Advances in science and technology have made nursing practice in acute care settings complex, rapid and demanding. Hospital visiting hours and rules are established for the comfort and safety of patients and their loved ones. In addition, there is the need to focus on the needs of 'the customer'. The researcher adopted a descriptive, exploratory approach to determine the perceptions and preferences of patients, family members/friends and nurses of visiting time in ICUs. The aim was to recommend mechanisms and measures with regard to the desired visiting schedule that would enhance patient-centred integrated care in ICUs. The study found that patients and family members/friends preferred extended visiting time and perceived this as beneficial to them, while the majority of the nurses preferred scheduled visiting time. / Health Studies / M. A. (Health Studies)

M.Cur. / The nursing service manager is accountable for the managerial outputs of the nursing service, being quality nursing care, cost effectiveness and quality nursing staff management. These managerial responsibilities will influence the overall management efficiency of the health delivery system. There is a need for a more scientific basis of staffing in South African critical care units. Various methods are used to determine staffing needs, but the most accurate and acceptable method being used is the patient classification system. The success of a critical care patient classification system is based upon the accurate determination of the ideal nurse-patient ratio. Ideal nursepatient ratio depends on matching the competency of the critical care nurse to the severity of the critical care patient's illness. Internationally and nationally very few guidelines describe the competency requirements that the critical care nurse should have to function effectively in the critical care unit. To maintain a high standard of quality nursing care, the critical care nurse should be assigned to a critical care patient according to her competency level. The aim of this study was to describe a scientific patient classification system for critical care patients according to which workload and nursing requirements can be ascertained. Secondly, to describe guidelines for the competency requirements of a registered critical care nurse assigned to nurse the different categories of critical care patients categorised by the patient classification system as prescribed. The aim of the study is justified by means of an exploratory, descriptive, contextual research design. A critical care patient classification system has been developed and validated by a group of critical care nursing experts using a structured two phase research method. The statistical validity of each item of the critical care patient classification system was determined by means of a content validity index. All the items of the critical care patient classification system were rated as valid and therefore the critical care patient classification system as a whole has been accepted as valid. The reliability of the critical care patient classification system was tested by means of a pilot study in two selected research units. It was determined that the inter-rater reliability was within the 95 per cent confidence interval, that the system could discriminate between different critical care patients and nurse-patient ratios were effectively determined by the system. Critical care nurse competency requirements were identified by critical care nursing experts by means of a focus group interview. The results obtained from the focus group interview were verified by a literature control and peer group review. Guidelines for the competency requirements of the critical care nurse were compiled. The critical care patient classification system developed will equip the critical care manager with a scientific instrument to assign personnel to critical care units. The critical care patient classification system will furthermore assist the critical care unit manager in the daily utilisation of valuable human resources, in that critical care nurses with the appropriate level of expertise can be assigned to each patient, thus facilitating quality critical care nursing.

This project offers evidence and data to measure how progressive and sustained mobilization strategies that are implemented by nurses impact early discharge on a single stay Cardiothoracic Intensive Care Unit for patients undergoing first-time Coronary Artery Bypass Surgery (CABG) surgery.

Bakgrund: Tidigare forskning belyser att post intensivvårdspatienter har svårt att skilja på illusioner och den reella verkligheten under intensivvårdsbehandlingen. Det framkom även att patienter har upplevt psykisk ohälsa och nedsatt livskvalitet efter intensivvårdsbehandlingen. Patienter har betonat att intensivvårdsdagboken var värdefull för deras återhämtning efter vårdtiden på intensivvårdsavdelningen (IVA) eftersom de har fått hjälp att rekonstruera verkligheten av deras upplevelse. Syfte: Att beskriva intensivvårdssjuksköterskors erfarenheter och anhörigas upplevelser av intensivvårdsdagboken. Metod: En litteraturstudie som omfattas av en kvalitativ deskriptiv design. 18 originalartiklar inkluderades och analysprocessen baserades på nyckelfynd, teman och subteman. Resultat: Analysen genererade tre teman: intensivvårdsdagboken som omvårdnadsåtgärd, holistiskt förhållningssätt och närvarandets betydelse, utifrån dessa skapades åtta subteman. Resultatet påvisade att intensivvårdsdagboken kan leda till att IVA sjuksköterskor kunde arbeta mer holistiskt utefter patienters och även anhörigas unika omvårdnadsbehov. Det framkom dock att IVA sjuksköterskor saknade riktlinjer och rutiner för hur och när de ska använda intensivvårdsdagboken. Anhöriga kunde även använda intensivvårdsdagboken för att bearbeta känslor och tankar över den rådande situationen. Slutsats: Intensivvårdsdagboken är en omvårdnadsåtgärd som har betydelse för både patienter, anhöriga men även för IVA sjuksköterskor. Användning av intensivvårdsdagboken kan leda till en mer evidensbaserad, holistisk omvårdnad för patienter och anhöriga. / Background: Previous research shows that patients had a hard time to separate the real reality from their illusions during the stay at the Intensive Care Unit (ICU) and experienced mental illness and decreased quality of life after. Furthermore patients have emphasized that the ICU diaries have been a valuable tool for their recovery. Purpose: To describe the intensive care nurses’ perceptions and relatives’ experiences of The ICU diary. Method: A literature study that has a qualitative descriptive design. 18 original articles were included and the analysis process was based on key findings, themes and sub-themes. Results: The analysis generated three themes: The ICU diary as a caring action, holistic approach and the meaning of being present. From these themes eight sub-themes were created. The result showed that ICU diaries can help ICU nurses to have a more holistic approach and therefor see to the unique caring needs of both the patient and relatives. ICU nurses emphasized that they wanted guidelines and routines of how to use The ICU diary. Relatives could also use the ICU diary as a tool to process thoughts and emotions. Conclusion: The ICU diary is a caring action that has meaning for both patients, relatives but also for ICU nurses. The use of the ICU diary can result in a more evidenced based and holistic nursing approach.

Bakgrund: Beslut om att avstå och avbryta livsuppehållande behandling har de senaste åren ökat i antal inom intensivvården i Europa. Intensivvårdspatienter har ofta nedsatt autonomi, och läkare och sjuksköterskor måste därför försöka avgöra vad som är rätt för patienten. Detta kan orsaka moralisk stress eftersom att det inte finns några enhetliga riktlinjer för när den livsuppehållande behandlingen övergår till att vara meningslös. Motiv: Beslut kring att avstå eller avbryta livsuppehållande behandling kan vara ett mångfacetterat etiskt beslut som försvåras av intensivvårdspatientens nedsatta autonomi. Den föreliggande studien syftar till att belysa de etiska utmaningar som uppstår när beslutet ska fattas. Syfte: Att belysa läkares och sjuksköterskors resonemang kring att avstå och avbryta livsuppehållande behandling på en intensivvårdsavdelning. Metod: En vinjettstudie genomfördes med individuella semistrukturerade intervjuer med intensivvårdsläkare (n=5) och intensivvårdssjuksköterskor (n=5). Insamlad data analyserades med kvalitativ innehållsanalys. Resultat: Deltagarnas resonemang kring att avstå och avbryta livsuppehållande behandling utmynnade i nio subteman som delades in i tre olika teman; Strävan efter att göra gott, Involvering av närstående och Behov av reflektion i teamet. Konklusion: Teamet ansågs betydelsefullt i beslut kring livsuppehållande behandling. Det fanns ibland olika uppfattningar inom teamet kring vilken behandling som gagnar patienten och vidare forskning behövs kring metoder, exempelvis etiska ronder, för att överbrygga dessa meningsskiljaktigheter. Om de etiska utmaningarna läkare och sjuksköterskor upplever kring beslut att avstå eller avbryta livsuppehållande behandling uppmärksammas och diskuteras, ökar chanserna för att alla involverade känner att rätt beslut fattas för patienten som individ. / Background: There is an increase of decisions to withhold or withdraw life sustaining treatment within intensive care units in Europe. Intensive care patients often have a limited autonomy and physicians and nurses therefore have to decide what is right for the patient. This can cause moral stress due to a lack of unitary guidelines for when life sustaining treatment becomes futile. Motive: Decisions to withhold or withdraw life sustaining treatment can be a multifaceted ethical dilemma that is complicated by the intensive care patients' limited autonomy. This study aims to illustrate the ethical challenges occurring when this decision is to be made. Aim: To illustrate the reasoning of physicians' and nurses' about withholding and withdrawing life sustaining treatment in an intensive care unit. Methods: A vignette study was conducted with individual semi structured interviews with intensive care physicians (n=5) and intensive care nurses (n=5). Collected data was analysed with qualitative content analysis. Result: The participants reasoning to withhold or withdraw life sustaining treatment resulted in nine subthemes that was further divided into three themes; Striving to do good, Involment of relatives and A need to reflect within the team. Conclusion: The team was considered important in decisions regarding life- sustaining treatment. Sometimes there were different views within the team about what treatment would benefit the patient and further research is needed of methods, such as ethical rounds to overcome disagreements regarding decisions to withhold and withdraw life-sustaining treatment within intensive care. If these ethical challenges experienced by physicians and nurses due to these decisions are acknowledged and discussed, chances increase that everyone involved feels that the right decision is made for the patient as an individual.

Bakgrund: Intensivvård är den högsta vårdnivån inom svensk sjukvård och omhändertar kritiskt sjuka patienter. Intensivvård innebär stora påfrestningar på patienten och förutom sin primärdiagnos finns det stor risk att drabbas av sekundära komplikationer relaterat till intensivvården. En av flera negativa konsekvenser på grund av passiviteten är intensivvårdsförvärvad svaghet (ICU-AW). Interventionen tidig mobilisering är en av flera åtgärder för att förebygga intensivvårdsförvärvad svaghet. Syfte: Syftet med studien var att beskriva evidensen för och effekter av tidig mobilisering av respiratorbehandlade vuxna patienter på intensivvårdsavdelning. Metod: Studien utformades som en systematisk litteraturöversikt och metaanalyser. Sökningar gjordes i databaserna PubMed och CINAHL. Sökningarna bestod av sökblocken Intensivvård, Respiratorbehandling och Tidig mobilisering. Metaanalyser utfördes i Review Manager. Resultat: Denna studie innehåller totalt sju RCT-studier med fokus på tidig mobilisering av respiratorbehandlade vuxna patienter, totalt 976 patienter. Tre parametrar analyserades; Dagar i respirator, Dagar på IVA och Dödlighet på IVA. Dagar i respirator och Dödlighet på IVA visade ingen statistisk signifikans. Endast parametern Dagar på IVA hade statistisk signifikans (P=0,01). Slutsats: Denna systematiska översiktsstudie och metaanalys resulterade i evidens för förkortad vårdtid på intensivvårdsavdelning vid tidig mobilisering av respiratorbehandlade vuxna patienter jämfört med standardmobilisering. Kortare vårdtid på intensivvårdsavdelning minskar risken för intensivvårdsförvärvad svaghet. / Background: Intensive care is the highest level of care in Swedish healthcare and takes care of critically ill patients. Intensive care involves great strain on the patients and in addition to their primary diagnosis, there is a great risk of suffering from secondary complications related to intensive care. One of several negative consequences due to inactivity is intensive care acquired weakness (ICU-AW). The early mobilization intervention is one of several interventions to prevent intensive care-acquired muscle weakness. Aim: The aim of this study was to describe the evidence for and effects of early mobilization of mechanically ventilated adult patients in the intensive care unit. Method: The study was designed as a systematic literature review and meta-analysis. Searches were performed in the PubMed and CINAHL databases. The searches consisted of the search blocks Intensive Care, Respirator Treatment and Early Mobilization. Meta-analysis were performed in the Review Manager. Results: This study contains a total of seven RCT studies focusing on early mobilization of ventilator-treated adult patients, a total of 976 patients. Three parameters were analyzed; Days in ventilator (Dagar i respirator), Days in ICU (Dagar på IVA) and Mortality in ICU (and Dödlighet på IVA). Days in ventilator and Mortality in the ICU showed no statistical significance. Only the parameter Days in ICU had statistical significance (P = 0.01). Conclusion: This systematic review study and meta-analysis resulted in evidence of shortened care time in the intensive care unit due to early mobilization of ventilator-treated adult patients compared to standard mobilization. Shorter care time in the intensive care unit reduces the risk of intensive care acquired weakness.

Introduktion: Under Covid-19-pandemin var det besöksförbud på de flesta intensivvårdsavdelningar (IVA) och ett stort flöde av smittade patienter. Närståendes fysiska besök ersattes med videosamtal och andra digitala kommunikationslösningar. Syfte: Syftet med denna studie var att beskriva IVA-sjuksköterskors erfarenheter av digital kommunikation med närstående och patienter under Covid-19 pandemin i samband med besöksförbud. Metod: En induktiv kvalitativ intervjustudie med åtta IVA-sjuksköterskor genomfördes och materialet transkriberades ordagrant. Det transkriberade materialet analyserades med en konventionell innehållsanalys. Resultat: När pandemin uppkom såg IVA-sjuksköterskor att det fanns ett behov av kommunikationsvägar med närstående vid införande av besöksförbud, vilket gjorde att videosamtal ersatte närståendes tidigare fysiska avdelningsbesök. Närståendes virtuella kontakt med patienten och IVA-sjuksköterskor ökade delaktigheten och förståelsen för patientens vård och situation på IVA. IVA-sjuksköterskors erfarenheter påvisade att digital kommunikation fungerade tillfredsställande med närstående och patienter under pandemin. Slutsats: Närståendes delaktighet, förtroende och förståelse till patientens IVA-vistelse förbättrades ju mer de tilläts att deltaga i patientens vård genom digital kommunikation då det var besöksförbud. / Introduction: During the Covid-19-pandemic, most intensive care units (ICU) were prohibited from visiting and there was a large flow of infected patients. Relatives’ physical visits were replaced by digital communication solutions, for example video calls. Aim: This study aimed to describe ICU nurses' digital communication experiences with relatives and patients during the Covid-19 pandemic during prohibited from visiting. Method: An inductive qualitative interview study of eight ICU-Nurses' was conducted, and the material was transcribed verbatim. The content analysis performed on the transcribed material had a conventional approach. Results: When the pandemic arose the ICU-Nurses' saw that there was a need for communication channels with relatives' when the prohibitions from visiting was introduced, which meant that video calls replaced relatives' previous physical ward visits. Relatives' virtual contact with the patient and ICU-nurses increased their participation and understanding of the patient's care and situation in the ICU. The experiences from ICU-Nurses' showed that digital communication worked satisfactorily with relatives and patients during the pandemic. Conclusion: Relatives' participation, trust and understanding of the patient's ICU stay improved the more they were allowed to participate in the patient's care through digital communication when there is a restraining order.

ABSTRACT  Background: ICU diaries are initiated by critical care nurses to document events that take place during patients’ ICU stays with the aim to help patients recall memories of what happened. The relationship dimension in the Fundamentals of Care (FoC) framework begins with the ability of nurses to connect with patients, and through this connection, nurses try to meet and help the patient to meet his/her fundamental needs. The role of ICU diaries in establishing a nurse-patient relationship is unknown. Aim: The aim of the study was to examine the use of the ICU diary as a tool to strengthen nurse-patient relationships.  Method: A literature review with inductive content analysis of 20 primary articles. The results were interpreted and discussed using the establishing relationship dimension of the FoC framework. Findings: The statements of patients and nurses about the use of diaries reflect a strong nurse-patient relationship dimension. When combined with ICU follow-up sessions, the relationship is further strengthened, as there is more understanding and knowledge of the bond retrospectively. Conclusion: All elements of the FoC establishing relationship dimension, namely focus, knowing, trusting, anticipating and evaluating are visible in the diaries, and several statements by nurses suggest that using the diaries may have a positive effect on the nurse-patient relationship. However, to what extent the nurse-patient relationship is strengthened by the use of the diaries is less clear and remains an open question. To answer this question, controlled comparative studies would be required. / SAMMANFATTNING Bakgrund: IVA-dagböcker initieras av intensivvårdssjuksköterskor för att dokumentera vad som händer under en patients IVA-vistelse, med syftet att hjälpa patienter att senare komma ihåg vad de varit med om. Dimensionen etablera vårdrelation i ramverket Fundamentals of Care (FoC) börjar med sjuksköterskors förmåga att anknyta till patienter, och genom denna anknytning försöker sjuksköterskorna att möta och hjälpa patienten för att tillfredsställa dennes fundamentala behov. Det är inte känt vilken roll IVA-dagbok spelar i att etablera en vårdrelation mellan sjuksköterska och patient. Syfte: Studiens syfte var att undersöka användning av IVA-dagbok som ett verktyg för att stärka vårdrelation mellan sjuksköterska och patient. Metod: Litteraturöversikt med induktiv innehållsanalys av 20 originalartiklar. Resultaten tolkades och diskuterades inom ramen för FoC-dimensionen etablera vårdrelation. Resultat: Det patienter och sjuksköterskor säger om användning av IVA-dagbok ger uttryck för en stark vårdrelation. När dagboken efter att patienten skrivits ut används vid uppföljning på IVA stärks denna relation ytterligare, eftersom uppföljningen leder till att patienten får en fördjupad förståelse och kunskap om den vårdrelation som etablerats under vistelsen på IVA. Slutsats: Alla element i FoC-dimensionen etablera vårdrelation (vara närvarande, vara påläst, skapa förtroende, förutse behov, reflektera och utvärdera) är synliga i det patienter och sjuksköterskor säger om dagbok. Utsagor från flera sjuksköterskor tyder på att användning av IVA-dagbok kan ha en positiv effekt på vårdrelationen, men i vilken utsträckning dagboken stärker relationen är mindre klart och fortsätter att vara en öppen fråga. För att besvara denna fråga skulle kontrollerade jämförande studier behövas.

Bakgrund Delirium är ett tillstånd som drabbar många patienter inom intensivvården.Patienters upplevelse och beskrivning av tillståndet kan ge ökad förståelse hur man ska bemöta patienter med delirium. Syftet Syftet med denna studie är att beskriva patienternas upplevelse av delirium under intensivvård. Metod En litteraturstudie med hjälp av en systematisk ansats. Artiklar söktes i databaser PubMed och Cinahl, där begränsades sökande till år 2011-2021, artiklar skrivna på engelska, tillgång till abstrakt och fulltext. Artiklarna söktes under perioden januari 2021 till april 2021. Kvaliteten på artiklarna granskades med hjälp av Evans. Resultat Sex artiklar som inkluderas i studien analyserades. Artiklarna beskriver hur patienten upplever deliriet under intensivvården, både positiva och negativa upplevelser. Sällsynt att deliriet som en skräckupplevelse, utan mer som en verklighet utan förankringpunkt och att patienten befinner sig i en situation med lösryckta händelser. Slutsats Delirium är en unik personlig upplevelse. Alla intensivvårdspatienter kan drabbas av delirium. Medvetenheten av delirium hos intensivvårdspatienter ger tryggare patientvård och ökad patientsäkerhet. Ökad svårighetsgraden av delirium ger ökad riskt för mortaliteten under intensivvårdstiden. Studien ger en inblick om hur patienter upplever och uppfattar delirium. Uppfattningen om hur patienterna upplever delirium, kan hos sjuksköterskor och annan vårdpersonal ge en ökad förståelse för deliriumsyndromet.

Background Nutritional treatment in the intensive care unit (ICU) has evolved from meeting nutritional requirements to manipulating patient outcome. Pharmaconutrition, referring to nutrients that are applied for their pharmacological properties, forms part of the standard nutritional care plan. The most abundant amino acid in the body, glutamine, is also the most-researched pharmaconutrient. It is an independent predictor of mortality in ICU patients, at both deficient and very high levels. Glutamine supplementation is recommended in the ICU setting for its proven outcome benefits. However, recent data showed that glutamine supplementation increases mortality risk in certain patient groups. Moreover, it suggested that not all ICU patients are glutamine deficient. Therefore, the main aim of this study was to investigate the plasma glutamine levels of adult ICU patients, on admission to the ICU. In addition, to elucidate the profile of ICU patients that can be expected to present with a glutamine deficiency or excess, with regards to gender, diagnosis and inflammatory markers. Methods In this observational, cross-sectional study, 60 mixed ICU adult patients admitted to two hospitals in the North West province were included in the study group. Blood sampling was conducted within 24 hours following ICU admission, to determine plasma glutamine, interleukin (IL)-6 and C-reactive protein (CRP) levels. Plasma glutamine levels were compared with those of a control group of healthy individuals, matched by age, race, and gender. Gender-related differences in plasma glutamine levels were investigated, as well as differences between patients with various medical conditions. The relationship between plasma glutamine levels and IL-6 or CRP was examined. Additionally, a CRP concentration cut-off point at which glutamine becomes deficient was determined by means of a receiver operating characteristic (ROC) curve. Results and discussion Intensive care unit patients had significantly lower plasma glutamine levels than healthy individuals on day one of ICU admission (p < 0.0001). However, only 38.3% (n = 23) had deficient plasma glutamine levels (< 420 μmol/L), while 6.7% (n = 4) presented with supra-normal levels (> 930 μmol/L). No significant difference could be detected between the plasma glutamine levels of male and female ICU patients (p = 0.116). Likewise, levels between diagnosis categories were also not significantly different (p = 0.325). There was a significant inverse association between plasma glutamine levels and CRP concentrations (r = -0.44, p < 0.05), and a trend towards an inverse association with IL-6 (r = - 0.23, p = 0.08). A CRP cut-off value of 95.5 mg/L was determined, above which plasma glutamine values became deficient; however, more research is needed to confirm this result. Conclusion and recommendations This research therefore showed that ICU patients, when compared with healthy individuals, had lower plasma glutamine levels on day one of admission to the ICU. However, not all were glutamine deficient, as the majority had normal and some presented with supra-normal plasma glutamine levels. An individualised approach should therefore be followed in identifying candidates for glutamine supplementation. The patients‟ condition alone may not be sufficient to predict glutamine status, but an association between plasma glutamine levels and CRP was firmly established, as well as a cut- off CRP-value above which glutamine can be expected to become deficient, which could be of use in this regard. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2015