nÃo hà / MudanÃas que aconteceram no sÃculo XX, permitiram que avanÃos tecnolÃgicos aumentassem a sobrevida diante de doenÃas anteriormente incurÃveis e processos patolÃgicos irreversÃveis. No entanto, a busca incessante pela cura, alÃm de levar ao aumento da sobrevida, tambÃm gerou a obstinaÃÃo terapÃutica, ou seja, medidas terapÃuticas fÃteis diante de evoluÃÃo inexorÃvel para a morte, impactando em indicadores como Ãndice de satisfaÃÃo do cliente e cuidadores, tempo mÃdio de permanÃncia, elevaÃÃo de custos, bem como em prejuÃzo na distribuiÃÃo equitativa de recursos. No inÃcio dos anos 90, a limitaÃÃo do suporte de vida (LSV) comeÃou a ser estudada e considerada, em paÃses da Europa, Estados Unidos, Canadà e Austrlia, como forma de assistir os pacientes nesses casos, uma vez que as medidas terapÃuticas nÃo mais trariam benefÃcios, mas gerariam prolongamento do sofrimento e do processo de morrer. No Brasil, contudo, os estudos sÃo limitados e os dados referentes ao Nordeste do paÃs sÃo ainda muito escassos. O objetivo do estudo foi caracterizar as condutas mÃdicas que antecederam o Ãbito de pacientes em UTI pediÃtrica e neonatal em um hospital de referÃncia do Nordeste Brasileiro. Foram estudados 86 prontuÃrios de pacientes que morreram nas referidas UTIs no perÃodo de dezembro/09 a novembro/10. Apenas 3,5% dos Ãbitos ocorreram apÃs LSV registrada em prontuÃrio, destes 33,7% tinham doenÃa crÃnica associada, sendo as neoplasias as mais comuns. As causas de Ãbito mais comuns foram sepse (23,5%), falÃncia de mÃltiplos ÃrgÃos (18,8%), insuficiÃncia respiratÃria (12,9%), cardiopatias congÃnitas (8,2%) e as outras causas somaram 36,6%. A maior parte dos pacientes morreu apÃs aumento das medidas de suporte avanÃado de vida, considerando as ultimas 24h antes do Ãbito: drogas vasoativas (59,3% 24h antes e 70,9% no momento do Ãbito); VentilaÃÃo mecÃnica (89,5% 24h antes e 95,2% no momento do Ãbito). Enquanto as medidas de cuidados e conforto nÃo tiveram a mesma expressÃo, tendo um aumento irrelevante: sedaÃÃo (39,5% 24h antes e 43% no momento do Ãbito); analgesia (60% 24h antes e 60,5% no momento do Ãbito). As manobras de ressuscitaÃÃo cardiopulmonar foram registradas em 4,7% 48h antes do Ãbito, 29,1% 24h antes e 69,4% no momento do Ãbito. O uso de adrenalina foi registrado em 55,4% antes do Ãbito. Conclui-se que a LSV ainda nÃo à frequentemente considerada como uma alternativa de assistÃncia de final de vida a pacientes pediÃtricos e neonatais no Estado do CearÃ, onde as condutas mais prevalentes incluem o incremento do suporte avanÃado de vida em detrimento das medidas de conforto e cuidados paliativos. Comparando-se com estudos do Sul e Sudeste do paÃs, evidencia-se uma grande diferenÃa, onde se observam uma maior prevalÃncia de LSV e cuidados paliativos para pacientes em fase terminal, o que denota prÃticas mais humanas e de maior qualidade na assistÃncia. / Changes around the world at the XX century allowed new technologies to improve the possibilities of surviving in so many cases of sickness that were incurable before. Besides the benefits it brought, other consequences have come together specially futility, in other words futile therapeutic measures when the cure is impossible and the death is inevitable. These facts have influence in client satisfaction, lengh of stay and costs elevation. Since 1990 life support limitation (LSL) started to be considered in Europe, United States, Canada and Austrlia to assist patients in terminal conditions to whom curative practices wouldnât bring any benefit. In Brazil there is a limited number of studies and the data from the Northeastern are even less. The aim of this study was to describe the medical practices before death in patients in PICU and NICU at a reference pediatric hospital in Brazilian Northeastern. Data were collected from 86 medical charts. Only 3.5% of LSL was registered. 33.7% of patients had some chronic disease and neoplasic ones were more comons. The main causes of death were: sepsis (23.5%), MDOS (18.8%), respiratory failure (12.9%), congenital heart disease (8.2%) and the other causes 36.6% together. Most of patients died after increment in vasoatives administration, considering the final 24 hours before death (59.3% 24h before, 70.9% at the momento of death). Mechanical ventilation (89.5% 24h before, 95.2% at the moment). In the other hand palliative care and pain control were not so frequent as could be expected: sedative (39.5 24h before, 43% at the moment) analgesic (60% 24h before, 60.5% at the moment). CPR was offered in 4.7% of patients 48h before death, 29.1% 24h before and 69.4% at the moment of death. Adrenaline was used in 55.4% at the moment of death. These data show that LSL is not a frequente alternative to assist terminal patients at PICU and NICU in Brazilian Northeastern, where more prevalent practices are to maintain life support instead of offer palliative care and pain control. At Southern and Southeastern practice include LSL and palliative care more frequently, what suggests better practices of the end-of-life care.

M.Cur. / It is a well known fact that the environment plays an important rol in the development of the individual. In an intensive care unit, a child is exposed to an enormous amount of stimuli that is confusing and frightening and also has no meaning for the child. The experience of a child in an intensive care unit, upon whom major procedures are performed, is observed. The purpose of this study is to examine and describe the intensive care experience of children between the ages of 3 and 12 so that guidelines for the nursing of these children can be provided. This is a qualitative study and the phenomenological method of research was used. Interviews were conducted with the help of three photographs. These were shown to the respondents and they were asked to tell a story about the child in the photo. Fieldnotes were taken immediately after each interview to describe the situation and the researchers impressions. A taperecording was made of each interview and was transcribed verbatim. The transcriptions were analised and conclusions were reached. Guidelines can thus be drawn up for the nursing of a child in an intensive care unit.

M.Cur. / In the cardiothoracic critical care unit, the respiratory management, post-extubation forms an important component of the total nursing care of the patient. To ensure optimal respiratory management the critical care nurse needs guidelines through which quality and continuity of nursing care can be ensured. Through the effective management of the respiratory system of the patient the critical care nurse contributes to maintaining, promoting and restoring health. In this way the critical care nurse facilitates the patient's strive towards reaching his/her objective of obtaining wholeness and he/she obtains his/her objective of quality nursing. The aim of this study is to formulate guidelines for the respiratory mangement of the cardiothoracic patient, post-extubation. A qualitative-descriptive contextual spesific reseach was followed in which a focus group interview, the opinions of field specialists and the deductive analysis of a literture study were used to formulate guidelines for the respiratory management of the cardiothoracic patient, post-extubation. An analysis was done through which the focus group interview was coded and categories were formulated. These main categories and subcategories were then further explored and described by the literature and by die opinions of the field specialists. The guidelines which were formulated must relieve the uncertainty that exists among different critical care nurses and it must ensure continuity of nursing care. After the guideliness have been established to promote the nursing practice recommendations were made for nursing practice, nursing education and for further research.

M.Cur. / From out the researchers experience of the critical care nursing practice, a need for clinical learning outcomes was identified. There are no listed guidelines or outcomes of what the critical care learner should be able to do at the end of the program, to function as a competent critical care-nursing practitioner. From the above mentioned problemstatement the following question were asked namely: Which knowledge's, skills, attitudes and values do the critical care learner need to function as a compatend critical care nursing practitioner? The main aim of this study was to compile a manual with clinical learning outcomes for the following disciplines within the critical care practice + Cardiology and cardio-thorasic surgery + General surgery and Pulmonary + Neuro-surgery and trauma From out the constructivistic learning approach a contextual, qualitative and describing study was done.The first objective namely the formulation of clinical learning outcomes from out the literature was done by means of a extensive literature survey. The second and third objective of the study namely the formulation of clinical learning outcomes for the different disciplines within the critical care practices. And compiling a manual for the preceptor in the critical care practice was done simultaneously. The clinical learning outcomes was written directly into the format of a manual. Eighty questioners was handed out to critical care trained registered nurses. The data gathered from out the questioners was used in identifying learning outcomes. There are generic clinical learning outcomes, these outcomes are universal for al the disciplines within the critical care practice. Specific clinical learning outcomes where identified for • Coronary and thoracic surgery • Neuro-surgery and • Trauma Specific learning outcomes are outcomes that are only applicable within that specific discipline. If effective clinical guidance are facilitated by means of the clinical learning outcomes and the learner has reached al the outcomes, he/she should be able to function as a competend critical nursing practitioner.

M.Cur. (Intensive Care Nursing) / The problem of intensive care nurses leaving the profession due to non-conducive working environments and uncompetitive conditions of employment is becoming more alarming and is therefore as relevant as ever. The researcher is concerned about the quality of nurse-awareness nurses create in order to practice quality nurse care. Confusion among nurses about their professional rights and responsibilities adds fuel to the fire. The management of health care services is at times not sensitive to the needs of nurses, and nurses are not always recognized for their inherent professional worth. In the adult intensive care unit at which the researcher practices as unit manager she perceived her colleagues to be experiencing some sort of emotional and spiritual discomfort in going about their daily activities. As the researcher felt responsible for the well-being of the staff in the unit she decided to investigate the phenomenon via a formal research study. The objectives of the study were two-fold: Firstly to explore and describe the registered nurse's experience of nursing in the intensive care unit and then to use the information obtained to describe guidelines for the compilation of a support programme for the nurses nursing in the unit The research questions that were generated are: How do registered nurses in the intensive care unit experience nursing there and how can the information be utilized to describe guidelines to support these nurses? The researcher used an exploratory, descriptive, contextual and phenomenological qualitative design to answer these research questions. Phenomenological interviews were conducted with five interviewees who had been possessively selected.

Bakgrund: Intensivvårdssjuksköterskor upplever intensivvårdsavdelningen som en stressfylld arbetsplats. Patienterna är svårt sjuka och akuta situationer kan hastigt uppstå. Miljön är högteknologisk och har stundvis ett högt tempo. Tidigare stressforskning har visat att en ökad stressnivå har en negativ inverkan på hälsan. Stresshantering utgår ifrån problemfokuserade – eller känslofokuserade copingstrategier. Syfte: Att beskriva de faktorer som stressar intensivvårdssjuksköterskor, samt hur de upplever och hanterar denna stress. Metod: En kvalitativ ansats med fokusgruppsintervjuer. Fem intensivvårdssjuksköterskor deltog. Intervjun var ostrukturerad med två öppna frågor. Materialet analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Tre huvudkategorier och tio subkategorier framkom. Huvudkategorierna bestod av; Upplevda stressorer, Känslor och upplevelser av stress och Förmåga att hantera stress. Under intervjun framkom att stress framkallades under vissa arbetssituationer och i viss arbetsmiljö. Detta väckte känslor av frustration och maktlöshet hos intensivvårdssjuksköterskorna. Intensivvårdssjuksköterskorna använde en rad olika copingstrategier såsom till exempel att söka stöd samt planera och organisera sitt arbete, för att hantera stressfulla situationer. Slutsats: Det framkomna resultatet visade att intensivvårdssjuksköterskorna upplevde känslan av att varken räcka till eller kunna påverka sin arbetssituation. Detta ledde i sin tur till frustration och stress hos intensivvårdssjuksköterskorna. Trots detta fanns en hög nivå av trivsel. För att hantera den uppkomna stressen valde intensivvårdssjuksköterskorna att söka stöd hos varandra som den främsta copingstrategin Klinisk betydelse: Framkommen kunskap ur denna uppsats kan vara av betydelse för yrkesverksamma intensivvårdssjuksköterskor och deras arbetsmiljö. Även chefer kan ha användning av denna kunskap för att kunna organisera och ge intensivvårdssjuksköterskor stöd. / Background: Intensive care nurses perceive the Intensive Care Unit (ICU) as a stressful workplace. Patients are critically ill and emergency situations can occur quickly. The environment is high-tech and occasionally a high tempo. Previous stress research has shown that increased levels of stress have a negative impact on health. Stress management is based on problem-focused - or emotion-focused coping strategies. The Aim: To describe the factors that stress critical care nurses, and how they experience and cope with this stress. Method: A qualitative approach with focus group interviews. Five critical care nurses participated. The interview was unstructured with two open questions. The material was analyzed using qualitative content analysis. Results: Three main categories and ten subcategories emerged. The main categories consisted of: Perceived stressors, feelings and experiences of stress and ability to handle stress. During the interview revealed that stress was induced in certain work situations and in particular working environment. This caused feelings of frustration and powerlessness in ICU nurses. Critical care nurses used a variety of coping strategies such as seeking support and plan and organize their work, to cope with stressful situations. Conclusion: It originated results showed that intensive care nurses experienced the feeling of not enough or able to influence their work situation. This in turn led to frustration and stress among critical care nurses. Although this was a high level of comfort. To cope with the present stress chose critical care nurses to seek support from each other as the primary coping strategy Clinical significance: Arrived knowledge from this study may be important for professional’s intensive care nurses and their work environment. Although managers could use this knowledge to organize and provide critical care nurses support.

Critical care nursing is a vital and significant part of health care provision to critically ill patients. It is a specialty area of nursing that requires registered nurses who are highly motivated, knowledgeable and skilled to provide optimal care to critically ill patients. These patients are nursed in a complex environment consisting of specialised equipment (such as ventilators, defibrillators, intravenous pumps, and cardiac monitors) that is not found in any other field of nursing. Collegial support and an adequate registered nurse: patient ratio is vital in critical care units in order to provide optimal quality care to critically ill patients. However, an understaffed work environment, the demands of critical care nursing and other work-related problems, such as conflict with physicians, inadequate remuneration packages and an increased workload can cause serious distress and dissatisfaction amongst registered nurses in this specific environment (Carayon & Gürses, 2005:287). The objectives of this study therefore are to explore and describe the experiences of registered nurses of their work environment in a critical care unit and to make recommendations that will assist registered nurses working in a critical care unit. A qualitative, explorative, descriptive and contextual research design will be utilised. Data will be collected by means of semi-structured interviews and analysed according to the framework provided by Tesch (in Cresswell, 2003:192). Purposive sampling will be used to select a sample of registered nurses working in a critical care environment. Guba’s model (in Krefting, 1991) will be utilised to verify data and to ensure trustworthiness of the study. Ethical considerations will be adhered to throughout the study. Once data has been analysed, recommendations will be made that will assist registered nurses working in a critical care unit.

This descriptive comparative and correlational study was designed to determine the degree of environmental stress perceived by mothers and fathers during the first week of their infant's admission to a Special Care Nursery (SCN) and to determine the differences in their perceptions. In addition, the variables of gestational age, birth weight and paternal attitude toward caregiving were investigated for their relationship to the perceived degree of environmental stress. A convenience sample of 31 sets of parents was selected from a tertiary level SCN in a large urban children's hospital. Both parents completed the Neonatal Intensive Care Unit Parental Stress Scale and an information sheet; fathers also completed the Paternal Attitude Scale. Overall, mothers and fathers perceived the SCN environment as a low source of stress. Mothers were moderately stressed by their altered parental role. In addition, mothers were significantly more stressed by the environmental aspects of SCN and the total SCN experience than were fathers. Environmental stress arising from staff communications and relations was significantly negatively related to birth weight and gestational age. No significant relationship was found between paternal attitude toward care giving and the fathers' perception of environmental stress. / Applied Science, Faculty of / Nursing, School of / Graduate

Bakgrund: Fetma är ett globalt och regionalt växande problem. Patienter med fetma är överrepresenterade på intensivvårdsavdelningar (IVA) och det finns risker och komplikationer associerade till fetma på IVA. Att vårda patienter med fetma på IVA kan vara emotionellt påfrestande. Syfte: Att beskriva intensivvårdssjuksköterskors (IVA-sjuksköterskors) erfarenheter av att vårda patienter med fetma på IVA. Metod: Studien har en kvalitativ metod med induktiv ansats. Datainsamling har skett genom semi-strukturerade intervjuer med åtta intensivvårdssjuksköterskor som jobbar på en IVA i norra Sverige. Data analyserades med hjälp av kvalitativ innehållsanalys enligt Elo och Kyngäs. Resultat: Två huvudkategorier, att värna om patienten och förutsättningar för att ge ett bra vårdande framkom med fem underkategorier. Att prata om fetma, att tillgodose patientens unika behov, att ge lika vård, att behöva vara fler och vikten av utrustningen Slutsats: Att vårda patienter med fetma på IVA kan skilja sig åt jämfört med normalviktiga och förutsättningarna för att vårda patienterna kan inte alltid tillgodoses. Det kan vara utmanande att tillgodose patientens unika omvårdnadsbehov som att hjälpa patienten att andas, att lägesändra och mobilisera patienter på ett säkert sätt och att hålla en god hygien. Vården kan ytterligare begränsas genom ett ökat behov av personal som inte alltid är möjligt, att patienter inte kan genomföra vissa undersökningar och att de finns ett behov av speciellt anpassad utrustning. / Background: Obesity is a regional and global growing problem. There is a higher prevalence of obesity in the intensive care unit (ICU), compared to the general population and obesity is associated with certain risks at the intensive care unit. To care for obese patients in the ICU can be emotionally demanding. Aim: To explore intensive care nurses’ (ICU-nurses’) experiences caring for obese patients. Method: The study is a qualitative design with inductive approach. Data was collected using semi-structured interviews. Eight intensive care nurses working at an ICU in the north of Sweden participated. Data was analyzed using qualitative content analysis according to Elo and Kyngäs. Results: Two main categories derived from the analysis: safeguarding the patient and pre-requisites needed to provide good care. Sub-categories that emerged were talking about obesity, meeting the patient’s unique needs, to give equal care, the need for extra staff and the importance of equipment. Conclusion: The care for obese patients on the ICU can be different compared to normal weight patients and pre-requisites for care cannot always be met. It can be a challenge to meet the patient’s unique needs by helping the patient to breathe, to reposition and mobilize patients in a safe manner and to keep a good hygiene. The care can further be limited by a need for extra staff that cannot always be met, the incapability to perform certain examinations and a need for specialized equipment.

Bakgrund: Barn behöver få information anpassad för sin ålder. Enligt barnkonventionen har barn rätt att säga sin åsikt och att bli hörda. Om barn får besöka en svårt sjuk familjemedlem kan det påverka den sjuke positivt genom att hen känner mer hopp. Även barn kan påverkas genom att de känner mindre hopplöshet och skuldkänslor. Syfte: Att undersöka hur intensivvårdssjuksköterskan bemöter barn som är anhörig på en intensivvårdsavdelning. Metod: En integrativ litteraturstudie, sökningar gjorda i PubMed och CINAHL. Resultat: Utifrån syftet identifierades tre huvudteman: stöd till barn som besöker, anpassa mötet efter barns behov och intensivvårdssjuksköterskans attityder till barn som anhörig. Sex studier ingår i resultatet, studierna är av kvantitativ, kvalitativ och mixad metod. Konklusion: Intensivvårdssjuksköterskan behöver i bemötandet av barn engagera och bekräfta barnet genom att se till barnets individuella behov. Det kan göras genom att i mötet med barn informera, visa och engagera. Intensivvårdssjuksköterskans attityd till att bemöta barn kan påverka barns möjligheter att få komma på besök. Det finns attityder som underlättar för barn att få komma på besök medan andra attityder kan hindra barn som besökare.