This ethnographic study investigated nurses’ experiences of managing nurses and being managed by nurses within the context of a critical care unit. The four specific aims of the study were to: valorise and make space from which nurses could speak of their management perceptions and experiences; investigate and interrogate the cultural practices and knowledges that comprised and reinscribed the discourses of nursing management; identify the marginal, contradictory or subjugated discourses in the form of alternate or oppositional knowledges and practices embedded in nurses’ experience; and reveal how participants were inscribed by or resisted the various discourses, including the multiple and mobile subject positions they adopted. The ethnography was theoretically informed by critical, feminist, and postmodern perspectives. Utilising the strategy of writing from the authorial position of occupying a mobile or nonunitary subjectivity, the research highlighted the methodological tensions so as to struggle for social justice whilst contesting the romance of knowledge as cure (Lather, 2000). Music was metaphorically appropriated to interrupt, subvert, and draw attention to the partial, interpretive, and intertextual nature of ethnographic representation and to represent the feminine other in a thesis normatively privileging written text. Conducted over a period of ten months, direct participant observation, individual interviews, and reflective field notes comprised the data. Eleven registered nurses, from all levels of the nursing hierarchy, participated in the study, in addition to the researcher. The findings of this research revealed nurses experienced feeling abnormal, lonely, angry, and rejected. Interprofessional relations reflected a lack of individual valuing and predominantly vertical violence. Shifting subject positions were primarily informed by dominant instrumental, patriarchal, managerialist, and modernistic discourses that homogenised the identity of nurses and defined the meaning of progress and normal. Management activities were deemed superior to the activities and being of a clinical nurse. Alternate and subjugated discourses included notions of teamwork, equality, mateship, and viewing management as superfluous and contemptuously. Patriarchal behaviours separating personal life from work life were contested, and behaviours often denigrated and stereotyped as female were valued. Valuing and sharing being human within ordinary nursing work, valuing work for the enjoyment of the work itself, and viewing power as with rather than over were further alternate discourses. The major implications from this study for nursing as a profession relate to nurses explicitly and foremost valuing their own practice and fostering a culture that genuinely permits individual diversity to alter the existing pre-scripted relations that constrain nurses’ ability to engage in more meaningful interpersonal relations. Questioning current discourses and practices that value specific economic and scientific knowledges, support patriarchal behaviours, and silence nurses is essential. The articulation of alternative discourses that value women and nursing is crucial for reconstructing a reality that does not result in women and nurses feeling abnormal, rejected, and alienated; particularly within the context of a nursing shortage.

Parents’ presence and participation in their child’s care in the paediatric intensive care unit (PICU) is now commonplace. Despite parents expressing a deep need to be with their child particularly during periods of crisis, it is precisely at these times that they are often prevented from staying. The growing debate regarding family presence during a cardiopulmonary (CPR) resuscitation attempt continues to be controversial and conflicting. Current knowledge is mostly derived from quantitative studies conducted in the adult intensive care or emergency environments. The experiences of parents of children in the PICU, and the nurses caring for them are unknown. Using van Manen’s hermeneutic phenomenological approach, this study describes the phenomenon of parental presence during resuscitation of a child in PICU for eight Australian parent couples and six nurses. Experiential descriptions, obtained in tape-recorded unstructured interviews were subjected to two layers of analysis. Thematic analysis provided the phenomenological description in seven themes. Four themes refer to the parents’ experience in Being only for a child; Making sense of a living nightmare; Maintaining hope: facing reality and Living in a relationship with staff. Three themes describe the nurses’ experience: Under the parents’ gaze; Walking in their shoes and Holding parents in mind. A second layer of hermeneutic analysis revealed parents’ and nurses’ collective experience to have their being in four elements of the phenomenon. These elements are Being in chaos; Struggling to connect; Being for another and Being complete. The final description of the parents’ and nurses’ experience of parental presence during resuscitation in PICU as Sharing and surviving the resuscitation is drawn from the findings from each of these layers of meaning. The findings from this study conclude that the parents’ inherent need to be with their child overrode their anxieties of the resuscitation scene, curbing their feelings of chaos. Parental presence however, was a complex and dynamic concept that required a new relationship between parents and nurses. Implications of this study include recommendations for improving staff knowledge and education, as well as practical interventions for enhanced support for both parents and nurses / Doctor of Philosophy (PhD)

Problem investigated: The activation and implementation of the Medical Emergency Team (MET) system. Procedures followed: The ability of the objective activation criteria to accurately identify patients at risk of three serious adverse events (cardiac arrest, unexpected death and unplanned intensive care admission) was assessed using a nested, matched case-control study. Sensitivity, specificity and Receiver Operating Characteristic curve (ROC) analyses were performed. The MET implementation process was studied using two convenience sample surveys of the nursing staff from the general wards of twelve intervention hospitals. These surveys measured the awareness and understanding of the MET system, level of attendance at MET education sessions, knowledge of the activation criteria, level of intention to call the MET and overall attitude to the MET system, and the hospital level of support for change, hospital capability and hospital culture. The association of these measures with the intention to call the MET and the level of MET utilisation was assessed using nonparametric correlation. Results obtained: The respiratory rate was missing in 20% of subjects. Using listwise deletion, the set of objective activation criteria investigated predicted an adverse event within 24 hours with a sensitivity of 55.4% (50.6-60.0%) and specificity of 93.7% (91.2-95.6%). An analysis approach that assumed the missing values would not have resulted in MET activation provided a sensitivity of 50.4% (45.7- 55.2%) and specificity of 93.3% (90.8-95.3%). Alternative models with modified cut-off values provided different results. The MET system was implemented with variable success during the MERIT study. Knowledge and understanding of the system, hospital readiness, and a positive attitude were all significantly positively associated with MET system utilisation, while defensive hospital cultures were negatively associated with the level of MET system utilisation. Major conclusions: The objective activation criteria studied have acceptable accuracy, but modification of the criteria may be considered. A satisfactory trade-off between the identification of patients at risk and workload requirements may be difficult to achieve. Measures of effectiveness of the implementation process may be associated with the level of MET system utilisation. Trials of the MET system should ensure good knowledge and understanding of the system, particularly amongst nursing staff.

Bibliography: p. 137-154. / 154 p. : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / This thesis details a series of studies in patients, in human volunteers and in large animals. Haemodynamics and left ventricular systolic and diastolic mechanics are reported during lactic acidosis, during therapies for lactic acidosis, and during hyperdynamic and hypovolemic shock. The study has the unifying hypothesis that cardiac dysfunction is important in hyperdynamic and hypovolemic shock and is not caused by lactic acidosis. / Thesis (M.D.)--University of Adelaide, Dept. of Anaesthesia and Intensive Care, 1997?

ABSTRACT Naturalistic Inquiry was used to explore, describe and discover the experiences and perceptions of men whose partners have been admitted to an Intensive Care Unit (ICU) immediately after childbirth. The sixteen men's experiences were explored using semi-structured open-ended questions. Data were analysed using thematic content analysis. The research questions driving this study were: • What are men's experiences and perceptions of the incidence and impact of their partners being admitted to ICU following the complications of childbirth? • What is the nature of the relationships and interactions that men have with healthcare professionals before, during and after their partner's ICU admission following the complications of childbirth? • What impact did the experience of their partners being admitted to ICU, following the complications of childbirth, have on the men's relationships with their partners, newborn child, and other children? • What impact did the experiences of their partners being admitted to ICU following the complications of childbirth have on their future life plans? During the time of their partners' obstetric crisis the men, in this study, were left isolated, alone and struggling. The current healthcare policy and practice for men with their partners in life-threatening situations intrapartum and immediately postpartum failed 16 families.

Problem investigated: The activation and implementation of the Medical Emergency Team (MET) system. Procedures followed: The ability of the objective activation criteria to accurately identify patients at risk of three serious adverse events (cardiac arrest, unexpected death and unplanned intensive care admission) was assessed using a nested, matched case-control study. Sensitivity, specificity and Receiver Operating Characteristic curve (ROC) analyses were performed. The MET implementation process was studied using two convenience sample surveys of the nursing staff from the general wards of twelve intervention hospitals. These surveys measured the awareness and understanding of the MET system, level of attendance at MET education sessions, knowledge of the activation criteria, level of intention to call the MET and overall attitude to the MET system, and the hospital level of support for change, hospital capability and hospital culture. The association of these measures with the intention to call the MET and the level of MET utilisation was assessed using nonparametric correlation. Results obtained: The respiratory rate was missing in 20% of subjects. Using listwise deletion, the set of objective activation criteria investigated predicted an adverse event within 24 hours with a sensitivity of 55.4% (50.6-60.0%) and specificity of 93.7% (91.2-95.6%). An analysis approach that assumed the missing values would not have resulted in MET activation provided a sensitivity of 50.4% (45.7- 55.2%) and specificity of 93.3% (90.8-95.3%). Alternative models with modified cut-off values provided different results. The MET system was implemented with variable success during the MERIT study. Knowledge and understanding of the system, hospital readiness, and a positive attitude were all significantly positively associated with MET system utilisation, while defensive hospital cultures were negatively associated with the level of MET system utilisation. Major conclusions: The objective activation criteria studied have acceptable accuracy, but modification of the criteria may be considered. A satisfactory trade-off between the identification of patients at risk and workload requirements may be difficult to achieve. Measures of effectiveness of the implementation process may be associated with the level of MET system utilisation. Trials of the MET system should ensure good knowledge and understanding of the system, particularly amongst nursing staff.

<p><strong><p>Sammanfattning</p><p>Syftet med studien var att belysa vilka faktorer expertsjuksköterskor vid intensivvårdsavdelningar ansåg vara viktiga att ta hänsyn till vid lyckad urträning av patienter vid ventilatorvård. En beskrivande kvalitativ ansats valdes för denna studie. Datainsamlingen genomfördes med semistrukturerade intervjuer och analyserades med kvalitativ innehållsanalys. Tolv expertsjuksköterskor inom intensivvård valdes ut av sina avdelningschefer på tre intensivvårdavdelningar i Mellansverige under hösten 2008. I resultatet från intervjuerna framkom åtta kategorier som bildade två teman. Första temat var, sjuksköterskan driver processen framåt genom erfarenhet och beslutsamhet. Det bildades ur kategorierna, helhetsbild av urträningsprocessen, patientens förutsättningar, beslutsprocessen, tvärprofessionellt samarbete och sjuksköterskornas egna upplevelser. Det beskrev hur urträningsprocessen drevs framåt av intensivvårdssjuksköterskornas beslutsamhet och erfarenhet, men visade också hur viktigt teamarbetet var. Det andra temat var, sjuksköterskan använder sig själv som verktyg. Det framkom ur kategorierna, en trygg patient, samarbete med patienten och anhörigas roll. Temat visade att sjuksköterskornas intuition och fingertoppskänsla var viktig och att sjuksköterskrna hade ett stort personligt engagemang i patientens med- och motgångar. Studien visade att det inte finns någon enhetlig metod eller "guidelines" för att träna ur patienterna vid ventilator behandling. Mycket av framgången berodde på teamets förmåga till samarbete. Intensivvårdssjuksköterskor verkade ha en central roll i hela urträningsprocessen och använde sig själv som redskap.</p><p>Nyckelord: urträning, omvårdnad, intensivvård, teamarbete</p></strong></p> / <p><strong><p>Abstract</p><p>The aim of the study was to elucidate which factors expert nurses at intensive care units considered to be important with regard to successful weaning patients from ventilator treatment. A descriptive qualitative approach was chosen for this study. The data collection was conducted with semi-structured interviews. Twelve expert nurses in intensive care were chosen by their head nurses at three intensive care units in mid Sweden in autumn 2008. In the results based on interviews eight categories emerged that formed two themes. The first theme was, the nurse drives the process forward by experience and determination. It was formed from the categories: the overall picture of the weaning process, the patient’s condition, the decision process, interdisciplinary cooperation and the nurses own experiences. It described how the weaning process was driven forward by the intensive care nurses determination and experience, but also showed how important the teamwork was. The second theme was, the nurse uses herself as a tool. It was formed from the categories: a confident patient, cooperation with the patient and the role of the relatives. The theme showed that the nurses’ intuition and instinctive feeling were important and that the nurses really were engaged in the patients’ successes and setbacks. The study demonstrated there is no homogeneous method or guidelines how to perform weaning from the ventilator. The success was depending on the teamwork. Intensive care nurses seemed to have a central roll thru the entire weaning process and used them self as tools in the process.</p><p>Keywords: weaning, care, intensive care, teamwork</p></strong></p>

Thesis (M. Nurs.)--University of Hong Kong, 2006.

Thesis (Ph. D.)--University of Chicago, Dept. of Anthropology, June 1999. / Includes bibliographical references. Also available on the Internet.

Syfte: Studiens syfte var att jämföra en ny extubationsalgoritm med sedvanligtextubationsförfarande. Gruppen som studerades var patienter som genomgått en HIPEC-operationoch vårdats på Centrala intensivvårdsavdelningen. Metod: I En randomiserad kontrollerad klinisk pilotstudie randomiserades patienterna till en av tvågrupper. Därefter extuberades patienten enligt en studiealgoritm eller post-operativ standard. Resultat: Syresättningen var väsentligen oförändrad för studiegruppen (37,5 kPa till 36,6 kPa)medan den sjönk för kontrollgruppen (50,1 kPa till 40,6 kPa) vid jämförelse mellan 10 minuter efterankomst och 15 minuter efter extubation. Efter 13 till 18 timmars kontroll strax innan patienternalämnade intensivvårdsavdelningen var syresättningen på samma nivå som 15 minuter efterextubation för både studiegruppen och kontrollgrupp. Således kvarstod en försämrad syresättninghos kontrollgruppen vid utskrivning jämfört med 10 minuter efter ankomst. Slutsats: Studien visar att det skulle kunna vara fördelaktigt att extubera patienter enligt denstudiealgoritm som testats jämfört med dagens kliniska standard. Genom att fokusera på hur och ejnär extubationen ska ske är förhoppningen att denna studie kan bidra till att förbättra en procedursom i princip saknar konsensus. Mer forskning krävs för att kunna dra några generella slutsatser omresultatet. / Aim: To compare a new method of extubation with present standard procedure at the Central ICUafter HIPEC surgery. Method: In a randomized controlled study patients were randomized into two groups. Patients wereeither extubated according to a study algorithm based on best current knowledge, or according tostandard procedure. Results: The oxygenation remained on the same level in the study group (37,5 kPa to 36,6 kPa) butdecreased in the control group from 50,1 kPa to 40,6 kPa from 10 minutes after arrival to 15minutes after extubation. After 13 to 18 hours, just before the discharge from the ICU theoxygenation in both groups was at the same level as 15 minutes after extubation. Thus a decrease inoxygenation in the control group was found at discharge compared to 10 minutes after arrival in theICU. Conclusion: The result of the study showed that it may be benificial to extubate according to thestudy algorithm compared to present standard procedure. By directing focus from when to how theextubation is made, this study may contribute to the improvement of a clinical procedure that iscurrently lacking in scientific consencus. Further studies are needed to confirm these findings.