Tele-intensive care collaboration in care of critically ill patients improves both the safety and quality of nursing care. However, the full benefits of the telemedicine service may not be realized unless tele-critical care nurses have the ability to communicate clearly with their remote nursing peers. The purpose of this DNP project was to create and validate an acronym style communication tool to assist the tele-critical care nurses with their communication. The relational coordination theory was the primary communication theory utilized for tool development. The tool creation phase of the project included informal observations and discussion with a convenience sample of 11 tele-critical care staff nurses. The formative feedback from this group helped to identify the episode of communication for which the tool was designed and suggested communication elements for inclusion. During the validation phase of this project, 9 volunteer experts evaluated the communication tool with a 5-point Likert scale survey. Descriptive statistics were used to analyze the survey results and provided summative feedback for validation of the tool. Mean scores between 3.44 and 4.44 demonstrated that the experts agreed with the applicability, relevance, and necessity of the tool. Feedback indicated the need for a pilot study implementing the tool to compare it with traditional communication practices and to evaluate its performance in clinical practice. This tool will be useful for future partnerships utilizing telemedicine. The project is socially significant because of its focus on communication and collaboration among healthcare providers in facilitating the patient experience and safety.

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Introduction: Nosocomial infections remain a major cause of mortality and morbidity. The problem is most apparent in intensive care units (ICUs). Most ICU patients are compromised and vulnerable as a result of disease or severe trauma. One in ten people admitted to hospital is given an antibiotic for infection. The risk of acquiring a nosocomial infection in a European ICU is approximately 20%. It is vitally important that ways are found to prevent transmission between patients and personnel, and that local hygiene routines and antibiotic policies are developed. This thesis is a holistic work focused particularly on antimicrobial antibiotic resistance, antibiotic consumption and to some extent on hygiene in Swedish ICUs. Aims: The general aim of this thesis was to investigate bacterial resistance and antibiotic consumption in Swedish ICUs and to try to correlate ICU demographic data with antibiotic consumption and antibiotic resistance. Additional aims were to investigate on which clinical indications antibacterial drugs are prescribed in the ICU, and to investigate the emergence of resistance and transmission of Pseudomonas aeruginosa in the ICU using cluster analysis based on antibiograms and genotype data obtained by AFLP. Material and methods: In paper 1-3, antibiotic consumption data together with bacterial antibiotic resistance data and specific ICU-demographic data were collected from an increasing number of ICUs over the years 1997-2001. Data from ICUs covering up to six million out of Sweden’s nine million inhabitants were included. In paper 4, the indications for antibiotic prescribing were studied during two weeks in 2000. Paper 5 investigated Pseudomonas aeruginosa isolates in order to detect cross-transmission with genotype obtained by AFLP, and antibiogram-based cluster analysis was also performed in order to see if this could be a quicker and easier substitute for AFLP. Results: This thesis has produced three important findings. Firstly, antibiotic consumption in participating ICUs was relatively high during the study period, and every patient received on average more than one antimicrobial drug per day (I-IV). Secondly, levels of antimicrobial drug resistance seen in S. aureus, E. coli and Klebsiella spp remained low when data were pooled from all ICUs throughout the study period, despite relatively high antibiotic consumption (I-V). Thirdly, the prevalence of antibiotic resistance in CoNS and E. faecium, cefotaxime resistance in Enterobacter, and ciprofloxacin and imipenem resistance in P. aeruginosa was high enough to cause concern. Conclusion: For the period studied, multidrug resistance in Swedish ICUs was not a major problem. Signs of cross-transmission with non-multiresistant bacteria were observed, indicating a hygiene problem and identifying simple improvements that could be made in patient care guidelines and barrier precautions. A need for better follow up of prescribed antibiotics was evident. With further surveillance studies and monitoring of antibiotics and bacterial resistance patterns in the local setting as well as on a national and international level, some of the strategic goals in the prevention and control of the emergence of antimicrobial-resistant microbes may be achievable.

The purpose of this qualitative study was to supply preliminary insights into improving the support of visiting families with children who are minors during the intensive care unit stay (ICU) of an adult family member. Hospitals often restrict children from visiting in ICUs; however, a review of the literature revealed that despite the prevalence of this policy, there has been little research into whether visiting is harmful or supportive (Liu et al., 2013; Manici & Ghillani, 2018). Although family-centred care (FCC) is considered beneficial for adult family members (Davidson et al., 2012; Eggenberger & Nelms, 2007), there is little evidence that policymakers have considered the involvement of children during an ICU stay (Knutsson & Bergbom, 2007). In this study, seven families shared their experiences of the critical illness of a loved one. Using a constructionist lens, this study explored the interaction between the gathered stories and the policies and practices associated with child and adult family members visiting adult critical care contexts in British Columbia (BC), Canada. This study found that the involvement of children in a family illness event is important and that tailoring involvement to the individual preferences of the child, and their family, is crucial. While navigating an ICU stay, families may benefit from a collaborative approach between the child, their caregiver/s, and a member of the ICU team. The goal of this research is that it will resonate with its readers and move people to deeper curiosity and further study. This exploratory study led to a list of seven preliminary recommendations that could inform the interdisciplinary policies and practices associated with supporting child and adult family members as visitors in an ICU. Further research is needed to explore the experiences of families with children more fully, and to understand the systems that need to be in place to support them during the critical illness of a loved one. / Graduate / 2021-12-16

Kritiskt sjuka spädbarn och deras föräldrar som vårdas inom barnintensivvården löper risk att få en otrygg anknytning till varandra, då det saknas etablerade omvårdnadsåtgärder för att främja anknytningen. Utebliven anknytning kan leda till oönskade långsiktiga fysiska samt kognitiva konsekvenser för föräldrar och spädbarn. Magisteruppsatsens syfte var att med hjälp av publicerade forskningsresultat beskriva ett vårdande som främjar anknytning mellan föräldrar och deras kritiskt sjuka spädbarn under vårdtiden på barnintensivvården. Vald metod är en systematisk integrativ litteraturöversikt. Bestående av 12 artiklar med kvalitativ ansats, tre artiklar med kvantitativ ansats och två med mixad metod. Totalt 17 artiklar. Litteratursökningen gjordes i databaserna Cinahl och PubMed. Efter att en systematisk urvalsprocess och kvalitetsgranskning gjorts ingick totalt 17 artiklar i datamaterialet. Magisteruppsatsen resulterade i tre huvudteman; Intensivvårdens inverkan på anknytningsprocessen, ett vårdande med inverkan på anknytningsprocessen samt en familjecentrerad vård- utgångspunkten för att främja anknytning. Resultatet presenterar vårdande metoder som kan främja anknytningsprocessen. Intensivvårdssjuksköterskan behöver vara lyhörd inför att familjer har olika behov i anknytningsprocessen och arbeta familjecentrerat, personcentrerat samt anpassa miljön för att möta dessa behov. Vårdande metoder som intensivvårdssjuksköterskan kan arbeta med är hud mot hud kontakt, kamerateknik och musikterapi. Hud mot hud kontakt visar sig i resultatet vara en avgörande faktor, men det kräver fysiskt närvarande föräldrar. Vid fysiskt frånvarande föräldrar kan kamerateknik och musikterapi fungera som en brygga i kommunikationen mellan föräldrar och spädbarn. Resultatet i magisteruppsatsen speglar vården i sin komplexa helhet, där varje liten pusselbit är viktig för att kunna nå ett optimalt resultat både kortsiktigt och långsiktigt. / There is a risk of insecure attachment developing between parents and critically ill infants where the infant is cared for in the pediatric intensive care unit as there is a lack of established nursing measures to promote attachment. Failure to bond can lead to unwanted long-term physical and cognitive consequences for parents and babies. The purpose of the master's thesis was to use published research results to describe care that promotes attachment between parents and their critically ill infants during the period of care in the pediatric intensive care unit. The chosen method is a systematic integrative literature review consisting of a total of 17 articles. 12 articles with a qualitative approach, three articles with a quantitative approach and two with a mixed method. The literature search was done in the databases Cinahl and PubMed. After a systematic selection process and quality review, a total of 17 articles were included in the data material. The Master's thesis resulted in three main themes; The impact of intensive care on the attachment process, care with an impact on the attachment process and a family-centered care starting point to promote attachment. The result presents nurturing methods that can promote the attachment process. The intensive care nurse needs to be sensitive to the fact that families have different needs in the attachment process and work family-centred, person-centred and adapt the environment to meet these needs. Caring methods that the intensive care nurse can work with are skin-to-skin contact, camera technology and music therapy. Skin-to-skin is a decisive factor in the results, but it requires physically present parents. In the case of physically absent parents, camera technology and music therapy can act as a bridge in the communication between parents and babies. The result in the master's thesis reflects the complexity of overall care, where every small piece of the puzzle is important to be able to achieve an optimal result both in the short term and in the long term.

Background. Patients, who are receiving life-threatening treatment at the intensive care unit (ICU), often suffer from failure in their vital organs. Supporting treatement of their organs is a important part of the work in the ICU.  An overlooked complication in these patients is cognitive failure due to critical illness, also known as ICU-delirium. Research studies show that patients with ICU-delirium have increased care time and increased mortality. Aims The aim of this study was to describe the intensive care nurse's perception of and how ICU-delirium is assessed. The aim was also to compare how often assessment of ICU-delirium occurs with the frequency of assessment of sedation depth. Results 45 intensive care nurses responded that ICU delirium requires active measures from healthcare professionals. 43 considered that ICU delirium is a common response to the environment in an intensive care unit. Some (n= 40) indicated that their department has a routine regarding sedation, but 21 states that the protocol does not specify how often ICU delirium is to be assessed. The most common method for assessing ICU delirium was to see if the patient can follow instructions (n= 19) and if the patient has an outgoing behavior (n = 10). 42 indicated that ICU delirium is an under-diagnosed problem and 40 that it is a challenge to assess the patient. The study showed a significant difference (p = .0001) between how often intensive care nurses assess sedation depth and how often ICU delirium is assessed. Conclusions. The conclusion is that sedation assessment is performed more often than assessment of ICU-delirium. More education in the subject and more in-depth research is recommended. / Bakgrund. Patienter som vårdas inom intensivvården har ofta drabbats av kritisk sjukdom med svikt i vitala organ som följd. Understödjande behandling av dessa organ är en viktig del i arbetet inom intensivvården. En förbisedd komplikation hos patienten är sviktande kognitiva funktioner på grund av kritisk sjukdom, även benämnt intensivvårdsdelirium (IVA-delirium). Patienter med IVA-delirium har tidigare forskning visat ge längre vårdtider och ökad mortalitet. Syfte  Syftet med studien var att beskriva intensivvårdssjuksköterskans uppfattning om och hur IVA-delirium bedöms. Syftet var också att jämföra hur ofta bedömning av IVAdelirium sker med hur ofta bedömning av sederingsdjup sker. Metod En beskrivande och jämförande studie med kvantitativ ansats. Enkäter (n=112) delades ut till intensivvårdssjuksköterskor där 45 besvarades.  Huvudresultat 45 intensivvårdssjuksköterskor svarade att IVA-delirium kräver aktiva åtgärder från vårdpersonalen. 43 ansåg att IVA-delirium är en vanlig respons på miljön vid en intensivvårdsavdelning. En del (n=40) angav att deras avdelning har en rutin angående sedering men 21 uppger att protokollet inte anger hur ofta IVA-delirium ska bedömas. Den vanligaste metoden för att bedöma IVA-delirium var att se om patienten kan följa instruktioner (n=19) och om patienten har ett utåtagerande beteende (n=10). 42 angav att IVA-delirium är ett underdiagnosticerat problem och 40 angav att det är en utmaning att bedöma hos patienten. Studien visade en signifikant skillnad (p=.0001) mellan hur ofta intensivvårdssjuksköterskor bedömer sederingsdjup och hur ofta IVA-delirium bedöms.  Slutsatser Slutsatsen är att bedömning av sedering utförs oftare än bedömning av IVA-delirium. Mer utbildning inom ämnet och mer djupgående forskning rekommenderas.

Background Critical illness myopathy (CIM) and polyneuropathy (CIP) are a common complication of critical illness. Both cause intensive-care-unit-acquired (ICU-acquired) muscle weakness (ICUAW) which increases morbidity and delays rehabilitation and recovery of activities of daily living such as walking ability. Focused physical rehabilitation of people with ICUAW is, therefore, of great importance at both an individual and a societal level. A recent systematic Cochrane review found no randomised controlled trials (RCT), and thus no supporting evidence, for physical rehabilitation interventions for people with defined CIP and CIM to improve activities of daily living. Therefore, the aim of our study is to compare the effects of an additional physiotherapy programme with systematically augmented levels of mobilisation with additional in-bed cycling (as the parallel group) on walking and other activities of daily living.