Inledning Intrahospitala transporter av intensivvårdpatient är ett ansvarsfullt arbetsmoment och en stor del av intensivvårdssjuksköterskans och undersköterskans arbete. Det är riskfyllt eftersom tillbud med patient och utrustning kan ske. Syfte: Syftet var att beskriva förekomsten av tillbud och typ av tillbud under intrahospitala transporter av intensivvårdspatienter, samt jämföra om det finns skillnader i förekomst av antalet tillbud under olika tidpunkter på dygnet och skillnad mellan akut respektive planerad transport. Syftet var också att undersöka sjuksköterskors och undersköterskors upplevda grad av stress och trötthet under transporten samt om det finns skillnad i förekomst av trötthet och/eller stress vid transporter där det sker tillbud respektive inte sker tillbud. Metod: Studien är kvantitativ, deskriptiv och jämförande. Förekomst av tillbud samt upplevelse av stress/trötthet besvarades på ett svarsformulär av sjuksköterska och undersköterska under eller direkt efter intrahospital transport. Totalt ingår 42 transporter. Resultat: Tillbud förekom vid 19 transporter. Inga skillnader i förekomst av tillbud mellan dagtransporter och nattransporter eller mellan akuta och planerade transporter kunde ses. Sjuksköterskor och undersköterskor rapporterade mer stress vid de transporter där det förekommit tillbud än vid de där tillbud inte förekommit. Slutsats: Tillbud förekommer i knappt hälften av intrahospitala transporter och sjuksköterskor och undersköterskor rapporterar mer stress i samband med transporter med tillbud än transporter utan tillbud. / Introduction: Intrahospital transport of critical care patient is a responsible working operation and much of the critical care nurse and the assistant nurses´ work. It is risky, because incidents of patient and equipment can happen. Purpose: The objective was to describe the occurrence of incidents and types of incidents during intrahospital transport of ICU patients, and compare if there are differences in the occurrence of incidents during different times of day and the difference between emergency and planed transportation. The aim was to investigate nurses and assistans nurses´ perceived level of stress and fatigue during transport and if there are differences in the incidence of fatigue and/or stress during transport where  incidents occurs or not occurs. Method: The study is quantitative, descriptive and comparative. The presence of the incident and the experience of stress/fatigue were answered on a response form of nurses and assistant nurse during or immediately after intrahospital transport. A total of 42 transports are included. Results: Adverse events occurred at 19 transports. No differences in the occurrence of incidents between day transports and night transport or between acute and planned transports could be seen. Nurses and assistant nurses reported more stress during the transports, where there have been adverse events than in those were adverse events had not occurred. Conclusion: Adverse events occurs in almost half of intrahospital transport and nurses and assistant nurses reported more stress associated with transports with adverse events other than the transports without adverse events.

Vårdas på en intensivvårdsavdelning och vara allvarligt sjuk är för många en obehaglig upplevelse. Övervakning och behandling av vitala funktioner sker dygnet runt i en miljö som är främmande för patienten. Många patienter har på grund av läkemedel och behandling svårt att kommunicera, vilket kan leda till minnesförlust och hallucinationer. Sjuksköterskan kan som en del i omvårdnaden skriva en dagbok över vårdtiden. Syftet med litteraturstudien var att belysa patientens upplevelser av att läsa sin dagbok över vårdtiden på intensivvårdavdelningen och hur det kan påverka patientens återhämtning. Tolv artiklar analyserades och sammanställdes i fem kategorier: Upplevelse av att få och läsa sin dagbok, Betydelsen av att känna sig omhändertagen, Att få insikt i sin egen sårbarhet, Att tolka minnen och fylla minnesluckor och Dagbokens betydelse för återhämtningen. Många patienter mår psykiskt dåligt efter intensivvårdstiden. Resultat visar att dagboken hjälpte dem att hantera tiden efteråt med att fylla minnesluckor och snabbare återhämta sig. Patienterna upplevde sig mer omhändertagna och såg dagboken som en gåva. För att hjälpa patienten på bästa sätt skulle vidare forskning om vad dagboken bör innehålla vara av intresse. / To become seriously ill and cared for in an intensive care unit is for many an unpleasant experience. Monitoring and treatment of vital functions takes place around the clock in an environment that is foreign to the patient. Many patients, due to drug treatment and difficulties in communication, can suffer from memory loss and hallucinations. As an act of caring, the nurse can write a diary throughout the hospital stay. The aim of this study was to focus on the patient's experience of reading a personal diary of their time in the intensive care unit and assess how it can affect the patient's recovery. Twelve articles were analyzed and summarized in five categories: Experience of receiving and reading the diary, The importance of feeling cared for, To gain insight into their own vulnerability, To interpret memories and fill memory gaps and The diary's importance for recovery. Many patients feel unpleasant after a period of intensive care. Results have shown that the diary helped them cope with time afterwards as it filled memory gaps which supported a faster recovery. Patients felt a greater level of care and received the diary as a gift. To optimize this support for the patient, further research on what the diary should contain would be of interest.

Η Μονάδα Εντατικής Θεραπείας – Μ.Ε.Θ. (Intensive Care Unit – ICU) προϋποθέτει ευρύ φάσμα γνώσεων από έναν επαγγελματία υγείας (νοσηλευτή ή ιατρό), που εργάζεται στον χώρο. Σε καθημερινή βάση έρχεται αντιμέτωπος µε απειλητικές καταστάσεις για τη ζωή του ασθενούς και η αντιμετώπιση των διαταραχών της οξεοβασικής ισορροπίας είναι το στοίχημα, που πρέπει να κερδηθεί. Η ορθή ερμηνεία της ανάλυσης των αερίων του αρτηριακού αίματος από έναν επαγγελματία υγείας αποτελεί το βασικό συστατικό για την προαγωγή της υγείας ενός ασθενή στη Μ.Ε.Θ. Όμως παρά την αλματώδη τεχνολογική εξέλιξη του εργαστηριακού τομέα διαπιστώνουμε μια πολύχρονη στασιμότητα στον διαγνωστικό τομέα. Αυτό έχει ως αποτέλεσμα την επιπλέον επιβάρυνση της υγείας του ασθενή, αλλά και επιπρόσθετο φορτίο στο οικονομικό σκέλος. Στη παρούσα διπλωματική εργασία περιγράφεται η δημιουργία ενός ευφυούς συστήματος υποστήριξης αποφάσεων, με σκοπό να αποτελέσει σύμβουλο λήψης αποφάσεων από μη εξειδικευμένους επαγγελματίες υγείας, όταν αυτοί αντιμετωπίζουν προβλήματα οξεοβασικών διαταραχών στις ΜΕΘ, αλλά και να συμβάλλει στην αποτελεσματικότερη και ταχύτερη υποστήριξη του νοσηλευτικού και ιατρικού προσωπικού γενικά. Επίσης στόχος της διπλωματικής αυτής εργασίας είναι να αξιολογηθούν και να συγκριθούν οι μέθοδοι, διά των οποίων δημιουργήθηκε το ευφυές σύστημα. Για να γίνει αυτό δημιουργήσαμε 4 διαφορετικά συστήματα. Στη δημιουργία του πρώτου συστήματος χρησιμοποιήθηκαν κανόνες ασαφούς λογικής(FuzzyClips) και στα επόμενα τρία, μέθοδοι εξόρυξης γνώσης με μηχανική μάθηση. Στο τέλος έγινε η σύγκριση αποτελεσματικότητάς τους, με βάση διεθνώς χρησιμοποιούμενες μετρικές.Τα συστήματα με τη βοήθεια μεθόδων εξόρυξης γνώσης του WEKA παρουσίασαν και τη μεγαλύτερη αποτελεσματικότητα. Τα συστήματα αυτά δεν έχουν σκοπό την αντικατάσταση ενός επαγγελματία υγείας. Έχουν ως κύριο στόχο να λειτουργήσουν επικουρικά, στην καλύτερη, ταχύτερη και πιο αξιόπιστη διάγνωση οξεοβασικών διαταραχών των ασθενών, που νοσηλεύονται σε Μονάδα Εντατικής Θεραπείας ενός νοσοκομείου, αλλά και να χρησιμοποιηθεί ως εργαλείο με εκπαιδευτικό χαρακτήρα σε αρχάριους επαγγελματίες υγείας . / -

Syftet med litteraturstudien var att beskriva hur patienter som vårdats på IVA upplever sin livskvalitet efter att ha kommit hem. Vidare var syftet att bedöma och beskriva kvaliteten på de ingående artiklarna utifrån den metodologiska aspekten urval och bortfall. Litteraturstudien hade en deskriptiv design med kvalitativ ansats. Till litteraturstudien analyserades 14 kvalitativa artiklar som hittades genom sökning i Pubmed, Cinahl och PsycINFO samt manuell sökning. Upplevelsen av livskvalitet relaterades till tre huvudkategorier. Huvudresultatet visade att patienter upplevde sin livskvalitet som försämrad när de kommit hem efter utskrivning från sjukhus, men att den vanligtvis förbättrades succesivt med tiden. Hur livskvaliteten höjdes eller sänktes var beroende av patienternas copingstrategier. Typ av urval beskrevs tydligt i tio artiklar, resterande fyra beskrev inte urvalstyp. Bortfall beskrevs i elva artiklar. Slutsatsen var att relationer och samspel med närstående var betydelsefulla copingstrategier och inverkade på patienternas livskvalitet. Information om realistiska förväntningar ansågs saknas i omvårdnaden. Författarna ansåg att mer information och stöd behövs till patienter och närstående angående realistiska förväntningar efter IVA. Författarna anser vidare att patienterna bör erbjudas personligt uppföljningsstöd. / The aim of this study was to describe how patients admitted to ICU experience their quality of life (QOL) after coming home. A further aim was to assess and describe the quality of the included articles according to the methodological aspect selection and nonresponse bias. The literature study had a descriptive design with a qualitative approach. For the literature study 14 articles were analyzed. The articles were found by searching Pubmed, Cinahl, PsycINFO and by manual search. The experience of quality of life was related to three main categories. The main results showed that patients experienced their QOL as impaired after coming home from the hospital, but usually improved gradually with time. How the QOL was raised or lowered, depended on the patients' coping strategies. Type of selection was described clearly in ten articles, the remaining four described no type of selection. Nonresponse bias was described in eleven articles. The conclusion was that relationships and interactions with relatives were important coping strategies and had an impact on patients QOL. Information about realistic expectations was found missing in nursing. The authors felt that more information and support to patients and relatives is needed about realistic expectations after ICU. The authors consider that patients should be offered a personal follow up support.

The birth of a child diagnosed with congenital diaphragmatic hernia (CDH) involves significant intensive care at the beginning of life and the need for surgery. Parents’ experiences during the acute phase of hospitalization for a critically ill infant not born premature is currently limited in the literature; in particular, there is no literature describing parents’ experiences of nursing care for having a infant with CDH in the Neonatal Intensive Care Unit (NICU). Using narrative inquiry this study explores stories of parents’ early experiences of nursing care in the NICU for an infant born with CDH. A thematic analysis revealed a main overarching theme of “not knowing” with three interrelated subthemes related to parents’ need for information and open communication; participation, power and partnership; and nursing presence to transition from not knowing to knowing their infant. The findings from this study suggest that parents want to be recognized as key members within the multidisciplinary team and that the nurse has the ability to facilitate aspects of care to impact parents positively or negatively. Implications for practice focus on supporting parents through evolving empowerment and participation in the care of their infant. / Graduate / 0569

This thesis presents the development and evaluation of a computerized physician-parent decision support tool for a neonatal intensive care unit (NICU), known as Physician and Parent Decision Support (PPADS). The NICU is a specialized hospital unit that treats very-ill neonates. Many difficult care decisions are made daily for this vulnerable population. The PPADS tool aims to augment current NICU decision-making by helping parents and physicians make more informed decisions, improving physician-parent communication, increasing parent decision-making satisfaction, decreasing conflict, and increasing decision efficiency. The development of the PPADS tool followed a five-step methodology: assessing the clinical environment, establishing the design criteria, developing the system design, implementing the system, and performing usability testing. Usability testing of the PPADS tool was performed on neonatologists and on parents of neonates who have graduated (survived) from a tertiary level NICU. The usability testing demonstrated the usefulness and ease of use of the tool.

Bakgrund: Sjuksköterskor bär ansvaret för omvårdnadsarbetet med patienterna och förväntas agera adekvat i såväl vardagliga som komplexa situationer. För att klara av dessa situationer har de olika verktyg att använda sig av för att exempelvis kontrollera vitalparametrar samt underlätta kommunikationen. Studier visar att sjuksköterskor upplever att det är viktigt med god kommunikation och bra samarbete när patienter ska flyttas över från intensivvårdsavdelningar till vårdavdelningar. Syfte: Syftet var att beskriva sjuksköterskors upplevelser av övertagandet och omvårdnaden av patienter från intensivvårdsavdelningar samt att undersöka om sjuksköterskorna upplever att något skulle kunna förbättras. Metod: Studien genomfördes via en kvalitativ intervjustudie med deskriptiv design. Intervjuerna bestod av semi-strukturerade frågor och insamlad data analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Deltagarnas upplevelser kring övertagandet och omvårdnaden av patienterna skiljde sig och påverkades bland annat av erfarenhet. En känsla av osäkerhet, främst hos de mindre erfarna, förekom ofta inför övertagandet. Deltagarna upplevde inte omvårdnaden av dessa patienter som särskilt problematisk men det kunde ibland uppstå ovana eller komplicerade moment. Detta gjorde att de blev mer skärpta och tittade till patienten oftare. Tydligare riktlinjer för vården, korrekta ordinationer och ytterligare utbildning lyftes fram som förslag på förbättring. Slutsats: Deltagarna i studien hade varierande upplevelser kring övertagandet och omvårdnaden av patienter från olika intensivvårdsavdelningar. Patienterna från intensivvårdsavdelningarna upplevdes ofta som mera komplicerade och omvårdnadskrävande vilket ställde högre krav på deltagarnas kompetens samt att de var mer fokuserade i sitt yrkesutövande. Övertagandet och omvårdnaden gick ofta bra men hade kunnat förbättras ytterligare med avdelningsanpassade ordinationer och riktlinjer. / Background: Nurses are responsible for the nursing care of patients and are expected to act adequately in both everyday and complex situations. To cope with these situations, the nurses have different tools that they can use when checking patients’ vital signs and when communicating with other nurses. Studies show that nurses feel that it is important with good communication and cooperation when patients are being transferred from intensive care to hospital wards. Aim: The aim was to describe nurses' experiences of the takeover and care of patients from an intensive care unit and also to investigate if the nurses felt that something could be improved. Method: The study was conducted as a qualitative interview study with a descriptive design. The interviews consisted of semi-structured questions and the data was analyzed using qualitative content analysis. Results: The participants experienced differences in the takeover and care of the patients and these differences were affected by the participants’ experience. A sense of insecurity, particularly among the less experienced participants, often occurred before the takeover. The participants did not experience that the care of these patients was particularly problematic but unfamiliar or difficult moments sometimes appeared. In these moments the participants were more alert and they also observed these patients more frequently. More explicit guidelines for the care, accurate prescriptions and further training were highlighted as suggestions for improvement. Conclusion: The participants of the study had varying experiences of taking over and caring for the patients from ICU. The former ICU patients were often experienced as more complex. They also demanded more care, which required more knowledge and focus from the nurses in their daily work. The takeover and the care was often good but could have been further improved with more accurate prescriptions and guidelines.

This research study seeks to better understand the experience of South Asian immigrant women in the Neonatal Intensive Care Unit (NICU). The information gathered cannot be generalized to all South Asian and other immigrant populations nor is it the intent of this study. Instead, by examining the individual NICU experiences and challenges faced during this experience, themes emerge that can prompt neonatal nurses to examine their own practice with immigrant families. The main, overall theme identified in all participant responses was, Fear of the Unknown. Three subthemes that emerged from discussions regarding how participants experience nursing care were Trust, Teaching and Advocating. In terms of what participants identified as their most critical concerns while their infant was in the NICU, the three subthemes that arose were Language Barriers, Lack of Knowledge about the NICU and A More Comfortable NICU. On a broader scale, it is hoped that this research study will inspire all nurses to examine their interactions with all immigrant families in order to provide care that is holistic and individualized to the needs of their immigrant patient. / Graduate

No description available.

Kangaroo Mother Care (KMC) is an alternative model of care that prevents parent-infant separation when preterm infants need neonatal intensive care by skin-to-skin contact between infants and their parents. KMC is also a strategy that involves parents in their infants’ care and enables them to assume the responsibility for the care. Furthermore, KMC promotes parent-infant bonding and attachment. The overall aim of this thesis was to gain a deeper understanding and knowledge about parents’ capacity, willingness, and experiences of KMC and to which extent parents choose to use KMC throughout their infants' hospital stay. These studies were conducted in the NICUs at two Swedish university hospitals (NICU A and NICU B). Mothers of infants cared for at NICU A (n=17) answered a questionnaire about their experiences of KMC (Paper I). Twenty parents of infants cared for at NICU A recorded the duration of each KMC session during a period of 24 hours and the identity the KMC provider (Paper II). Seven fathers were interviewed about their experiences of KMC (Paper III) and 76 mothers and 74 fathers completed a questionnaire about what facilitated or rendered it difficult to perform KMC (Paper IV). The time of initiation of KMC and duration in minutes, and the identity of the KMC providers was recorded continuously during the infants’ (n=104) hospital stay: 83 mothers and 80 fathers also completed a questionnaire during their infants’ hospital stay (Paper V). This thesis provides new knowledge about parents’ practice of KMC, also continuously day and night, in a high tech NICU in an affluent society, with good resources for infant care in an incubator by trained staff. The accuracy of parents’ records of KMC were comparable to nurses’ records. The results indicate that parents want to be together with their infant in the NICU and be actively involved in the infants’ care. Although parents may experience KMC as exhausting and uncomfortable, they still prefer KMC to conventional neonatal intensive care as it supports their parental role. Early initiation of KMC after birth appears to result in a longer total duration of KMC during the infants’ hospital stay.