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Background: When life-saving interventions are not compatible with a meaningful and dignified life for a patient in the intensive care unit, decisions are made to withdraw life-sustaining treatment, allowing for the possibility of organ donation. There are clear laws and guidelines for the process of donation. Previous research highlights the complex work of intensive care nurses, involving the care of both potential organ donors and relatives. Aim: The aim was to describe intensive care nurses' experiences of nursing care during the process of organ donation. Method: A qualitative interview study with 12 intensive care nurses. Content analysis was conducted. Results: The analysis resulted in three categories: The complex nursing care, The meaningful nursing care and Meeting the relatives in the donation process and eight subcategories emerged. Conclusion: Intensive care nurses experienced nursing care in the donation process as meaningful and as an opportunity to contribute to another person's continued life. However, nursing care was also perceived as challenging and time-consuming, both in relation to the donor and relatives. Nurses described facilitating factors such as knowledge and education about the donation process, as well as the importance of the team. A significant part of nursing care involved supporting and informing relatives. Key words: Intensive care nurses, interview study, nursing care, organ donation.

Improved survival in patients with hematological malignancy (HM) admitted to the intensive care unit (ICU) has largely been reported in uncontrolled cohorts from single academic institutions. We compared hospital mortality between 147 patients with HM and 147 general medical admissions to five non-specialist ICUs. The proportion of patients surviving to hospital discharge was significantly worse in patients with HM (27% vs. 56%; p < 0.001). Six-month and 1-year survival in patients with HM was 21% and 18%, respectively. HM, greater age, mechanical ventilation (MV) and acute physiology and chronic health evaluation (APACHE) II score were independent predictors of poor outcome. For patients with HM, culture proven infection, age, MV and inotropes were negative predictors. Disease-specific factors including hematological diagnosis, neutropenia, remission status, prior stem cell transplant, time from diagnosis to admission and degree of prior treatment were not predictive. Overall survival of patients with HM was worse than that recently reported from specialist units.

Bibliography / Thesis (PhD ( Interdisciplinary Health))--University of Stellenbosch, 2010. / Bibliography / ENGLISH ABSTRACT: Introduction: It is increasingly being recognized that how intensive care services are delivered may have a greater impact on patient outcome than the individual therapies. Uncertainty regarding the optimal physiotherapy service provision model in a surgical intensive care unit (ICU) exists. Methodology: The aims of this study were to 1) develop an evidence-based physiotherapy protocol; 2) validate the content of the protocol; and 3) conduct an explorative intervention trial to compare usual care to the estimated effects of providing a physiotherapy service guided by an evidence-based physiotherapy protocol by a dedicated physiotherapist. A systematic review process was used to synthesize the evidence in eight subject areas. The GRADE system was used to formulate best practice recommendations and algorithm statements. Forty-two experts from a variety of disciplines were invited to participate in a Delphi process. Finally, the evidence-based physiotherapy protocol was implemented in a surgical ICU over four three-week intervention periods by a group of research therapists. The outcomes measured included ventilator time, ventilation proportions, failed extubation proportions, length of ICU and hospital stay, mortality, functional capacity, functional ability and cost (using nursing workload as proxy). Results: Fifty-three research reports in eight subject areas were identified, 23 draft best-practice recommendations and 198 algorithm statements were formulated. The draft protocol consisted of five clinical management algorithms. Fifteen international research experts and twelve national academics in the field of critical care agreed to participate in the Delphi process. Consensus was reached on the formulation of 87% (20/23) recommendations and the rating of 66% (130/198) statements. The risk of an adverse event during the protocol care intervention period was 6:1000 treatment sessions (p=0.34). Patients admitted to the unit during the protocol care intervention period were less likely to be intubated (RR 0.16 95%CI 0.07 – 0.71; RRR 0.84 NNT 5.02; p=0.005) or fail extubation (RR 0.23 95%CI 0.05 – 0.98; RRR =0.77 NNT 6.95; p=0.04). The mean difference in the daily unit TISS-28 score between the two condition periods was 1.99 95%CI 0.65 – 3.35 (p=0.04). Patients managed by the protocol tended to remain in the hospital for a shorter time after unit discharge (p=0.05). There was no difference in the time spent on the ventilator (p=0.50), mortality (p=0.52) or in the six minute walk distance (p=0.65). In addition there was no difference in the proportion of patients who reached independence in any of the Barthel Index activities measured within 48 hours of discharge from the unit. Conclusions: The use of an evidence-based physiotherapy protocol for the comprehensive physiotherapeutic management of patients in a surgical ICU was feasible and safe. The preliminary results of this study suggest that a physiotherapy service, which is guided by an evidence-based protocol and offered by a dedicated unit therapist, has the potential to lower the cost of ICU care and facilitate the functional recovery of patients after unit discharge. This information can now be considered by administrators to optimize the physiotherapy service provided in ICU. / AFRIKAANSE OPSOMMING: Inleiding: Daar word toenemend erken dat die wyse waarop dienste gelewer word, ‘n groter impak mag hê op die uitkoms van pasiënte as die spesifieke modaliteite in gebruik. Onsekerheid heers tans oor die optimale fisioterapie diens model om te volg in ‘n chirurgiese intensiewe sorg eenheid (ISE). Metodologie: The doel van hierdie projek was om 1) ‘n bewysgesteunde protokol te ontwikkel; 2) die geldigheid van die protokol te bevestig; en 3) om deur middel van ‘n eksploratiewe studie die uitkoms van pasiënte te vergelyk wanneer die fisioterapie diens gelewer word aan die hand van die bewysgesteunde protokol deur ‘n toegewyde fisioterapeut, teenoor wanneer die gewone fisioterapie diens gelewer word. Die empiriese bewyse in agt onderwerp areas is gesintetiseer na afloop van ‘n sistematiese literatuur oorsig proses. Die GRADE sisteem is gebruik om beste praktyk aanbevelings en algoritme stellings te formuleer. Twee en veertig kundige persone van verskeie disiplines is genooi om deel te neem aan die Delphi proses om die geldigheid van die protokol te bevestig. Uiteindelik is die geldige bewysgesteunde protokol oor ‘n tydperk van vier drie weke intervensie periodes deur ‘n groep navorsings terapeute in ‘n chirurgiese ISE geïmplementeer. Die tyd wat pasiënte geventileer is, die proporsie pasiënte wat geïntubeer en geherintubeer is in die tydperk, die lengte van ISE en hospitaal verblyf, mortaliteit, funksionele kapasiteit asook funksionele vaardigheid en koste (deur die verpleeg werkslading te gebruik as ‘n indikasie van koste) is gemeet. Resultate: Drie en vyftig navorsings verslae in agt onderwerp areas is geïdentifiseer, 23 konsep aanbevelings en 198 algoritme stellings is geformuleer. Die konsep protokol het uit vyf algoritmes bestaan. Vyftien internasionale en twaalf nasionale kundiges het die uitnodiging aanvaar om aan die delphi proses deel te neem. Konsensus is bereik vir die formulering van 87% (20/23) van die aanbevelings en die gradering van 66% (130/198) van die algoritme stellings. Die risiko vir ‘n ongunstige episode tydens die protokol intervensie periode was 6:1000 sessies (p=0.34). Pasiënte wat tydens die protokol intervensie periode tot die eenheid toegelaat is was minder geneig om geïntubeer te word (RR 0.16 95%CI 0.07 – 0.71; RRR 0.84 NNT 5.02; p=0.005) of om ‘n ekstubasie te faal (RR 0.23 95%CI 0.05 – 0.98; RRR =0.77 NNT 6.95; p=0.04). Die gemiddelde verskil in die daaglikse eenheid TISS-28 telling tussen die twee intervensie periodes was 1.99 95%CI 0.65 – 3.35 (p=0.04). Patiente wat tydens die protokol intervensie periode behandel is was geneig om vinniger uit die hospitaal ontslaan te word nadat hul uit die eenheid ontslaan is (p=0.05). Daar was geen verskil in die ventilasie tyd, (p=0.50) die mortaliteit (p=0.52) of die afstand wat pasiente in ses minute kon aflê binne 48 uur na ontslag uit die eenheid (p=0.65) nie. Daar was ook geen verskil in die proporsie pasiente wat onafhanklikheid bereik het in enige van die kategorieë van die Barthell Index instrument nie. Gevolgtrekking: Die gebruik van die protokol vir die omvattende hantering van pasiënte in ‘n chirurgiese eenheid is haalbaar en veilig. Die voorlopige resultate van hierdie studie dui daarop dat wanneer ‘n fisioterapie diens in ‘n chirurgiese ISE gelewer word aan die hand van ‘n bewysgesteunde protokol deur ‘n toegewyde fisioterapeut dit die potensiaal het om ISE koste te verminder en die funksionele herstel van pasiente na ontslag uit die eenheid te fasiliteer. Hierdie inligting kan nou deur administrateurs oorweeg word om ‘n optimale fisioterapie diens in ‘n chirurgiese ISE te verseker.

The purpose of the research was to describe the relationships between social support and role strain and preventative health behaviors. The sample consisted of 62 critical care nurses employed in three southwest acute care facilities. Subjects completed instruments measuring social support, role strain, and four preventative health care behaviors. Pearson correlations revealed significant positive relationships between social support and personal/household roles women perform and ways women handle stress. Additional significant negative relationships existed between marital/relationship roles women perform and leisure physical activities, a subset of preventative health behaviors. The parental roles, obligations, and responsibilities women perform were also significantly related with leisure physical activities. Conclusions drawn indicate that the critical care nurses did not perceive themselves susceptible to cardiovascular disease and therefore did not participate in preventative health care activities, regardless of perceived helpful social support and an absence of role strain.

For my diploma thesis I chose the topic of education of nurses in intensive care. In the field of nursing education, it was necessary to respond to new trends in the European Union. In recent years, the situation in the field of education has changed in many ways. Act No. 201/2017 Coll. it has brought a novelty that the credit system of education has been abolished and it is therefore possible to conclude that the motivation of nurses to education may have fallen. The theoretical part describes the history of intensive care in the world and in the Czech Republic. Mentioned is the history of nursing education in intensive care and the history of nursing education in the Czech Republic. The next chapter points to the current situation of intensive care, the requirements for qualification education of a nurse and the competence of a nurse specialist. The possibilities of intensive care education, including lifelong learning, are being announced. An integral part is the motivation chapter. The main aim of my thesis was to find out the motivation of nurses to specialize in intensive care. Subsequently, I then mapped the nurses' motivation to continue their education in lifelong learning. Research questions were chosen: 1.What preview do nurses themselves have from intensive care to specialized...

Includes bibliographical references. / 1 v. (various paging) : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (D.Nurs.)--University of Adelaide, Dept. of Clinical Nursing, 2002

<p>Neuropathic pain of central and peripheral origin presents a substantial clinical problem as it is often resistant to pharmacological treatment.</p><p>The health related quality of life of 126 patients with peripheral neuropathic pain was studied, to provide a cross sectional description from this point of view. Two generic health-related quality of life instruments; the SF-36 and the Nottingham Health Profile were used together with pain assessments, global rating of health and verbal rating scales of pain and other symptoms, as well as patient descriptors.</p><p>The analgesic effect of ketamine, lidocaine and morphine were assessed in a double blind, placebo-controlled, randomized study design. Three groups of patients were studied: patients with peripheral neuropathic pain of traumatic origin, patients with central post-stroke pain and patients with neuropathic pain after spinal cord injury. Somatosensory function was examined to see if this could predict response to treatment and to investigate if the drugs caused changes in thermal or mechanical sensibility.</p><p>The results shows that the intense pain, limited efficacy and tolerability of available treatments, the low overall rating of health, reduced work status and troublesome symptoms constitute a substantial impact on the quality of life for patients with peripheral neuropathic pain.</p><p>The NMDA-antagonist ketamine yielded substantial pain relief to patients with peripheral neuropathic pain and patients with neuropathic pain after spinal cord injury. However, the reported side effects limit the clinical usefulness of the treatment. Lidocaine did not give significant pain relief to the patients in the three studied groups. Morphine may represent a therapeutic alternative for some patients with central post-stroke pain, although only a small group of this category of patients responded with analgesia.</p><p>Assessment of baseline somatosensory functions could not be used to identify responders to treatment with either drug, nor did ketamine, lidocaine or morphine cause any changes in thermal or mechanical sensibility.</p>

Neuropathic pain of central and peripheral origin presents a substantial clinical problem as it is often resistant to pharmacological treatment. The health related quality of life of 126 patients with peripheral neuropathic pain was studied, to provide a cross sectional description from this point of view. Two generic health-related quality of life instruments; the SF-36 and the Nottingham Health Profile were used together with pain assessments, global rating of health and verbal rating scales of pain and other symptoms, as well as patient descriptors. The analgesic effect of ketamine, lidocaine and morphine were assessed in a double blind, placebo-controlled, randomized study design. Three groups of patients were studied: patients with peripheral neuropathic pain of traumatic origin, patients with central post-stroke pain and patients with neuropathic pain after spinal cord injury. Somatosensory function was examined to see if this could predict response to treatment and to investigate if the drugs caused changes in thermal or mechanical sensibility. The results shows that the intense pain, limited efficacy and tolerability of available treatments, the low overall rating of health, reduced work status and troublesome symptoms constitute a substantial impact on the quality of life for patients with peripheral neuropathic pain. The NMDA-antagonist ketamine yielded substantial pain relief to patients with peripheral neuropathic pain and patients with neuropathic pain after spinal cord injury. However, the reported side effects limit the clinical usefulness of the treatment. Lidocaine did not give significant pain relief to the patients in the three studied groups. Morphine may represent a therapeutic alternative for some patients with central post-stroke pain, although only a small group of this category of patients responded with analgesia. Assessment of baseline somatosensory functions could not be used to identify responders to treatment with either drug, nor did ketamine, lidocaine or morphine cause any changes in thermal or mechanical sensibility.

Bakgrund: Arbetet på en intensivvårdsavdelning innefattar ofta ett högt tempo och intensivvårdssjuksköterskan förväntas utöver sin kunskap inom medicin och omvårdnad, kunna hantera de psykologiska reaktionerna som kan uppstå i samband med kritiska tillstånd.Debriefing och avlastande samtal är båda verktyg för att bearbeta känslor då en svår situation inträffat. Syfte: Att belysa intensivvårdssjuksköterskors upplevelser om vad som påverkar behovet av debriefing och avlastande samtal i det dagliga arbetet. Metod: Genom ett strategiskt urval valdes totalt 10 intensivvårssjuksköterskor ut att delta i denna deskriptiva kvalitativa studie, som genomfördes på tre olika intensivvårdsavdelningar i Sverige. Halvstrukturerade intervjuer utfördes och analyserades i enlighet med Granheim och Lundmans metod för kvalitativ innehållsanalys. Resultat: Sjuksköterskorna upplevde generellt ett behov av debriefing/avlastande samtal i samband med större olyckor. Behovet påverkades av olika faktorer som presenteras i kategorierna; akut och/eller oväntad händelse, etiska dilemman, igenkännande och personligt engagemang, personliga förmågor, erfarenhet, tid och ansvar. Slutsats: Erfarenhet i yrket underlättade för sjuksköterskorna att bearbeta svåra händelser på egen hand, medan igenkännande, i form av sjuksköterskans egna livsituation och föräldraskap, ökade behovet av debriefing/avlastande samtal. / Background: The work at an intensive care unit often involves a high tempo and the specialist nurse in intensive care is expected, in addition to the medical and nursing knowledge, to deal with the psychological reactions that may arise in critical conditions. Debriefing and defusing are both tools to process emotions when a difficult situation occurred. Aim: To illustrate intensive carenurses experience of what effects the need of debriefing and defusing in the daily work. Method:This descriptive qualitative study was conducted in three different intensive care units in Sweden.Through a strategic selection were a total of 10 intensive care nurses selected to participate in semi-structured interviews. Which were performed and analyzed in accordance with Granheimand Lundman's method for content analysis. Result: Intensive care nurses generally experience aneed of debriefing/defusing for major accidents. The need is affected by various factors which are presented in following categories; acute or unexpected situation, ethical dilemmas, recognition and personal engagement, personal abilities, experience, time and responsibility. Conclusion:Professional experience made it easier for intensive care nurses to process difficult situations on their own, while recognition, such as life situation and parenthood, increased the need for debriefing/defusing.