Bakgrund: Hypotoni är en vanlig bieffekt vid induktion av generell anestesi.  År 2018 registrerades 318 komplikationer till följd av hypotension under generell anestesi i Sverige. Medelartärtrycket (MAP) kan fås fram av beräkning med hjälp av diastoliska- och systoliska blodtrycket. Flera studier visar tydligt att låga MAP-värden samt durationen av dessa låga värden har tydlig koppling till organskada och mortalitet. Anestesisjuksköterskan har ett ansvar att ligga steget före och förebygga anestesirelaterade komplikationer.   Syfte: Att beskriva anestesisjuksköterskans erfarenheter och strategier av att hantera ett MAP under 55 mmHg hos patienter som genomgår generell anestesi.   Metod: Kvalitativ ansats med deskriptiv design. Individuella intervjuer har genomförts med nio anestesisjuksköterskor intervjuades på en operationsavdelning i mellan Sverige mellan januari till mars år 2022.  Resultat: Anestesisjuksköterskans erfarenheter och strategier presenterades i två kategorier. Tillsammans med underkategorierna ”Det är en vardag”, ”Trygghet att arbeta tillsammans med kolleger”, ”Arbeta utifrån riktlinjer” och ”Att läsa på och förbereda sig”, ”Anpassa anestesin utifrån individen” och ”Strategier för att undvika ett lågt MAP”.   Slutsats: Låga MAP-värden var vanliga under generell anestesi enligt narkossjuksköterskan. Att vara förberedd och läsa på i förväg var viktigt. Vidare var det viktigt att ha kolleger i närheten som hjälpte till vilket gav en känsla av trygghet. Denna studie visade även att det fanns ett behov av riktlinjer för hur agerandet ska ske när ett lågt MAP uppstår. / Background: Hypotension is a common side effect during general anesthesia. During the year 2018, 318 cases were registered as a complication caused by hypotension during general anesthesia in Sweden. Mean artery pressure (MAP) can be computed by using the diastolic and systolic blood pressure. Studies shows that there is a sharp connection between low MAP-values, and the duration of the low MAP-value towards organ failure and mortality. The nurse Anesthetist has a responsibility to be one step ahead in order to avoid anesthesia related complications such as hypotension.  Purpose/aim: To describe the nurse anesthetist experiences and strategies when handling a MAP below 55mmHg among patients during general anesthesia.  Method: A qualitative study with descriptive design. Individual interviews were conducted with nine nurse anesthetists at an operation unit. Data were collected between January and March in year 2022.    Result: The nurse anesthetists experiences and strategies are presented in two categories, together with under categories which are “It is happening on a daily basis”,  “To feel safety and to work together with colleagues”, “To work out of guidelines” and ” To read and be prepared”, ”Adjust the anesthesia based on the individual” and ”Strategies to avoid a low MAP".   Conclusion: Low MAP- Values were common during induction of anesthesia according to the nurse anesthetist. To be prepared and read beforehand were important. Furthermore, it was important to have colleagues nearby to help which gave a feeling of safety. This study showed also that there is a need for guidelines in how to act with a low MAP-occurred.

Bakgrund: När den livsuppehållande behandlingen på intensivvårdsavdelningen inte längre upplevs meningsfull för patienten utreds möjligheten för organdonation. Intensivvårdssjuksköterskan har en aktiv roll i donationsprocessen och tidigare forskning visar att sjuksköterskan upplever det som en generös handling av patienten att donera och intensivvårdssjuksköterskan gör sitt yttersta för att värna om det i vårdandet av både patienten och dennes närstående. Syfte: Syftet var att beskriva intensivvårdssjuksköterskors erfarenheter av att underlätta vårdandet av patienter i donationsprocessen. Metod: En kvalitativ studie utifrån semistrukturerade intervjuer med tio intensivvårdssjuksköterskor, dataanalys genom kvalitativ innehållsanalys. Resultat: Två kategorier framkom, ”Fokus på patienten” samt ”Möta närstående med värdighet”. Fem subkategorier framkom från kategorierna, ”Att värna om patientens vilja”, ”Att samordna vården av patienten”, ”Att bygga relationer”, ”Att anpassa informationen” och ”Att ge stöd i sorgen”. Slutsats: Intensivvårdssjuksköterskors erfarenheter av att underlätta vårdandet av patienten beskrivs som att värna om patientens vilja till donation och att få fokusera på endast donationspatienten tillsammans med teamet. I vårdandet av patienten framkom tydligt närståendes centrala roll och att intensivvårdssjuksköterskorna underlättar för dem genom relationen, information samt stöttning.

No description available.

The objectives were to determine whether or not manual hyperinflation (MHI) is used as a treatment technique by physiotherapists on respiratory compromised patients in intensive care units (ICU), to determine physiotherapists‟ knowledge on the use of MHI (indications, contra-indications, treatment effect) as a treatment technique on respiratory compromised patients in ICU, to compare the physiotherapists‟ knowledge on the use of MHI to their utilisation of MHI in ICU, and to determine whether the effect of clinical experience has an influence on physiotherapists‟ decision making regarding the use of MHI in the ICU setting. The last objective was to investigate whether the working environment has an influence on the utilisation of MHI by physiotherapists practicing in adult ICUs in South Africa.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2016 / Mechanical ventilation is a life-saving and frequently used treatment modality in a variety of medical diagnosis in the intensive care unit (ICU). Despite that fact, mechanical ventilation can be a distressing experience for the patient, and may result in anxiety and discomfort. In recent years, light or no sedation and the practice of wake-up calls have become common approaches allowing the patient to be more awake during mechanical ventilation. Little is known about how patients experience this particular aspect of ICU treatment in light of changes in sedation practices. This study explored and described the experiences of patients on mechanical ventilation in the intensive care unit of one public sector hospital in Johannesburg. A qualitative, descriptive and explorative design was used and ten mechanically ventilated patients were recruited from the intensive care units of one public sector hospital in Johannesburg. The data was collected using audio-taped in-depth interviews to keep a record of the actual information presented by the participants. The collected data was transcribed and the information was analysed using Clarke and Braun’s (2013) descriptive method. A general expression from the participants was the fact that being connected to a ventilator induces a physical and emotional discomfort. The data analysis identified three themes which were (i) physical experiences, (ii) emotional experiences and (iii) communication. The participants described their experiences of breathlessness, mouth dryness, pain and physical discomfort as a result of being placed on the ventilator which caused the physical experiences for the patients. The experiences of bothering, fear of unknown, anxiety, feeling shocked and frightened at the moment of waking up from anaesthesia culminated into an emotional experience for the patients. The participants described that the extubation process has hard and difficult to endure, also powerlessness, loss of body image and control and near death experiences were findings of the participants. The lack of information was viewed by the participants in terms of being connected to mechanical ventilation as an important component of the recovery period, the benefit of purpose of connection during this period and the weaning process although, some of the participants alluded to receiving a measure of information but described it as inadequate to prepare them emotionally for the procedure. The short time for visitation and family presence was also evident in this study as impacting on the emotional state of the participants. In the midst of these unpleasant experiences, most of the participants appreciated the caring attitude of the ICU nursing staff which gave them a sense of comfort and safety. The findings of this study further showed that administration of sedation to some of the participants affected their memory as they could not recollect things that happen while in the ICU. Communication was the third theme that emerged from this study as findings revealed that the participants were not happy with the inability to talk as a result of the endotracheal tube. Nevertheless, the use of alternative communication methods such as the use of sign language, writing, scribbling on paper and lip reading gave the participants a bit of a relief. The findings of this study support the previous findings of the experiences of patients on mechanical ventilation. The findings add to the body of knowledge from the South African context as little is known regarding the patients experiences of mechanical ventilation from the South African context and Africa at large. As the field of intensive care nursing is growing in the African continent, it becomes imperative for research to be conducted in order to determine the clinical, educational and managerial gaps in ICU focusing more on measures to reduce these unpleasant experiences, increase evidence based practise and nursing perspectives. It may be appropriate for this study to be replicated in other private and public institution on a larger scale to compliment these findings. / MT2017

Bakgrund: Förekomsten av delirium på intensivvårdsavdelningar är stor, cirka 80% av patienterna som vårdas på intensiven drabbas vid något tillfälle av delirium. Patienter beskriver en rädsla då delirium medför vanföreställningar och hallucinationer. Oupptäckt delirium orsakar ett lidande hos patienten och kan medföra konsekvenser för patienten såväl som samhället. Syfte: Syftet med studien är att beskriva intensivvårdssjuksköterskors erfarenheter av att vårda patienter med delirium. Metod: En integrativ litteraturstudie av 20 artiklar enligt Whittmore och Knafl. Resultat: I resultatet identifieras två teman. (1) Att uppleva okunskap och osäkerhet vid vårdandet av patienter med delirium och (2) Att arbeta omsorgsfullt. Att få tillräckligt med utbildning och ha tydliga riktlinjer är en viktig faktor för intensivvårdssjuksköterskor i hanteringen av delirium. Ökad kunskap leder till ökat självförtroende vilket i sin tur leder till tidigare upptäckt och snabbare behandling för patienten. Slutsats: Examensarbetet presenterar intensivvårdssjuksköterskors erfarenheter av att identifiera och behandla patienter med delirium. Delirium är underdiagnostiserat vilket betonar viken av att intensivvårdssjuksköterskor besitter adekvat kompetens I ämnet.

No description available.

Sammanfattning  Bakgrund: Arbetet i en operationssal kräver effektivt samarbete mellan olika yrkesgrupper. Anestesisjuksköterskan och anestesiläkaren jobbar nära varandra, men utmaningar uppstår ofta på grund av skillnader i yrkesroller, hierarkiska strukturer och överlappning av ansvarsområden. Anestesisjuksköterskors attityder till samarbete är generellt mer positiva än anestesiläkares. Relationen mellan dessa två yrkesgrupper är också den främsta källan till stress för anestesisjuksköterskor, vilket kan påverka både arbetsmiljön och patientsäkerheten negativt.   Syfte: Att beskriva anestesisjuksköterskors upplevelser av att samarbeta med anestesiläkare på en anestesiavdelning.     Metod: En beskrivande intervjustudie med kvalitativ ansats. Semistrukturerade intervjuer har genomförts med fem anestesisjuksköterskor på en operationsavdelning i Mellansverige. För att analysera intervjuerna användes en kvalitativ innehållsanalys.   Resultat: Anestesisjuksköterskans upplevelse av att samarbeta med anestesiläkaren vid anestesi presenteras i tre kategorier: ”Uppfattningar om samarbete”, ”Förutsättningar för ett fungerande samarbete”, ”Utmaningar för ett fungerande samarbete”, samt nio underkategorier: ”Positiv syn på samarbetet”, ”Vikten av samarbete”, ”Tydlig kommunikation”, ”Planering för anestesi”, ”Inflytande i beslutsprocessen”, ”En god arbetsrelation”, ” Variation i anestesiläkares preoperativa bedömningar”, ”Arbetserfarenhets påverkan” samt ”Stresspåverkan”.   Slutsats: Samarbetet mellan anestesisjuksköterskor och anestesiläkare var övervägande positivt. Vikten av tydlig kommunikation, planering för anestesi, inflytande i beslutsprocessen och en god arbetsrelation betonades. För att förbättra samarbetet föreslås träning i kommunikationsfärdigheter och främjande av delaktighet i beslutsprocessen. Implementering av riktlinjer för konsensusbeslut och mentorstöd till nya ST-läkare kan öka effektiviteten. Dessutom kan tillhandahållande av stresshanteringsstrategier och personligt stöd hjälpa anestesisjuksköterskor och anestesiläkare att hantera stress i svåra situationer. / Abstract Background: Work in an operating room requires effective collaboration among various professional groups. The nurse anesthetist and the anesthesiologist work closely together, but challenges often arise due to differences in professional roles, hierarchical structures, and overlapping responsibilities. Nurse anesthetists generally have more positive attitudes towards collaboration than anesthesiologists. The relationship between these two professional groups is also the primary source of stress for nurse anesthetists, which can negatively affect both the work environment and patient safety.   Purpose: To describe nurse anesthetists’ experiences of collaborating with anesthesiologists in an anesthesia department.   Method: A descriptive interview study with a qualitative approach was conducted. Semi-structured interviews were carried out with five nurse anesthetists in an operating department in central Sweden. A qualitative content analysis was used to transcribe and analyze the interviews.   Result: The nurse anesthetist’s experience of collaborating with the anesthesiologist during anesthesia was presented in three categories: "Perceptions of collaboration", "Prerequisites for functional collaboration", "Challenges for functional collaboration", and nine subcategories: "Positive view of collaboration", "Importance of collaboration", "Clear communication", "Planning for anesthesia", "'Influence in the decision-making process", "A good working relationship", "Variation in anesthesiologists’ preoperative assessments ", "Impact of work experience" and "Impact of stress".   Conclusion: The collaboration between nurse anesthetists and anesthesiologists was mostly positive. Emphasis was placed on communication, planning, shared decision-making, and work relationships. To enhance collaboration, training in communication skills and encouraging participation in decision-making are recommended. Implementing consensus decision guidelines and providing mentorship support to new residents can improve efficiency. Offering stress management strategies and personal support can assist nurse anesthetists and anesthesiologists in coping with stress.

M.Cur. / The purpose of this study was to describe the clinical competencies of the shift leader in the ICU setting in order to determine if there is a gap between what is expected of the shift leader and what is happening in reality. A quantitative, descriptive design was used and cluster sampling implemented. A survey, utilizing questionnaires, was used to gather data from three clusters, comprising 11 hospitals from a single private healthcare group. 251 questionnaires were distributed and 98 were returned, indicating a response rate of 39%. Validity and reliability were ensured. Results indicated that respondents classified the majority of competencies as essential competencies. None were classified as critical competencies and only four were classified as specific competencies. Shift leaders were viewed as competent by all respondents in all three clusters. Results were used to describe a typology of the competencies of the shift leader in the ICU setting.

Thesis (LL.M.). / Written for the Biomedical Ethics Unit, Faculty of Law. Title from title page of PDF (viewed 2008/12/04). Includes bibliographical references.