As lombalgias têm influenciado no absenteísmo e no presenteísmo de trabalhadores de enfermagem. O objetivo geral deste estudo foi identificar os fatores do trabalho associados à lombalgia não específica, caracterizada no âmbito da resistência da musculatura extensora lombar, em trabalhadoras de enfermagem de Unidades de Terapia Intensiva. Trata2se de um estudo exploratório do tipo transversal com abordagem quantitativa dos dados, realizado em Unidades de Terapia Intensiva. A amostra foi composta por 48 trabalhadoras (enfermeiras, técnicas e auxiliares de enfermagem) atuantes há mais de seis meses na Unidade de Terapia Intensiva de um hospital público (HA) (n=32) e um hospital privado (HB) (n=16) da cidade de Ribeirão Preto2SP. Os instrumentos utilizados para coleta dos dados foram: Questionário de caracterização dos sujeitos (características sociodemográficas e ocupacionais), Questionário Nórdico de Sintomas Osteomusculares - adaptado (caracterização dos sintomas osteomusculares, segundo as regiões do corpo), Fatores do trabalho que podem contribuir para os sintomas osteomusculares 2 adaptado, Teste de Sorensen (identificação da resistência da musculatura extensora lombar) e Escala RPE de Borg (identificação do esforço percebido). Os dados foram coletados em 2011, nos hospitais, pelo pesquisador, após a aprovação do projeto de pesquisa pelo Comitê de Ética em Pesquisa (Processo 122/2011) e permissão dos chefes dos serviços. Resultados: as participantes do estudo eram mulheres, na faixa etária entre 20 e 56 anos, a maioria se declarava branca, solteira (58,3%), com filhos (52,1%), sedentária (64,6%), com acúmulo de trabalho profissional e doméstico (89,6%). As enfermeiras executam tarefas gerenciais e assistenciais, com predomínio das gerenciais, e os técnicos e auxiliares de enfermagem executam o cuidado direto aos pacientes, tarefas que são consideradas desgastantes. O sintoma lombar foi a principal queixa osteomuscular (66,7%), seguido dos segmentos ombros (54,2%), pescoço (47,9%) tornozelos (41,7%) e região dorsal (41,7%). As trabalhadoras com sintoma lombar atingiram um tempo menor (93,06 s.) de resistência da musculatura extensora da coluna no teste de Sorensen, em comparação às trabalhadoras assintomáticas (116,30 s), e o esforço percebido após o teste foi intenso (15) para todos os sujeitos. Os principais fatores do trabalho que contribuem para os sintomas lombares identificados pelas trabalhadoras de enfermagem foram relacionados a aspectos posturais (torção e flexão de coluna, curvar as costas, postura estática) e organizacionais (repetitividade, horas extras, falta de descanso e velocidade do trabalho). Concluímos que os sintomas lombares são frequentes entre as trabalhadoras de enfermagem das unidades estudadas, embora a resistência da musculatura extensora da coluna não tenha apresentado diferenças estatisticamente significativas entre os grupos de sujeitos sintomáticos e assintomáticos. Os resultados obtidos e os fatores identificados pelas trabalhadoras como contribuintes aos sintomas lombares são indicadores da inadequação das condições de trabalho e de que ações de intervenção no ambiente e na organização do trabalho são necessárias. O estudo contribuiu para o avanço do conhecimento das áreas de Saúde do Trabalhador, Fisioterapia e Enfermagem. / Low back pain is a condition that has influenced absenteeism and presenteeism of nursing workers. The overall goal of the present study was to identify the work2related factors associated to nonspecific low back pain characterized by the resistance of lumbar extensor muscles among female nursing workers of Intensive Care Units. This is an exploratory cross2 sectional study under a quantitative approach held in Intensive Care Units. The sample consisted of 48 workers 2 nurses, nursing technicians and assistants2 who had been active for over six months in the Intensive Care Unit of a public hospital (HA) (n=32) and a private hospital (HB) (n=16) in the city of Ribeirão Preto, São Paulo, Brazil. The tools used for data collection were; Subject characterization questionnaire (sociodemographic and occupational), Nordic Musculoskeletal Questionnaire - adapted (characterization of musculoskeletal symptoms according to body regions), Job risk factors that may contribute to musculoskeletal symptoms - adapted, Sorensen test (identification of resistance of lumbar extensor muscles) RPE on Borg scale (perceived exertion rating).The data were collected in 2011 in hospitals, by the researcher, thereafter the Research Ethics Committee had approved the project (petition 122/2011) and Chief Service Officials had granted their permission. Results: The participants in the study were females aged between 20 to 56 years old, self reported as Caucasian, single (58.3%), with children (52.1%), sedentary (64.6%), both professionally and housework overloaded (89.6%). Tasks Performed: Nurses perform both care and, predominately, managerial activities. Nursing technicians and assistants perform direct care of patients. These latter tasks are considered more overwhelming. The major musculoskeletal complaints relied on the Lower back system (66.7%), followed by shoulder segments (54.2%), neck (47.9%) and dorsal region (41.7%).The workers presenting low back symptoms reached a shorter resistance time on the spinal extensor muscles when compared to asymptomatic workers using the Sorensen test (93.06 s. versus 116.30 s). All subjects (15) perceived intense exertion after the test. The main job factors that contribute to low back symptoms identified by the subjects were related to both postural (spine torsion and bending, back bending, static posture) and organizational (repetitiveness, excessive work hours, lack of rest, and work pace) aspects. Conclusion: We conclude that lumbar symptoms are frequent among the female nursing workers of the studied units. In addition, although spinal extensor muscles resistance has not shown significant statistical differences between the symptomatic and asymptomatic groups, the obtained results and factors identified by the workers as contributing to low back symptoms are indicators of inadequate labor conditions. Therefore, interventions on the work organization and environment are needed. Finally, the present study contributes to the progress of knowledge in the areas of Occupational Health, Physiotherapy and Nursing.

The purpose of this research was to determine if significant differences exist between the APACHE II scores of intubated mechanically ventilated patients who ultimately received a tracheostomy and those who did not. In addition to this inquiry, the study also investigated the possibility of a range of APACHE II scores, a particular age group, and the presence of chronic organ insufficiencies and their relationship to the tracheostomy result. Methodology was non-experimental, quantitative, and retrospective. It was observational in that the goal was to simply record and quantify the potential association between these variables. Data was obtained from patients at Bristol Regional Medical Center from January 1- August 31, 2011. Information was calculated using descriptive statistics and the t-test for independent samples. Participants included all intubated mechanically ventilated patients who were at least eighteen years of age with a documented APACHE II score in the allotted time frame. There were 468 total patients, 79 (16.9%) of which received a tracheostomy. The mean APACHE II score for patients who received a tracheostomy was 21.8354 as compared to the mean APACHE II score of 21.6735 for those who were extubated. There was no significant difference between the APACHE II scores of these groups. The tracheostomy group had the highest frequency of patients with APACHE II scores of less than 25 and a range of 20-29. 84.8% of tracheostomy patients had some form of chronic organ dysfunction. Respiratory failure was the most frequent admitting diagnosis for all 468 patients and respiratory insufficiency was the most prevalent co-morbidity for the tracheostomy patients. The age range that included more tracheostomy patients was 65-74. 40% of re-intubated patients eventually received a tracheostomy and 69.6% of tracheostomy patients had the procedure performed early (within the first seven days of intubation). The managerial team of this respiratory therapy department decided to stop calculating the APACHE II score on all intubated patients in an attempt to save time and staff resources.

The purpose of the study was to identify NANDA - I diagnoses, NOC outcomes, and NIC interventions used in nursing care plans for ICU patient care and determine the factors which influenced the change of the NOC outcome scores. This study was a retrospective and descriptive study using clinical data extracted from the electronic patient records of a large acute care hospital in the Midwest. Frequency analysis, one-way ANOVA analysis, and multinomial logistic regression analysis were used to analyze the data. A total of 578 ICU patient records between March 25, 2010 and May 31, 2010 were used for the analysis. Eighty - one NANDA - I diagnoses, 79 NOC outcomes, and 90 NIC interventions were identified in the nursing care plans. Acute Pain - Pain Level - Pain Management was the most frequently used NNN linkage. The examined differences in each ICU provide knowledge about care plan sets that may be useful. When the NIC interventions and NOC outcomes used in the actual ICU nursing care plans were compared with core interventions and outcomes for critical care nursing suggested by experts, the core lists could be expanded. Several factors contributing to the change in the five common NOC outcome scores were identified: the number of NANDA - I diagnoses, ICU length of stay, gender, and ICU type. The results of this study provided valuable information for the knowledge development in ICU patient care. This study also demonstrated the usefulness of NANDA - I, NOC, and NIC used in nursing care plans of the EHR. The study shows that the use of these three terminologies encourages interoperability, and reuse of the data for quality improvement or effectiveness studies.

A pediatric intensivist in the University of Iowa Hospitals and Clinic's (UIHC) Pediatric Intensive Care Unit (PICU) was concerned about antimicrobial use in the unit. However, no one had quantified antimicrobial use in the UIHC's PICU or described the patterns of antimicrobial use in this unit. To address the intensivist's concern, the principal investigator (PI) conducted a retrospective study to determine the percentage of patients who received antimicrobial treatments, to determine the indications for antimicrobial use, and to identify antimicrobial agents used most frequently in the unit. On basis of our data, we hypothesized that empiric antimicrobial use, particularly the duration of therapy, could be decreased. We implemented a six-month intervention during which we asked the pediatric intensivists to complete an antimicrobial assessment form (AA) to document their rationale for starting antimicrobial treatments. We postulated that this documentation process might remind physicians to review antimicrobial therapies, especially empiric therapies, when the microbiologic data became available. In addition, we utilized the AA form to identify factors pediatric intensivists considered when deciding to prescribe empiric antimicrobial treatments. Data from the AA forms suggested that pediatric intensivists in the UIHC's PICU often considered elevated C-reactive protein, elevated white blood cell counts, and elevated temperatures when deciding to start empiric antimicrobial therapy. Data from the three nested periods showed that the median duration of empiric and targeted treatments decreased during the intervention and remained stable during the post-intervention period. The PI estimated that 193 days of empiric antimicrobial therapy and 59 days of targeted antimicrobial therapy, respectively, may have been saved by the decreased durations of therapy. Time series analysis assessing the trend in use of piperacillin-tazobactam, cefepime, and ceftriaxone (measured in mg/wk) did not reveal a significant change over time. On the basis of our results, an intervention strategy using an AA form alone may not be an effective strategy for antimicrobial stewardship in PICUs. Additional measures such as automatic stop orders and computer decision support may be useful for reducing the duration of empiric therapy in PICUs.

<p>Syftet med denna studie var att beskriva i vilka situationer IVA-sjuksköterskor upplever stress och hur de hanterar stressen i det vardagliga arbetet. Studien hade en beskrivande design med kvalitativ ansats. I studien deltog 10 intensivvårdssjuksköterskor. Inklusionskriterierna var att sjuksköterskorna skulle ha en specialistutbildning, och de skulle ha arbetat mer än ett år som intensivvårdsjuksköterska. Data samlades in med en semistrukturerad intervju som varade mellan 7 till 25 minuter. De teman som växte fram under bearbetning av data var ´Låg påverkansmöjlighet, höga arbetskrav och avsaknad av bekräftelse leder till rädsla för att tappa kontrollen´, Obalans mellan krav och bemanning´ samt ´Stödjande faktorer och eget ansvar kan minska stressupplevelsen´. Slutresultatet visade på att IVA-sjuksköterskor upplevde stress i situationer när arbetskraven var för många och ledde till oro för att tappa kontrollen. De höga kraven och otillräcklig bemanning ledde till en obalans där IVA-sjuksköterskorna upplevde otillräcklighet i sitt arbete. Stöd från arbetskollegorna samt individuella sätt att hantera den egna stressen, ansågs vara ett sätt att hantera stress på arbetsplatsen bland intensivvårdssjuksköterskorna. Sammanfattningsvis kan sägas att IVA-sjuksköterskorna upplevde stress på sin arbetsplats av olika orsaker samt att hanteringen av stressen skedde främst via ventilering med arbetskollegor.</p> / <p>The aim of the study was to describe in what situations Intensive Care Unit (ICU) nurses experiences stress and how they cope with the stress in the ordinary work. The study had a descriptive design with a qualitative approach. Ten intensive care nurses took part in the study. The inclusions criteria were that the nurses had an education in intensive care and had worked more than a year as an intensive care nurse. The data were collected with a semi- structured interview that lasted between 7 to 25 minutes. The themes developed from the data were ‘Low influence possibility, high work demands and lack of confirmation leads to fear of loosing the control’, ‘Imbalance between demands and number of staff’, and ‘Supportive factors and own responsibility can reduce the stress experience’ The final result showed that nurses experience stress in situations when the work demands were to high which led to anxiety of loosing control. High demands and insufficient number of staff led to an imbalance and the nurses felt inadequacy in their work. Support from the colleagues and own individual ways to handle the stress, were considered to be ways to cope with it among the nurses. To sum up, the intensive care nurses experienced stress their workplace from various causes and they coped with their stress principally through ventilation with their colleagues.</p>

Syftet med denna studie var att beskriva i vilka situationer IVA-sjuksköterskor upplever stress och hur de hanterar stressen i det vardagliga arbetet. Studien hade en beskrivande design med kvalitativ ansats. I studien deltog 10 intensivvårdssjuksköterskor. Inklusionskriterierna var att sjuksköterskorna skulle ha en specialistutbildning, och de skulle ha arbetat mer än ett år som intensivvårdsjuksköterska. Data samlades in med en semistrukturerad intervju som varade mellan 7 till 25 minuter. De teman som växte fram under bearbetning av data var ´Låg påverkansmöjlighet, höga arbetskrav och avsaknad av bekräftelse leder till rädsla för att tappa kontrollen´, Obalans mellan krav och bemanning´ samt ´Stödjande faktorer och eget ansvar kan minska stressupplevelsen´. Slutresultatet visade på att IVA-sjuksköterskor upplevde stress i situationer när arbetskraven var för många och ledde till oro för att tappa kontrollen. De höga kraven och otillräcklig bemanning ledde till en obalans där IVA-sjuksköterskorna upplevde otillräcklighet i sitt arbete. Stöd från arbetskollegorna samt individuella sätt att hantera den egna stressen, ansågs vara ett sätt att hantera stress på arbetsplatsen bland intensivvårdssjuksköterskorna. Sammanfattningsvis kan sägas att IVA-sjuksköterskorna upplevde stress på sin arbetsplats av olika orsaker samt att hanteringen av stressen skedde främst via ventilering med arbetskollegor. / The aim of the study was to describe in what situations Intensive Care Unit (ICU) nurses experiences stress and how they cope with the stress in the ordinary work. The study had a descriptive design with a qualitative approach. Ten intensive care nurses took part in the study. The inclusions criteria were that the nurses had an education in intensive care and had worked more than a year as an intensive care nurse. The data were collected with a semi- structured interview that lasted between 7 to 25 minutes. The themes developed from the data were ‘Low influence possibility, high work demands and lack of confirmation leads to fear of loosing the control’, ‘Imbalance between demands and number of staff’, and ‘Supportive factors and own responsibility can reduce the stress experience’ The final result showed that nurses experience stress in situations when the work demands were to high which led to anxiety of loosing control. High demands and insufficient number of staff led to an imbalance and the nurses felt inadequacy in their work. Support from the colleagues and own individual ways to handle the stress, were considered to be ways to cope with it among the nurses. To sum up, the intensive care nurses experienced stress their workplace from various causes and they coped with their stress principally through ventilation with their colleagues.

No description available.

The purpose of this study was to develop a theory to explain how nurses experience and respond to uncertainty arising from patient care-related situations and the influence of uncertainty on their information behaviour. Strauss and Corbin’s (1998) grounded theory approach guided the study. Semi-structured face-to-face interviews were conducted with 14 staff nurses working in an adult medical-surgical intensive care unit (MSICU) at one of two participating hospitals. The grounded theory recognizing and responding to uncertainty was developed from constant comparison analysis of transcribed interview data. The theory explicates recognizing, managing, and learning from uncertainty in patient care-related situations. Recognizing uncertainty involved a complex recursive process of assessing, reflecting, questioning and/or predicting, occurring concomitantly with facing uncertain aspects of patient care situations. Together, antecedent conditions and the process of recognizing uncertainty shaped the experience of uncertainty. Two main responses to uncertainty were physiological/affective responses and strategies used to manage uncertainty. Resolved uncertainty, unresolved uncertainty, and learning from uncertainty experiences were three consequences of managing uncertainty. The ten main categories of antecedent, actions and interactions, and consequences that comprised the theory were interrelated and connected through temporal and causal statements of relationship. Nurse, patient, and contextual factors were linked through patterns of conditions and intervening relational statements. Together, these conceptual relationships formed an explanatory theory of how MSICU nurses experienced and responded to uncertainty in their practice. This theory provides understanding of how nurses think through, act and interact in patient situations for which they are uncertain, and provides insight into the nature of the processes involved in recognizing and responding to uncertainty. Study implications for practice, nursing education, and further theory development and research are discussed.

The purpose of this study was to develop a theory to explain how nurses experience and respond to uncertainty arising from patient care-related situations and the influence of uncertainty on their information behaviour. Strauss and Corbin’s (1998) grounded theory approach guided the study. Semi-structured face-to-face interviews were conducted with 14 staff nurses working in an adult medical-surgical intensive care unit (MSICU) at one of two participating hospitals. The grounded theory recognizing and responding to uncertainty was developed from constant comparison analysis of transcribed interview data. The theory explicates recognizing, managing, and learning from uncertainty in patient care-related situations. Recognizing uncertainty involved a complex recursive process of assessing, reflecting, questioning and/or predicting, occurring concomitantly with facing uncertain aspects of patient care situations. Together, antecedent conditions and the process of recognizing uncertainty shaped the experience of uncertainty. Two main responses to uncertainty were physiological/affective responses and strategies used to manage uncertainty. Resolved uncertainty, unresolved uncertainty, and learning from uncertainty experiences were three consequences of managing uncertainty. The ten main categories of antecedent, actions and interactions, and consequences that comprised the theory were interrelated and connected through temporal and causal statements of relationship. Nurse, patient, and contextual factors were linked through patterns of conditions and intervening relational statements. Together, these conceptual relationships formed an explanatory theory of how MSICU nurses experienced and responded to uncertainty in their practice. This theory provides understanding of how nurses think through, act and interact in patient situations for which they are uncertain, and provides insight into the nature of the processes involved in recognizing and responding to uncertainty. Study implications for practice, nursing education, and further theory development and research are discussed.

Bakgrund: Att bli mamma till ett för tidigt fött barn (&lt;37 gestationsveckor) innebär en oväntad stress vilket påverkar hela familjen. Under de senaste årtionden har stora förbättringar skett inom perinatal vård och numera är chansen till överlevnad stor. Att barnet efter födseln vårdas på neonatal intensivvårdsavdelning (NICU) får konsekvenser för mamman både känslomässigt och i omvårdnaden av barnet. Syfte: Att undersöka föräldrastress och beskriva faktorer som påverkar tidig föräldrastress hos mammor till för tidigt födda barn när barnet är två månader i korrigerad ålder. Metod: Studien utfördes på fyra NICU i Sverige. Inklusionskriterierna för studien var att barnet var för tidigt fött samt vårdades på neonatalavdelning i minst 72 timmar. För att mäta upplevd föräldrastress fick mammorna (n=276) svara på enkäten Swedish Parental Stress Questionnaire (SPSQ) när barnet var två månader i korrigerad ålder. Resultat: Mammor vars barn inte vårdades på en samvårdsavdelning, som hade barn i kuvös, mammor till barn med äldre syskon, var äldre, rökte och/eller ammade helt upplevde mer föräldrastress än övriga mammor. Slutsats: Studien visar att faktorer i framför allt i miljön samt hos mamman har betydelse för upplevd föräldrastress. Våra resultat innebär att omhändertagandet bör bli bättre, både under tiden på neonatalavdelning men även efter utskrivning. Då studien också påvisar vikten av samvårdsavdelning bör förbättringar ske i den fysiska vårdmiljön för att minimera upplevelsen av föräldrastress. / Background: When an infant is born preterm (&lt;37 gestational weeks) unexpected stresses affect the whole family. Significant improvements in the perinatal care has been made in the recent decades and now the chance of survival is high. To become a mother in a Neonatal Intensive Care Unit (NICU) entail consequences for the mother emotionally and in her care for her infant. Aim: To investigate parental stress and describe factors associated to early parenting stress in mothers of preterm infants at two months of corrected age. Method: The study was conducted in four NICUs in Sweden. The inclusion criteria were that the infant was born prematurely and had a hospital stay for at least 72 hours. To measure perceived parental stress, the mothers (n=276) answered the Swedish Parental Stress Questionnaire (SPSQ) at two months of corrected age. Results: Mothers whose infants were not cared for in a NICU with co-care, whose infants were cared for in an incubator, who were multiparous, older, who smoked and/or who were breastfeeding exclusively, experienced more stress than their counterparts in various dimensions explored. Conclusion: The study shows that factors relating to the environment and the mother are associated to parental stress among mothers’ of preterm infants. These findings show the need for improved support, both during the NICU stay and after discharge. These findings also highlight the need for improvements in the physical environment of the NICUs to reduce the risk for parental stress.