιγράφεται ο βασικός εξοπλισμός της μονάδας και η ιατρική που παρέχεται. Ακολούθως στο δεύτερο κεφάλαιο περιλαμβάνονται οι κύριοι κανόνες, οδηγίες και οι συστάσεις που σχετίζονται με την εγκατάσταση του κτιρίου. Επίσης γίνεται αναφορά στον έλεγχο της ηλεκτρικής εγκατάστασης και του ειδικού εξοπλισμού της μονάδας. Στο τρίτο κεφάλαιο περιγράφεται η γενική ηλεκτρική ασφάλεια στη μονάδα, με ιδιαίτερη αναφορά στις μεθόδους και στα μέσα προστασίας από ηλεκτροπληξία. Στη συνέχεια στο επόμενο κεφάλαιο εξετάζεται το κατά πόσο οι μέθοδοι και τα μέσα προστασίας μπορούν να είναι λειτουργικά έναντι των δυσλειτουργιών που μπορεί να προκληθεί από την διακοπή ρεύματος. Για την όσο καλύτερη λειτουργία της μονάδας γίνεται αναφορά στο πέμπτο κεφάλαιο, όπου γίνεται νύξη για τον σχεδιασμό του χώρου της μονάδας, συμπεριλαμβανομένων των κύριων ηλεκτρικών εγκαταστάσεων συσκευών προστασίας και παρακολούθησης. Μέσα από μια εκτεταμένη ανασκόπηση, έρευνα και πληθώρα πειραμάτων στο τελευταίο κεφάλαιο παρουσιάζονται οι ηλεκτρικές δοκιμές ασφαλείας του εγκατεστημένου συστήματος, οι ειδικές συσκευές, σύμφωνα πάντα με τα Ευρωπαϊκά πρότυπα και κανονισμούς.

Made available in DSpace on 2014-12-17T14:46:38Z (GMT). No. of bitstreams: 1 DeboraRG.pdf: 691114 bytes, checksum: bfcd9e6dbde057375b05e9ef4df4600f (MD5) Previous issue date: 2005-12-09 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This study aimed to seize the general social representations of doctors and nurses who work in ICUs on the process of death and dying. We also aimed to know the social representations of these professionals in relation to death and the process of dying of people who are under their care, identify factors that influence the construction of these representations and identify similarities and differences between the two professions. The study was conducted from the perspective of the Theory of Social Representations of Serge Moscovici and the Central Nucleus of Jean-Claude Abric. The study was conducted in the Intensive Care Unit of Natal Hospital Center, a private hospital of the city of Natal - Rio Grande do Norte. This is descriptive and exploratory research. Twenty-four (24) professionals were interviewed, twelve (12) nurses and twelve (12) doctors. Data were collected through two instruments: Test of Free Association of Words, semi-structured interview. Later, they were coded, categorized and analyzed according to Content Analysis of Bardin (1977). The words evoked after the use of inducing words - death and dying - and the interviews, led to three thematic categories: Death and dying as a biological event, death and dying as a psychosocial event, death and dying as a transcendental event. As final considerations, we believe that the social representations of the group are translated in death and dying as biological and psychosocial events and anchored in the transcendental aspects, we do not see obvious differences in the testimonies of doctors and nurses , and the factors that interfere the construction of these offices is the culture, including religion / O presente estudo teve como objetivo geral apreender as representa??es sociais de m?dicos (as) e enfermeiros (as) que trabalham em Unidade de Terapia Intensiva UTI sobre a morte e o processo de morrer. Tivemos ainda como objetivos conhecer as representa??es sociais desses profissionais em rela??o ? morte e o processo de morrer de pessoas que est?o sob os seus cuidados, identificar os fatores que influenciam na constru??o dessas representa??es e identificar converg?ncias e diverg?ncias entre as duas profiss?es. O estudo foi realizado sob a ?tica da Teoria das Representa??es Sociais de Serge Moscovici e do N?cleo Central de Jean-Claude Abric. A pesquisa foi realizada na Unidade de Terapia Intensiva do Natal Hospital Center, institui??o da rede privada da cidade de Natal Rio Grande do Norte. Trata-se de uma pesquisa do tipo descritiva e explorat?ria. Para atender os objetivos propostos entrevistamos 24 (vinte e quatro) profissionais, sendo 12 (doze) enfermeiros (as) e 12 (doze) m?dicos (as). Os dados foram coletados atrav?s de dois instrumentos: Teste de Associa??o Livre de Palavras e entrevista semi-estruturada. Posteriormente, foram codificados, categorizados e analisados de acordo com a An?lise de Conte?do de Bardin (1977). As palavras evocadas ap?s o uso das palavras-indutoras morte e morrer , bem como as entrevistas, deram origem a tr?s categorias tem?ticas: Morte e morrer como evento biol?gico; Morte e morrer como evento psicossocial; Morte e morrer como evento transcendental. Como considera??es finais, entendemos que as Representa??es Sociais do grupo est?o objetivadas na morte e morrer como eventos biol?gico e psicossocial e ancoradas nos aspectos transcendentais; n?o percebemos diverg?ncias evidentes nos depoimentos de m?dicos(as) e enfermeiros(as); e os fatores que interferem na constru??o destas representa??es ? o cultural, especialmente, a religi?o

Introdução: A falha ou atraso no diagnóstico de morte encefálica resulta na ocupação desnecessária de um leito, em perdas emocionais e financeiras, e na indisponibilidade de captação de órgãos. O médico intensivista tem fundamental papel nesse diagnóstico, pois quase todos os pacientes encontram-se em unidades de cuidados intensivos no momento do diagnóstico de morte encefálica. Objetivo: Avaliar o conhecimento sobre morte encefálica entre os médicos que atuam em unidades de cuidados intensivos no município de Porto Alegre. Método: Estudo transversal descritivo, com aplicação de um questionário em 246 médicos que trabalham em unidades de cuidados intensivos, em uma amostra consecutiva entre abril e dezembro de 2005. Utilizamos testes estatísticos bilaterais, com um nível de significância alfa de 0,05. Resultados: Encontramos uma prevalência de desconhecimento do conceito de morte encefálica de 17%. Vinte por cento dos entrevistados desconheciam a necessidade legal de exame complementar para o diagnóstico. Quarenta e sete por cento se consideraram no nível máximo de segurança para explicar o conceito para a família de um paciente. Vinte e nove por cento desconehciam a hora do óbito legal para os pacientes em morte encefálica. Os intensivistas pediátricos tiveram um menor conhecimento do conceito em relação aos intensivistas de adultos. Conclusões: O atual conhecimento sobre morte encefálica é insuficiente entre os profissionais que mais freqüentemente se deparam com pacientes nessa situação. Há necessidade de educação sobre o tema a fim de evitar gastos desnecessários, diminuir o sofrimento familiar e aumentar a oferta de órgãos para transplantes. / Introduction: Failure or delay in diagnosing brain death leads to the needless occupation of a bed, emotional and financial losses, and unavailability of organs for transplants. The intensive care physician plays an essential role in this diagnosis, since almost all the patients are in intensive care units at the time brain death is diagnosed. Objective: To evaluate knowledge on the concept of brain death among physicians working in intensive care units in the municipality of Porto Alegre, Rio Grande do Sul, Brazil. Methods: Cross-sectional study. Two hundred forty-six physicians who work in intensive care units were interviewed in a consecutive sample between April and December 2005. We used two-sided statistical tests with a 0.05% alpha level of significance. Results: We found a prevalence of 17% ignorance regarding the concept of brain death. Twenty per cent of the interviewees ignored the legal need for complementary confirmatory testing in order to perform the diagnosis. Forty-seven per cent considered themselves as having the highest level of confidence to explain the concept to a patient’s family. Twentynine per cent made a mistake in determining the legal time of death for brain dead patients. Pediatric intensivists know less about the concept, compared with the adult intensivists (p<0.001). Conclusion: The current knowledge of brain death is insufficient among the health care professionals who most often encounter patients in this situation. There is need for education on the subject, in order to avoid unnecessary expenses, reduce family suffering and increase the offer of organs for transplants

Introdução: A falha ou atraso no diagnóstico de morte encefálica resulta na ocupação desnecessária de um leito, em perdas emocionais e financeiras, e na indisponibilidade de captação de órgãos. O médico intensivista tem fundamental papel nesse diagnóstico, pois quase todos os pacientes encontram-se em unidades de cuidados intensivos no momento do diagnóstico de morte encefálica. Objetivo: Avaliar o conhecimento sobre morte encefálica entre os médicos que atuam em unidades de cuidados intensivos no município de Porto Alegre. Método: Estudo transversal descritivo, com aplicação de um questionário em 246 médicos que trabalham em unidades de cuidados intensivos, em uma amostra consecutiva entre abril e dezembro de 2005. Utilizamos testes estatísticos bilaterais, com um nível de significância alfa de 0,05. Resultados: Encontramos uma prevalência de desconhecimento do conceito de morte encefálica de 17%. Vinte por cento dos entrevistados desconheciam a necessidade legal de exame complementar para o diagnóstico. Quarenta e sete por cento se consideraram no nível máximo de segurança para explicar o conceito para a família de um paciente. Vinte e nove por cento desconehciam a hora do óbito legal para os pacientes em morte encefálica. Os intensivistas pediátricos tiveram um menor conhecimento do conceito em relação aos intensivistas de adultos. Conclusões: O atual conhecimento sobre morte encefálica é insuficiente entre os profissionais que mais freqüentemente se deparam com pacientes nessa situação. Há necessidade de educação sobre o tema a fim de evitar gastos desnecessários, diminuir o sofrimento familiar e aumentar a oferta de órgãos para transplantes. / Introduction: Failure or delay in diagnosing brain death leads to the needless occupation of a bed, emotional and financial losses, and unavailability of organs for transplants. The intensive care physician plays an essential role in this diagnosis, since almost all the patients are in intensive care units at the time brain death is diagnosed. Objective: To evaluate knowledge on the concept of brain death among physicians working in intensive care units in the municipality of Porto Alegre, Rio Grande do Sul, Brazil. Methods: Cross-sectional study. Two hundred forty-six physicians who work in intensive care units were interviewed in a consecutive sample between April and December 2005. We used two-sided statistical tests with a 0.05% alpha level of significance. Results: We found a prevalence of 17% ignorance regarding the concept of brain death. Twenty per cent of the interviewees ignored the legal need for complementary confirmatory testing in order to perform the diagnosis. Forty-seven per cent considered themselves as having the highest level of confidence to explain the concept to a patient’s family. Twentynine per cent made a mistake in determining the legal time of death for brain dead patients. Pediatric intensivists know less about the concept, compared with the adult intensivists (p<0.001). Conclusion: The current knowledge of brain death is insufficient among the health care professionals who most often encounter patients in this situation. There is need for education on the subject, in order to avoid unnecessary expenses, reduce family suffering and increase the offer of organs for transplants

abstract: The physical environment influences the physiology, psychology, and the societal interactions of those who experience it. The environment can also influence human behavior. Critical care nurses are in constant interaction with the physical environment surrounding their patients. High acuity ICU patients are vulnerable and at risk for harm, infection, and poor outcomes while the physical and cognitive workload of nurses presents a demanding and continuous challenge. The goal of this qualitative study was to explore and understand the way critical care nurses navigate within the patient room and interact with its features. The study of critical care nurses interacting with the patient room environment was conducted in five critical care units at three tertiary care institutions in the Eastern United States, along with another unit in the pilot study at a community hospital in the Southwest United States. Nurses were observed in their typical work environment as they performed normal tasks and patient care activities for entire day and night shifts. The study involved ethnographic field observations, individual semi-structured participant interviews, and examination of photographs and floor plans. The exploratory study resulted in a comprehensive model for nurse navigation that includes both cognitive and action components, along with a conceptual framework for nurse behavioral activity. Repetitive patterns of nurse movement were identified and named. The findings produced recommendations for nurses’ effective use of space and architectural design of ICU patient rooms to improve patient outcomes. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2017

Introdução: A falha ou atraso no diagnóstico de morte encefálica resulta na ocupação desnecessária de um leito, em perdas emocionais e financeiras, e na indisponibilidade de captação de órgãos. O médico intensivista tem fundamental papel nesse diagnóstico, pois quase todos os pacientes encontram-se em unidades de cuidados intensivos no momento do diagnóstico de morte encefálica. Objetivo: Avaliar o conhecimento sobre morte encefálica entre os médicos que atuam em unidades de cuidados intensivos no município de Porto Alegre. Método: Estudo transversal descritivo, com aplicação de um questionário em 246 médicos que trabalham em unidades de cuidados intensivos, em uma amostra consecutiva entre abril e dezembro de 2005. Utilizamos testes estatísticos bilaterais, com um nível de significância alfa de 0,05. Resultados: Encontramos uma prevalência de desconhecimento do conceito de morte encefálica de 17%. Vinte por cento dos entrevistados desconheciam a necessidade legal de exame complementar para o diagnóstico. Quarenta e sete por cento se consideraram no nível máximo de segurança para explicar o conceito para a família de um paciente. Vinte e nove por cento desconehciam a hora do óbito legal para os pacientes em morte encefálica. Os intensivistas pediátricos tiveram um menor conhecimento do conceito em relação aos intensivistas de adultos. Conclusões: O atual conhecimento sobre morte encefálica é insuficiente entre os profissionais que mais freqüentemente se deparam com pacientes nessa situação. Há necessidade de educação sobre o tema a fim de evitar gastos desnecessários, diminuir o sofrimento familiar e aumentar a oferta de órgãos para transplantes. / Introduction: Failure or delay in diagnosing brain death leads to the needless occupation of a bed, emotional and financial losses, and unavailability of organs for transplants. The intensive care physician plays an essential role in this diagnosis, since almost all the patients are in intensive care units at the time brain death is diagnosed. Objective: To evaluate knowledge on the concept of brain death among physicians working in intensive care units in the municipality of Porto Alegre, Rio Grande do Sul, Brazil. Methods: Cross-sectional study. Two hundred forty-six physicians who work in intensive care units were interviewed in a consecutive sample between April and December 2005. We used two-sided statistical tests with a 0.05% alpha level of significance. Results: We found a prevalence of 17% ignorance regarding the concept of brain death. Twenty per cent of the interviewees ignored the legal need for complementary confirmatory testing in order to perform the diagnosis. Forty-seven per cent considered themselves as having the highest level of confidence to explain the concept to a patient’s family. Twentynine per cent made a mistake in determining the legal time of death for brain dead patients. Pediatric intensivists know less about the concept, compared with the adult intensivists (p<0.001). Conclusion: The current knowledge of brain death is insufficient among the health care professionals who most often encounter patients in this situation. There is need for education on the subject, in order to avoid unnecessary expenses, reduce family suffering and increase the offer of organs for transplants

"Objective: The purpose of this Doctoral of Nursing Practice (DNP) project was to conduct a survey to evaluate nurses’ knowledge, perceptions, attitudes, and beliefs regarding sleep promotion in the ICU. Background: Critically ill patients admitted into the Intensive Care Unit (ICU) are introduced into unfamiliar environments with numerous interruptions that interfere with proper sleep. Sleep deprivation among critically ill patients can have detrimental consequences for the patient and organization. Competing nursing priorities, lack of knowledge, opposing perceptions, and lack of resources prevent the implementation of strategies to promote patient sleep. Methods: This project used a descriptive design to conduct the assessment. A web-based survey was distributed to assess nurses’ knowledge, beliefs, attitudes and perceptions regarding sleep promotion in the ICU to help identify areas for improvement and barriers to implement an effective quality improvement plan. Setting: A 30-bed ICU at an academic medical center with 268 licensed beds in Phoenix, AZ with medical-surgical, cardiac, neurological, vascular, and transplant patient populations. Participants: Sample of 57 out of 175 critical care nurses who work in this project’s ICU setting. Findings: ICU nurses demonstrated concern for lack of sleep among critically ill patients, but it is difficult to promote due to competing priorities and tasks. Nurses overall understood the negative effects of sleep disruption among critically ill patients, but discussed the importance of maintaining staff accountability, working collaboratively with the interdisciplinary team, promoting consistency in care, and obtaining support and resources from administration to implement effective interventions. Implementation: Identified barriers and gaps should be utilized to direct quality improvement efforts that help promote uninterrupted sleep among critically ill patients."

Class of 2014 Abstract / Specific Aims: To evaluate the association of weight-based insulin dose with hypoglycemia in critically ill patients receiving continuous intravenous insulin infuions. To determine whether higher weight-based doses of insulin were associated with a higher incidence of hypoglycemia Methods: This was a retrospective, case-control study conducted at a tertiary care, academic medical center. Adult (>18 years) patients admitted to the intensive care unit (ICU) receiving intravenous (IV) regular insulin infusions for the management of hyperglycemia between 1 January 2008 and 30 March 2013 were included. Medical records were retrospectively reviewed. Each patient with hypoglycemia was matched with a non-hypoglycemic control subject, based on age range and sex. Laboratory data, patient demographics, hypoglycemic events, insulin infusion data, SOFA scores, length of hospital and ICU stay, and patient outcomes were collected and evaluated. Main Results: Sixty-one patients experienced a hypoglycemic event and were matched with 61 non-hypoglycemic control subjects for statistical analysis. With the exception of ethnicity (p = 0.041) as a demographic predictor of hypoglycemia; age, sex, weight, height, and BMI were not significant. The starting insulin infusion rate and the total number of insulin units per day administered were not found to be associated with hypoglycemia, p=0.107 and p=0.357, respectively. Conclusion: This study failed to show significance in the total units per day of insulin and the incidence of hypoglycemia. There was no statistical significance in BMI between case and control groups, thus no clear conclusion can be made associating hypoglycemia with weight-based insulin dosing.

Ventilator-associated events (VAEs) are patients' complications of respiratory conditions including ventilator-associated pneumonia (VAP). Research shows that VAP is the most common hospital-acquired infection among ventilated patients and a leading source of mortality. With greater risk for complications among ventilated- supported patients, nurses working in the ICU must keep abreast of new knowledge and update expertise to develop technical and clinical skills in daily practice. The purpose of this project was to assess whether an educational intervention would increase the ICU nurses' level of knowledge of the evidence-based intervention. Knowles' adult learning theory was chosen for this project. A paired-samples t-test was conducted to examine nurses' knowledge of VAE/VAP using a questionnaire measuring knowledge of VAP; 58 ICU nurses participated an educational intervention. Findings showed that nurses had an increase in knowledge following the education (M = 11.43, SD = .775) compared to nurses prior to education (M = 9.55, SD = .976), t(57) = -26.884, p < .001. Results of this project may guide the use of an evidence-based practice educational intervention to improve the quality and safety of ventilated patients. The implications for positive social change include preventing VAEs/VAP among patients, thus decreasing the length of hospital stay, cost, and deaths related to ventilator infections.

Previous research has shown increased saccade latencies in patients with Alzheimer’s disease and mild cognitive impairment; however, this is not well-understood in patients with delirium. The present study investigates eye-tracking metrics to evaluate the feasibility of using eye-tracking to discern delirious patients from disease control patients. We recruited 24 participants from the inpatient and intensive care units (ICU) at Massachusetts General Hospital (MGH) and assessed for delirium via CAM-S, a screening tool for delirium. Participants were instructed to follow a dot stimulus as it moves across the laptop screen as their eye movements were simultaneously tracked by a Tobii Pro Fusion eye-tracker. Our experimental paradigm involved gap saccades (central fixation extinguishes before the centrifugal target appears), overlap saccades (central fixation remains after centrifugal target onset), horizontal smooth pursuit, and circular smooth pursuit tasks. The eye-tracking metrics discussed in this study are the calibration and validation accuracies, saccade latencies and total target gaze duration. Our eye-tracking method was able to capture subjects’ gaze direction and path, but further research is needed to draw strong conclusions about the feasibility to detect oculomotor abnormalities in patients with delirium.