Critically ill patients in an intensive care unit (ICU) often require mechanical ventilation (MV). Humidification systems are essential devices for MV which replace the natural heat and moisture exchange process of inspired gases. A heat and moisture exchanger (HME) is commonly used for the humidification of MV patients in ICU. In contrast, a heated humidifier (HH) that is a more complicated device is used only for prolonged MV patients because of its higher cost and nurse workload. However, HME may increase the breathing workload of patients, thereby inflicting damage to their respiratory function, especially among respiratory failure patients. However, there was no evidence-based guideline that instructs nurses on choosing humidification devices in ICU. This dissertation aimed to 1) evaluate the current evidence and formulate evidence-based guideline in selecting a humidification device for mechanically ventilated acute respiratory distress syndrome (ARDS) patients in reducing the risks of breathing workload; 2) assess its implementation potential, as well as its feasibility and transferability; and 3) develop implementation strategies and evaluation plans for the use of this device in an adult ICU. Three electronic databases, namely, Proquest, Ovid, and Google Scholar, were searched for randomized controlled trials (RCTs) of humidification systems for MV. Eight articles were retrieved. Their reference lists were read and found two additional RCT. Four high-quality RCT showed that HH increased the breathing workload more than HME. Several studies showed that HME has potential drawbacks of significantly increase airway resistance, minute ventilation, CO2 retention, and respiratory discomfort. However, studies showed that no significant difference of ventilator-associated pneumonia (VAP) rate between HME and HH. The initial application of HME is safer and less costlyl. However, prolonged use of HME in ARDS patients may induce further workload on the respiratory system and worsen treatment progress. An evidence-based clinical guideline in choosing the humidification system was formulated and assessed using the appraisal instruments of Scottish Intercollegiate Guideline Network. It is deemed to be transferable with patient characteristics, clinical situation, and organizational infrastructure similar to studies evaluated the suggested innovation. Feasibility was also assessed and is considered to be high. The setup and running cost per year were HKD17450 and HKD6600. Although the humidification system had no actual cost reduction, non-material benefits such as prevention of tube blockage, reduction in breathing workload, and respiratory discomfort were more important than the cost. An implementation plan including a one-month communication plan with stakeholders and one-month pilot testing were developed. The evaluation of the guideline will last for 10 months. The effectiveness of the innovation will be determined by the reduction in breathing workload, cost and benefit ratio, and staff satisfaction level. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Ventilator-associated pneumonia (VAP) is a kind of frequently hospital-acquired infection that increases morbidity and mortality in patients in intensive care units (ICU), which would in turn increase length of ICU stay, cost of hospital stay, and duration of mechanical intubation. Pneumonia appeared within 48 hours before onset of infection in people whose respiration is mechanically supported through endotracheal tube or tracheostomy is ventilator-associated pneumonia. Combating VAP is a major challenge in ICU as almost all ICU patients require mechanical intubation. Development of evidence-based methods to reduce the incidence and prevalence of VAP becomes an important issue in ICU. The objectives of this dissertation are to conduct a thorough search of current evidence on the effectiveness of using different concentration, frequency of application, method of application and amount of chlorhexidine gluconate solution for oral care of adult intubated patients in reducing VAP incidence rate. MEDLINE (OvidSP), CINAHL PLUS (EBSCOhost), PubMed and British Nursing Index were used to conduct electronic search using keywords related to VAP. A total of 99 studies were identified and seven were selected according to inclusion criteria. The quality of the seven selected studies was tested using The Scottish Intercollegiate Guidelines Network (2008) tools for randomized controlled trials, and the evidence level coding from Scottish Intercollegiate Guidelines Network was used in grading of recommendations. Six studies were rated as high quality, which oral care using chlorhexidine gluconate solution had shown statistically significant VAP incidence rate reduction or VAP-related parameters improvement. Analysis on the implementation potential, transferability of findings, feasibility of implementation and cost-benefit ratio was conducted and the oral care guideline was beneficial to intubated patients. Implementation plan, communication plan and evaluation plan about oral care guideline application was formulated. The program designed to apply the new oral care guideline would last for one year, which includes communication with stakeholders, publication of the guideline, training of staff and a one month pilot test. The primary outcome was the decrease in VAP incidence rate and the process evaluation outcome were compliance and acceptability of the guideline, satisfaction and knowledge level of staff, and hospital cost reduction. The attainment of primary outcome and process evaluation outcome would be used to evaluate the effectiveness of the program. / published_or_final_version / Nursing Studies / Master / Master of Nursing

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No description available.

Burn victims are treated using the exposure method in a specially designed intensive care room in which sterile air at a controlled temperature (25-38^oC) is blown down on to the open wounds allowing them to dry and form an eschar. During this treatment, the patient's heat loss has to be maintained as low as possible to minimise thermal stress. This work involved the creation of an automated system to monitor patient heat loss, along with the development of a mathematical model to predict the optimum conditions for treatment. The monitoring system consists of a micro processor controlled interface board connected to an IBM PC which operates a multitasking operating system. The interface repetitively collects data from the monitoring equipment including an infra red camera, while the computer controls the rate of collection, calibration, storage and display of various environmental and physiological factors as well as the images obtained from the camera. The temperature distributions across burn wounds are complex and dependent on the depth and position of the wound as well as the time after injury The monitoring system allows the automatic collection of image data at regular intervals, with the sequence of images produced together with the environmental data recorded, being used in the calculation of body heat loss, and in the study of temperature changes during wound healing. A mathematical model has been developed, programmed and adapted to accurately model the responses of a group of 22 healthy subjects in the intensive care room over the range of ambient temperatures available. Further development was then made to enable the modelling of burned patients, with application to six patients studied in the room.

This study, drawing on the work of van Manen and based on hermeneutic phenomenological principles, sets out to lay open an ontological substance of emergency nursing-as-caring work by exploring the experiences and lived realities of eleven emergency nurses engaged in nursing practice in emergency departments within South Australia. / Thesis (PhD)--University of South Australia, 1998

Thesis (MHlthSc(OccTh))--University of South Australia, 1999

Making the transition to an area of specialist nursing practice is challenging for both the learner and staff who are responsible for education and skill development. This study uses grounded theory methodology to explore the question: "How do nurses learn critical care nursing?"The eight registered nurses who participated in this study were recruited from a range of intensive care settings. The criteria for inclusion in the study included the participant having attained competency within the critical care setting. Data was collected from individual interviews. The findings of this study developed during the coding and comparative analysis process, and subsequently theoretical sampling was used to further explore the identified concepts.This study found that nurses' focus on two main areas during their orientation and induction into critical care nursing practice. These are learning to do (skill acquisition) and learning to be (professional socialisation). The process of transition involves two stages: that of learning to do the tasks related to critical care nursing practice, and the ongoing development of competence and confidence in practice ability. The relationship of the learner with the critical care team is a vital part of the transition to competency within the specialist area.This study identifies factors that influence the learner during transition and also provides an understanding of the strategies used by the learners to attain competency. These findings are applicable to educators and leaders responsible for the education and ongoing learning of nurses within critical care practice. The use of strategies such as simulated learning and repetition are significant in skill acquisition. However attention must also be paid to issues which influence the professional socialisation process, such as the quality of preceptor input during orientation and the use of ongoing mentoring of the learner.

This study, drawing on the work of van Manen and based on hermeneutic phenomenological principles, sets out to lay open an ontological substance of emergency nursing-as-caring work by exploring the experiences and lived realities of eleven emergency nurses engaged in nursing practice in emergency departments within South Australia.

Proefschrift Universiteit van Amsterdam. / Met lit. opg. - Met samenvatting in het Nederlands.