Background: Every year around 400 000 patients arrives at the emergency wards on the hospitals in Stockholm. Emergency and intensive cares purpose is to take care of acute cases of illness and accidents, and the most prioritized cases ends up within the intensive care units, ICU. Intensive care regards specialized medical staff and modern medicinaltechnology equipment. Nurses task involves promoting the patients’ health, with a unique knowledge about the human with a holistic view, with an attitude well-founded in ethics. Nurses within the intensive care units use life-sustaining treatments and measures from respirators to medicines to save lifes. In spite of this, approximately every fifth patient who is hospitalized in the intensive care unit passes away, and many patients condition can be so critical that communication isn’t an option. Nurses within emergency and intensive care comes across a lot of obstacles in their profession to nurse the patients’ health and might have to perform life-sustaining treatments without approval from the patients. Aim: The aim of this study was to understand the   nurses experiences and how nurses handle descisions regarding life-sustaining   treatments on patients within emegergency and intensive care. Method: The authors made a litterature   review of allready existing data from scientificle articles, to summerize   nurses different experiences regarding descisions of life-sustatining   treatment, and how the nurses handle these situations. Results: Nurses described different   obstacles regarding deciscions of life-sustaining treatment which caused emotional   stress. The authors identified these obstacles as communication, cooperation,   planing, environment and an emotional weight. Nurses could find a purpose and   context in thier role as experts of caring even though there was a decision   about ending life-sustaining treatment on terminal patients. Discussion: The authours discussed the   choise of method for this study and the different obstacles, experiences and   how the nurses handle psychological and emotional stress, from litterature,   scientifical articales and Aaron Antonovsky’s contexttheory and Callista Roy’s theory about adaptation.

Bakgrund: Beröring har betydelse inom vården där patientenställs inför ett akut omhändertagande inom intensivsjukvård. Ett holistisktomhändertagande där vårdpersonalen med respekt och medkänsla berör patient ochnärstående kan skapa en trygghet, minska förekomsten av stress ochlindra lidande. Beröring kan uppfattas negativt om den ges på ettfelaktigt sätt. Syfte: Att beskriva vårdpersonalens upplevelse avden vårdande beröringens betydelse på en intensivvårdsavdelning. Metod: Kvalitativintervjustudie med vårdpersonal från en intensivvårdsavdelning i södra Sverige. Data analyserades med hjälp av en innehållsanalys. Resultat: Vårdandeberöring sker naturligt inom intensivvården och det är viktigtatt hitta rätt förutsättningar för att skapa beröring, då det finns barriärerav olika slag att ta hänsyn till och förebygga. Intensivvårdspersonal uppleveratt vårdande beröring både kan vara positiv och negativ och är därförinkännande genom ett professionellt förhållningssätt i mötet med patient ochnärstående. Beröring kan ge intensivvårdspersonal en bättre kontakt medpatienter och närstående, men ocksåinge trygghet och tröst. Slutsats: Vårdandeberöring ses dels som en nödvändig beröring i samband med vårdinsatser, delssom emotionell beröring med syftet att öka patientens och deras närståendesvälbefinnande. Emotionell beröring ökarvårdpersonalens välbefinnandedå de känner att de kan använda beröring som ett redskap och stöd i vårdandetav sina patienter.

Abstract Technical improvements in computed tomography (CT) scanners have provided new possibilities to exploit the resources of this imaging modality in the evaluation of patients with multiple injuries or patients being treated in an intensive care unit (ICU). The purpose of this study was to assess the significance of multi-detector computed tomography (MDCT) in diagnostics and treatment decisions concerning multiple trauma and critically ill patients. Findings of MDCT using a dedicated trauma protocol in 133 patients exposed to high-energy blunt trauma were retrospectively evaluated. Diagnostic information about the injuries that would enable planning of treatment was sought. The imaging protocol consisted of axial scanning of the head and helical scanning of the facial bones, cervical spine, thorax, abdomen, and pelvis. Ninety-nine of the patients (74%) had at least one finding consistent with trauma. Nineteen false negative findings and two false positive findings were made. The overall sensitivity of MDCT was 94%, specificity 100%, and accuracy 97%. The reliability of a structured 5-min evaluation of MDCT images from the scanner’s console was prospectively evaluated in 40 high-energy trauma patients. The dedicated trauma protocol covering the thorax, abdomen, and pelvis was used in MDCT scanning. The findings were compared with the final radiological diagnosis of the MDCT data made on a picture archiving and communicating system (PACS) workstation, the operative findings, and the clinical follow-up. The evaluation from the scanner’s console enabled diagnosis of all potentially life-threatening injuries, the sensitivity for all injuries being 60% and specificity 98%. The effects of MDCT on the treatment of patients in a 12-bed medical-surgical ICU were observed prospectively. Sixty-four patients with an ICU stay longer than 48 h had had inconclusive findings with other modalities of radiological imaging. They underwent altogether 82 MDCT examinations. Fifty examinations (61%) resulted in a change in treatment, and 20 (24%) of them otherwise contributed to or supported clinical decision-making. Twelve examinations (15%) failed to provide any additional information relevant to the patient’s treatment. MDCT examination was helpful in general ICU patients, with inconclusive findings with other imaging modalities. CT images of 127 mixed medical-surgical ICU patients were retrospectively reviewed for the previously determined findings. Forty-three of these patients underwent open cholecystectomy, revealing eight cases with a normal gallbladder (GB), 26 with an edematous GB, and nine with necrotic acute acalculous cholecystitis (AAC). Abnormal CT findings were present in 96% of all the ICU patients. Higher bile density in the GB body and subserosal edema were associated with an edematous GB. The most specific findings predicting necrotic AAC were gas in the GB wall or lumen, lack of GB wall enhancement, and edema around the GB. The frequent prevalence of nonspecific abnormal imaging findings in the GB of ICU patients limits the diagnostic value of CT scanning.

Introduction: Patients with acute kidney injury (AKI) in developing countries are described in a profile of young age, with less comorbidities, with unifactorial, and with a lower mortality compared to patients in developed countries. Objective: To assess mortality in patients with acute kidney injury undergoing hemodialysis (HD) and its associated factors in a developing country setting. Methods: Retrospective study. Demographic, clinical, and mortality variables were collected from patients who presented AKI and underwent HD between January 2014 and December 2015 at a national reference hospital in Lima, Peru. Risk ratios (RR) and 95% confidence intervals (95%CI) were estimated through Poisson regressions. Results: Data from 72 patients with AKI that underwent HD were analyzed, 66.7% of them were < 64 years old, and 40.2% of all patients died undergoing HD. Crude analysis showed higher mortality among those who used vasopressors, but lower mortality among those with creatinine values > 8.9 mg/ dL. The adjusted analysis showed that having had a creatinine level of > 8.9 mg/ dL, compared to a creatinine level of < 5.2 mg/dL at the time of initiating HD, was associated with 74% less probability of death. Conclusion: Four out of every ten AKI patients undergoing HD die. Higher levels of creatinine were associated with lower probability of mortality.

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.

M.A. (Clinical Psychology) / The purpose of this study was to establish whether a cognitive intervention with patients in an intensive care unit in a general hospital would lead to a decrease in the commonly observed "intensive-care syndrome", which previously led to a deterioration in patients’ condition irrespective of their physiological condition. In order to effect this study an intervention focused at the alleviation of cognitive factors possibly causing the intensive care syndrome was constructed and rendered on audio-tape. An experimental and control group were randomly selected and pre-tests were performed on these groups. After the pre-tests were performed, the cognitive intervention was applied and post-tests on the same measures were performed. The results were subjected to separate analysis of covariance where baseline levels of the dependent variables were used as covariates. No significant results were found, implying that cognitive factors might not be playing the role they were expected to play, and that organic-physiological factors might play a more important role in the causation of the intensive-care sydrome. In addition, it was hypothesised that patients used their own "cognitive intervention" in order to alleviate the severity of symptoms observed in the intensive care unit. Further research is suggested in order to determine the relevant factors inherent in such a condition.

It is essential that neonatal practitioners are able to use their theoretical knowledge in clinical practice in an appropriate manner, in order to render competent quality care to the critically ill neonate. However, theory and practice integration is also very difficult to achieve. Managers of neonatal units and neonatal students had voiced concerns regarding the integration of theory and practice in the neonatal programme offered by an Institution of Higher Education (IHE). Therefore the purpose of this research was to develop standards and criteria to facilitate the integration of theory and practice in the IHE Neonatal Programme A combined qualitative/quantitative exploratory, descriptive, contextual approach was followed, based on Muller's Model for the Development of Nursing Standards (1990:49-55). The design consisted of a development phase and a quantification phase. Standard development began with conceptualisation, that is, the definition of the research concepts and the integration of the study into existing theoretical frameworks. The legislative frameworks used for the study were those of the South African Qualifications Authority and the South African Nursing Council, that govern nursing education and nursing practice. The theoretical frameworks promote theory/practice integration. Standards and criteria were developed from the legislative and theoretical frameworks in order to facilitate the theory/practice integration of the IHE neonatal programme. Ten experts who met specific criteria for inclusion in the study were then asked to validate the standards. The quantification phase consisted of the statistical determination of the content validity of the standards, using a questionnaire. The original ten experts together with another forty participants who complied with specific inclusion criteria, were asked to evaluate the standards, using a four-point rating scale. A standard or criterion with a content validity index of 3.5 to 4. 0 was accepted as valid. The results of the data analysis for the fifty participants showed that all criteria had a mean score of over 3. 5 and thus could be considered valid and useful as a guideline for neonatal programmes. However it was evident from standard deviation scores that the expert group showed greater consensus than the additional participants regarding the validity of the standards. Further research may therefore be required in order to confirm the validity of the standards and criteria.

D.Cur. / The overall objective of this research study was to develop a model of emotional intelligence for the facilitation of wholeness in critical care nurses in South Africa. Critical care nurses often nurse three or more critically ill patients during one shift (Fiakus, 1998). The environment in the critical care unit is highly stressful, highly emotionally charged and emotionally demanding for the nurses that work there. This can lead to the nurse developing burnout (Coates, 2001 ). Burnout in a critical care nurse can have devastating consequences such as decreased well-being of the nurse, decreased quality of care, poor communication and increased costs to the employer related to absenteeism and high staff turnover (Poncet, Toullic, Papazian, Kentish-Barnes, Timsit, Pochard, Chevret, Schlemmer & Azoulay, 2006). In a study by Shipley, Jackson and Segrest (2004), it was found that staff with increased emotional intelligence enjoyed better emotional health and more satisfaction both at home and at work. The question that arose was what is the emotional intelligence of critical care nurses in South Africa. A theory-generative, exploratory, descriptive and contextual research design was used. The research study was carried out using a modification of the method of theory generation as described by Chinn and Kramer (1985). Step one dealt with the empirical phase in which the main concept was distilled from the results of the data analysis. The quantitative research design used for this phase was a typical descriptive survey design. The entire accessible population (N=380) consisted of registered nurses that attended the Critical Care Congress in 2009. They represented a wide range of registered nurses that worked or had worked in critical care in both the private and public health sectors in South Africa. The data collection instrument consisted of a biographical datasheet from which the sample (n=220) was divided into various context groups. Participation was voluntary and all participants signed a consent form. The second part of the data collection instrument consisted of the Trait Emotional Intelligence short form (TEIQue-SF). The data was analysed using SPSS. The sample consisted mainly of a group of mature, female and professionally experienced critical care nurses. They held a variety of job descriptions in critical care nursing. Nurses who are older and have more experience in critical care appear to have a higher range of emotional intelligence. This was also confirmed in a study by Shipley et al. (2004) in which emotional intelligence was associated with work experience. Based on the tests of normality, there was no significant difference in the emotional intelligence of the various context groups that were identified from the single sample (n=220). The exploratory factor analysis identified eight factors as having eigenvalues greater than 1. The statistical evidence pointed to concentrating on factors 1 and 2, and pragmatically these two factors became the focus of the model, as they form the central essence of emotional intelligence of the critical care nurse. The facilitation of inherent affective and mental resourcefulness and resilience was the main concept of the model. Step two comprised the definition and classification of the central and related concepts. This was achieved by finding dictionary meanings and their subject usage. The attributes identified were synthesised to form a definition in chapter five. Step three provided a description of the model. A visual application of the model was shown in chapter six, which highlighted the concepts as proposed by Dickoff, James and Wiedenbach (1968). Three stages of the process of facilitation of emotional intelligence were used to develop the inherent affective and mental resourcefulness and resilience of the critical care nurse. Step four entailed the description of guidelines for operationalising the model in practice to facilitate the emotional intelligence of the critical care nurse in South Africa. Evaluation of the model was undertaken according to Chinn and Kramer (1991 ). To ensure valid results a model of trustworthiness proposed by Guba (1981, in Krefting, 1999) was utilised for the macro argument for the total model. In this study ethical conduct was applied as described by Burns and Grove (2009). The limitations of the research study are highlighted in chapter seven and recommendations of the model for nursing practice, nursing research and nursing education are also made.

M.Cur. (Nursing Science (Critical Care)) / Qualified critical care nurses are under internal and external stresses in the workplace, relating to role conflict, role ambiguity, increased workloads, the need for rapid decision making and the speedy delivery of care. However, having inexperienced students in critical care units put responsibility and additional stress on the qualified critical care nurses within the units. This may result in some of these qualified nurses not being willing to help with the education of the students. The purpose of the study was to explore and describe the experiences of QCCNs regarding students working in CCUs in a Gauteng Academic Hospital and to describe the recommendations to support the QCCNs in the critical care units. The research question asked was: What are the experiences of the QCCNs regarding students working in the CCUs? A qualitative, exploratory, descriptive and contextual design was followed to provide an in depth description and understanding of the experiences of QCCNs regarding students in critical care units. The study followed a hermeneutic approach. The accessible population was QCCNs currently working in the CCUs in a Gauteng Academic Hospital. A purposive sampling method was followed. Focus group interviews were conducted to collect data. The participants were asked these questions: ‘How do you experience the students working in your unit?’ The follow up question was: ‘What can be done to help you?’ Data saturation occurred on the fourth (4) focus group interview. Data collection took place on field trips and was transcribed verbatim from a tape recorder. Ethical considerations were upheld at all times during the study. Data was analyzed using Tesch method. The results comprised of a central theme, namely, qualified critical care nurses experience working with students in critical care units as stressful, increasing workload and a burden. The four (4) themes that emerged were: stress and increased workload, emotions about working with students in critical care units, attitude of qualified critical care nurses towards working with students and recommendations for CCUs to handle stress. From the findings and the main themes that emerged, recommendations to support the QCCNs were described. Trustworthiness of the data collected was upheld at all times during the study.

No description available.