Background: Preventable medical error accounts for approximately 98,000 deaths in the hospital setting each year. A proposed solution to decreasing medical error encompasses the development of a culture of safety. Safety culture has been defined as a common set of values and beliefs that are shared by individuals within an organization that influence their actions and behaviors. In 2015, the safety culture of Registered Nurses (RN) and Patient Care Technicians (PCT) who regularly worked in the Intensive Care Unit (ICU) and Cardiovascular Intensive Care Unit (CVICU) at Flagstaff Medical Center (FMC) was assessed using the Hospital Survey on Patient Safety Culture. This survey functioned as a needs assessment and demonstrated that ICU/CVICU staff had negative reactions to safety culture and error reporting on eight of twelve composites tested. Based off these results, the Incident Decision Tree (IDT) was selected as an intervention to help improve the areas identified in the needs assessment. Purpose: The aims of this quality improvement project included: 1) Development of a protocol for IDT use by ICU/CVICU managers; 2) Implementing the IDT; and 3) Administering a post IDT implementation survey. Methods: The IDT was implemented during a 4-week period in the ICU/CVICU at FMC. During this time, managers used the IDT when processing reported error. Post implementation, an online survey was administered over the course of two weeks to ICU/CVICU managers and unit based RNs and PCTs to reassess their perceptions on the IDT, error reporting, and safety culture. Results: During the implementation period, 23 errors were reported in the ICU/CVICU at FMC with management utilizing the IDT a total of 12 times. Analysis of the reportable data demonstrated that of the 12 incidents, seven were attributed to system failures. The remaining five incidents were processed using the “foresight test.” Conclusions: Results from the post implementation survey demonstrated that ICU/CVICU staff felt the IDT contributed to a non-punitive environment. Staff also reported the IDT helped to increase communication after an error occurred. Lastly, the majority of staff felt the IDT increased transparency in the error reporting process.

Syftet med studien var att beskriva hur närstående till intensivvårdspatienter upplevde en intensivvårdsavdelning (IVA) med fokus på delaktighet och omvårdnad. I studien intervjuades fem närstående. Intervjuerna analyserades med hjälp av en förenklad variant av meningskodning och tre kategorier som beskrev de närståendes upplevelser av IVA utvecklades. Kategorierna benämndes: "Första intrycket av IVA", Att leva med osäkerhet" och "Att vara delaktig". De närstående upplevde ett inre kaos när deras anhörig vårdades på IVA och använde sig av olika copingstrategier. De närstående beskrev intensivvårdssjuksköterskornas omvårdnad och bemötande på ett positivt sätt men vissa upplevde att läkare och kurator var frånvarande. Den största oron handlade om hur patienten skulle återhämta sig och hur framtiden skulle bli. Att få vara delaktig på IVA var ingen självklarhet och några anhöriga hade själva krävt att få vara med. / The aim of this study was to describe the experience of the close relatives of patients in an intensive care unit (ICU) with focus on participation and nursing care. In the study five persons who were close relatives were interviewed. The analysis of the interviews was done with a simplified version of code-of-meaning and three categories that showed experiences of importance of the relatives in the ICU emerged. The categories were called: "The first impression of the ICU", "To live with uncertainty" and "To be involved". The close relatives of the patient experienced inner chaos when the patient was in the ICU and they used different coping strategies. The close relatives of the patients described the nursing care provided by the intensive care nurses and the way they had been treated in a positive way but some lacked contact with physicians or a counselor. Their biggest concern was whether the patient would recover and how their future would turn out to be. It was not obvious for the close relatives to bee involved in the care of the patient, some felt they have had to demand it.

Lidande utgör ett hot mot hela människan som ej kan undflys. Patientens lidande påverkar vårdaren. Det skapar ett eget lidande i sjuksköterskan som inte kan lindra patientens lidande eller till och med orsakar ytterligare lidande. Också anhörigas lidande påverkar intensivvårdssjuksköterskan. Syftet med uppsatsen var att beskriva hur intensivvårdssjuksköterskor upplevde att vårda patienter med svårt lidande. En deskriptiv, semistrukturerad intervjuundersökning genomfördes med tre intensivvårdssjuksköterskor och tolkades medelst innehållsanalys. Resultat: Temat Lidandet genomsyrar sjuksköterskans värld identifierades och handlade om hur sjuksköterskan måste hantera sitt eget lidande likväl som patientens och anhörigas. Temat var uppbyggt av tre kategorier. Lidandets former beskrev det lidande informanterna mötte på intensivvårdsavdelningen. Lidandets samspel beskrev hur positiva och negativa känslor väcktes i samarbetet med lidande patienter, anhöriga och kollegor. Att göra den andres lidande till sitt eget beskrev sjuksköterskans personliga, ofta negativa, känsloupplevelser som aktualiserades vid mötet med stort lidande. / Suffering is an unavoidable threat to the individual as a whole. Suffering of patient and relatives affects the nurse, and creates a personal suffering when incapable of relieving the patients suffering, or inflicting even more. The purpose of this study was to describe how ICU nurses experienced caring for suffering patients. A descriptive, semi-structured interview study was conducted on ICU nurses and interpreted by content analysis. Result: The theme Suffering permeates the nurse’s world was identified and described how the suffering of patient, relatives and self had to be handled by the nurse. The theme consisted of three categories. The manifestation of suffering described how suffering in the ICU is perceived. The interaction of suffering described how cooperating with suffering patients, relatives and colleagues caused negative and positive emotions. Integrating suffering of the other described often negative personal emotions of the nurse evoked when encountering suffering. / <p>2010 felaktigt årtal titelsida</p>

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.

Thesis advisor: Jane M. Flanagan / Purpose: The purpose of this study was to explore nurses’ experiences of Watson’s Theory of Human Caring Caritas Process Three: Cultivation of One’s Own Spiritual Practices and Transpersonal Self, Beyond Ego-Self. Background: There is currently an inadequacy of spiritual care provided to patients and families in the ICU despite a significant articulated need. Nurses report discomfort with and a lack of preparation in providing spiritual care competently. Nurses with strong personal spiritual development are more likely to report comfort with spiritual caregiving and provide spiritual care. Watson’s Theory of Human Caring Caritas Process Three; Cultivation of One’s Own Spiritual Practice and Transpersonal Self, Going Beyond Ego-Self makes explicit the primacy of relationship between nurse spiritual development and transpersonal spiritual nursing care. However, the nature of spiritual development of nurses in the ICU remains unknown. Methods: A qualitative descriptive methodology with directed content analysis applying Watson’s Caritas Process Three was used to analyze data for this study. Results: Ten ICU Nurses provided evidence of the experience of Caritas Process Three. Five themes were identified in the analysis of data: Caritas nurses vary in their ability to move beyond ego-self, Personal spiritual practices serve as a barrier and/or facilitator to nurses’ ability to provide spiritual care, Critical illness as experienced by patients and families provided the opportunity for nurses to explore spirituality with other, The care environment serves as a barrier and/or facilitator to nurses’ personal spiritual growth, and Cultivation of spiritual practice and spiritual identity is integral to a life-long process of consciousness evolution. Conclusions: The findings of this study extend and inform Caritas Process Three of Watson’s Theory of Human Caring. Nurses in this study provide evidence for the primacy of personal spiritual development for the delivery of spiritual and transpersonal care for patients in the ICU. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第22779号 / 工博第4778号 / 新制||工||1747(附属図書館) / 京都大学大学院工学研究科電気工学専攻 / (主査)教授 土居 伸二, 教授 萩原 朋道, 教授 小林 哲生, 教授 古谷 栄光 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

Background: The withdrawal of invasive mechanical ventilation (MV) within the context of withdrawal of life-sustaining measures (WLSM) is common in the intensive care unit (ICU). The method by which invasive MV is withdrawn during WLSM remains an ongoing topic of discussion and research; two methods are terminal weaning (TW) and terminal extubation (TE). Aims: To statistically describe and compare the processes of TW and TE as undertaken in two ICUs. Study Design: A secondary data analysis using data from a longitudinal retrospective chart audit. Results: A total of 78 patient charts were included. MV was withdrawn in 88.5% of patients undergoing WLSM. TW was used in 62.3% of the cases while TE was used in 37.7%. Patients who underwent TW were on average younger, had a longer ICU stay, higher respiratory support requirements, a longer duration of invasive MV, and shorter period from first change in MV parameters to patient death. Conclusion: This study highlights the nuances and complexities within MV withdrawal and WLSM in the ICU.

Please read the abstract in the front section of this document / Dissertation (MSc (Medical Microbiology))--University of Pretoria, 2005. / Medical Microbiology / unrestricted

The purpose of this research was to offer a description of the complexity of nurses’ medication administration practices in relationships with technology. The clinical situations and circumstances in which nurses administer medications today are comprised of rapidly changing technological initiatives that are intended to support safe, efficient care. Nurses’ medication administration practices are not immune to a rapidly changing technological health care environment. Research and literature has documented medication administration occurs in complex situations and nurses apply particular knowledge that supports decision-making and clinical practices for patient safety. Praxiographic methodology was used to describe deeply embedded knowledge and values that shape and guide contemporary nursing practice. Lack of attention to knowledge and values that shape and guide nursing practice and care, may contribute to the risk that those practices may be lost as nurses retire amongst a rapidly changing healthcare environment. A highly technical Neonatal Intensive Care Unit (NICU) was the location for the study. Participants included twelve NICU nurses and a pharmacist. The research findings included the significance of understanding NICU nurses’ use of local and universal maps to navigate the complexity of medication administration. Furthermore, the research documented NICU nurses’ medication administration practices as inseparable from technology. Further practice-based research is recommended to support the development of technologies that incorporate nurses’ medication administration practices. / Graduate

Bakgrund: Av de ca 110 000 – 120 000 barn som föds årligen i Sverige, behöver drygt tio procent vård på neonatalavdelning. Att amma sitt barn har väldokumenterade fördelar och är särskilt anpassat för det individuella barnets behov vilket ger fördelar både på fullgångna och prematurfödda barn. Syfte: Syftet med studien är att belysa faktorer vilka påverkar det amningsfrämjande arbetet på neonatalavdelningar. Metod: Allmän litteraturöversikt som innefattar totalt 16 vetenskapliga artiklar. Samtliga artiklar vilka inkluderats i resultatet har granskats enligt kvalitetsmall. Resultat: Amning och bröstmjölk väcker starka och blandade känslor hos vårdpersonalen. Vårdpersonal som genomgått någon form av utbildning inom området amning var generellt mer positivt inställda till att ge amningsstöd trots påverkan på arbetsbördan. Flaskmatning sågs som ett bekvämt alternativ även om bröstmjölkens fördelar var väl kända. Slutsats: I vilken utsträckning amningsstöd utförs och vilken kvalitet det har beror på stor del på vårdpersonalens egna upplevelser och känslor gällande amning. Då få studier fanns att tillgå är det en indikation på att vidare forskning inom området behövs. / Background: In Sweden, approximately 110,000 – 120,000 babies are born every year. More than ten percent of all newborn babies born in Sweden are in need of care in neonatal care units. Breastfeeding has well-documented benefits and is specifically tailored to the needs of the individual child, providing benefits for both full-term and premature born babies. Aim: The purpose of the study is to shed light on factors that affect breastfeeding work in neonatal wards. Method: General literature review. Including a total of 16 scientific articles. All articles included in the results have been reviewed according to the quality template.  Results: Breastfeeding and breast milk triggered strong and mixed feelings in the health care workers. Healthcare professionals who had undergone some form of training in the field of breastfeeding were generally more positive towards providing breastfeeding support despite the impact on the workload. Bottle feeding was seen as a convenient option although the benefits of breast milk were well known. Conclusion: The extent to which breastfeeding support is performed and the quality of it depends largely on the healthcare staff's own experiences and feelings regarding breastfeeding. Since few studies were available, it is an indication that further research in the field is needed.