Inom intensivvård bedrivs omvårdnad i en högteknologisk miljö. Flera av patienterna är i behov av andningshjälp i form av ventilatorbehandling vilket medför att patienten är sederad och har en endotrachealtub i trachea. Patienten kan inte själv utföra sin munvård och blir därför beroende av intensivvårdsjuksköterskans hjälp. Syftet med studien var att belysa intensivvårdssjuksköterskans erfarenhet av munvård av intuberade intensivvårdspatienter. Studien utfördes med en fokusgruppsintervju och analyserades med en kvalitativ innehållsanalys. Kategorierna som framkom i studien var att munvård handlar om prioritering, risker, teamarbete och kommunikation, utförande, patientperspektiv och ansvar. Förslag på fortsatt forskning skulle kunna leda till ett validerat bedömningsinstrument för munvård av intuberad patient samt evidensbaserade riktlinjer för munvård. / Intensive care is conducted in a high technological environment. Many of the patients are in need of breathing assistance with the help of a ventilator, which means that the patient is sedated and intubated. The patients can´t perform their oral care by themselves and therefore dependent on the help of intensive care nurses. The purpose of this study was to elucidate critical care nurses' experiences of oral care in intubated ICU patients. The study was performed with a focus group interview and analyzed by a content analysis. The categories that emerged from the study were that oral care is about priorities, risks, teamwork and communication, performance, patient perspective and responsibility. Suggestions for further research could lead to a validated assessment tool for oral care of intubated patients and evidensbased guidelines for oral care.

Meticillinresistenta staphylococcus aureus (MRSA) är en bakterie som har utvecklat resistens mot meticillin. Spridning av MRSA är ett stort globalt problem som ökar. På intensivvårdsavdelningar förekommer smittspridning till medpatienter som är svårt sjuka, ett problem som intensivvårdssjuksköterskr bör förhindra med hjälp av olika omvårdnadsåtgärder. Syftet med litteraturstudien var att undersöka hur intensivvårdssjuksköterskan kan förhindra smittspridning av MRSA på intensivvårdsavdelning (IVA). Studien baseras på 11 vetenskapliga artiklar. Resultatet visar brister i handhygien, bemanning av oerfarna sjuksköterskor, underbemanning, otillförlitlig infektionskontroll och att ej vårda patienterna på enkelrum ökar risken för smittspridning. Framtida forskning inom dessa områden bör fokusera på en ökad medvetenhet och kunskap hur följsamheten av hygienrutiner kan skapas. / Methicillin resistant staphylococcus aureus (MRSA) is a bacterium that has developed a resistance to methicillin and the spread of these bacteria. MRSA is fast becoming a major global problem. There exists an increased risk within Intensive care unit (ICU) departmentsbetween patients who are seriously ill, a problem that the ICU nurses should try to avoid using a variet of nursing intervention. The purpose of this literature study was to explore how ICU nurses can help prevent the spread of MRSA in the ICU. The study is based upon 11 scientific articles, sought in Pubmed, Cinahl and viamanual searching. the results expose deficiencies in handhygiene, staff shortages, staffing nurses, unreliable infection control and failure to care for patients on single occupancy, all increasing the risk of contamination. Future research in this area should focus on how an increased awareness and knowledge about the importance of following hygiene procedures can be created and executed.

Background: Getting admitted to CCU is viewed as a stressful event by patients. However, numerous studies have indicated that nurses do not always accurately perceive the stressors of their clients. Therefore, it is important for nurses to know what seems most stressful from the patients‘ perspective so that appropriate nursing measures can be directed towards minimizing such stressors. Objectives: The purpose of this study was to explore the perception of CCU stressors experienced by patients from both patients and nurses perspective and to compare between them, identify the effect of socio-demographic characteristics of participant's on the level of stress perception and to what extent clinical guidelines fulfil CCU needs. Methodology: A mixed method approach (qualitative and quantitative) was applied. Purposive random sampling was used to recruit data. Ethical approval was obtained prior to data collection. Data was collected from three CCUs within the West and Northwest NHS Trusts. Participants who met the inclusion criteria were interviewed and asked to rank the Environmental Stressor Questionnaire (ESQ). Qualitative data was analyzed using Gorgi's method of analysis. A quantitative data was analyzed using the SPSS software version 15. Results: There was some consistency in the data where patients and nurses provided same ranking for CCU stressors. Consistently nurses ranked physiological stressors higher than psychological stressors. Patients showed consistency in the findings between what they ranked in the ESQ and their narratives more than their counterparts. Perception of stress was affected by participant's socio-demographic characteristics. A key finding is that the current guidelines do not serve patients and nurses needs. Conclusions: Nurses should be well equipped with knowledge and experience to overcome stressful situations. Educational programs should be made available for nurses to improve stress management. Nurses should assess patient's needs by applying effectively communication skills.

The thesis presented here describes original research in the field of Natural Language Generation (NLG). NLG is the subfield of artificial intelligence that is concerned with the automatic production of documents from underlying data. This thesis in particular focuses on developing new and novel methods for generating text that takes into consideration the recipient’s level of stress as a factor to adapt the resultant textural output. This consideration of taking the recipient level of stress was particularly salient due to the domain that this research was conducted under; providing information for parents of pre-term infants during neonatal intensive care (NICU). A highly technical and stressful environment for parents where emotional sensitivity must be shown for the nature of information presented. We have investigated the emotional and informational needs of these parents through an extensive past literature review and two separate research studies with former and current NICU parents. The NLG system built for this research was called BabyTalk Family (BT-Family). A system that can produce a textual summary of medical events that has occurred for a baby in NICU in last twenty-four hours for parents. The novelty of this system is that is capable of estimating the level of stress of the recipient and by using several affective NLG strategies it is able to tailor it’s output for a stressed audience. Unlike traditional NLG systems where the output would remain unchanged regardless of emotional state of the recipient. The key innovation in this system was the integration of several affective strategies in the Document Planner for tailoring textual output for stress recipients. BT-Family’s output was evaluated with thirteen parents that previously had baby in neonatal care. We developed a methodology for an evaluation that involved a direct comparison between stressed and unstressed text for the same given medical scenario for variables such as preference, understandability, helpfulness, and emotional appropriateness. The results, obtained showed the parents overwhelming preferred the stressed text for all of the variables measured.

Bakgrund: Traumatisk hjärnskada (THS) orsakas av våld mot huvud i samband med fallolyckor eller trafikolyckor. Varje år söker 20 000 personer vård på grund av skallskador. Vården för traumatiskt hjärnskadade patienter i Sverige skiljer sig åt, mycket beroende på avstånden som finns till specialistsjukhus, tiden och rätta åtgärder är avgörande faktorer för denna patientgrupp. Syfte: Att undersöka vikten och intensivvårdssjuksköterskors behov av rutiner i samband med vård av patienter med hjärnskador på allmänintensivvårdsavdelningar och på neurointensivvårdavdelningar. Metod: Kvalitativ studie med fokusgruppsintervjuer av tio intensivvårdsjuksköterskor som arbetar på en allmänintensivvårdsavdelning (IVA) och specialistneurointensivvårdavdelningen (NIVA). Resultat: På NIVA finns väl inarbetade rutiner och tydliga riktlinjer nedskrivna. Sjuksköterskornas upplevelse var att det fanns tillräckligt med rutiner, men några rutiner kunde utvecklas. På IVA fanns det inga nedskrivna riktlinjer och inga tydliga rutiner för att vårda denna patientgrupp. Vården och kontrollerna ordinerades av läkare som är i tjänst. Slutsats: Vården kring hjärnskadade patienter är ytterst viktigt då man ständigt måste förebygga sekundära skador/insulter. Rutiner är väl inarbetade på specialistsjukhuset, men vården börjar först på hemsjukhuset på IVA där tydliga rutiner och riktlinjer saknas. / Introduction: Traumatic brain injury caused by violence against the head during a fall or traffic accident. Each year 20000 people gets medical care because of head injuries. The care for traumatic brain injured patients in Sweden differ greatly depending on the distances available to specialist hospitals, the time and the proper measures are crucial factors in this population. Aim: The study aims to examine the importance and intensive care nurses need routines in connection with care of patients with brain injuries in general intensive care units and in neurological intensive care units. The study consists of three group interviews in a general ICU unit in Falun and specialist unit (NIVA). Method: A qualitative study with focus group interviews. Results: The results showed that the level have clear procedures and written guidelines regarding the "avoidable factors" which are well established, their experience was that there were enough procedures, but that some could continue to develop. IVA there were no written guidelines and no clear procedures to care for this population without the care and controls prescribed by the doctor who is on duty. Conclusion: The conclusion is that care about the brain-damaged patients is extremely important when you constantly have to prevent secondary injury / insults and check the "avoidable factors". Routines are well established on specialist hospital care but starts first at home hospital where the importance of working towards the same goal and have clear procedures and guidelines from the start.

Critical care nurses work in an environment rich in informative interactions. Although there have been post hoc self-report survey studies of nurses' information seeking, there have been no observational studies of the patterns and content of their on-duty information behavior. This study used participant observation and in-context interviews to describe 50 hours of the observable information behavior of a representative sample of critical care nurses in a 20-bed critical care hospital unit. The researcher used open, in vivo, and axial coding to develop a grounded theory model of their consistent pattern of multimedia interactions. The resulting Nurse's Patient-Chart Cycle describes nurses' activities during the shift as centering on a regular alternation with the patient and the patient's chart (various record systems), clearly bounded with nursing "report" interactions at the beginning and the end of the shift. The nurses' demeanor markedly changed between interactions with the chart and interactions with the patient. Other informative interactions were observed with other health care workers and the patient's family, friends and visitors. The nurses' information seeking was centered on the patient. They mostly sought information from people, the patient record and other digital systems. They acted on or passed on most of the information they found. Some information they recorded for their personal use during the shift. The researcher observed the nurses using mostly patient specific information, but they also used some social and logistic information. They occasionally sought knowledge based information. Barriers to information acquisition included illegible handwriting, difficult navigation of online systems, equipment failure, unavailable people, social protocols and mistakes caused by multi-tasking people working with multiple complex systems. No formal use was observed of standardized nursing diagnoses, nursing interventions, or nursing outcomes taxonomies. While the nurses expressed respect for evidence-based practice, there clearly was no time or opportunity for reading research literature (either on paper or online) while on duty. All participants expressed frustration with the amount of redundant data entry required of them. The results of this study have significant implications for the design of clinical information systems and library services for working critical care nurses.

No description available.

Résumé : Aux soins intensifs (SI), une diminution du décompte plaquettaire peut avoir un impact important. Des études ont démontré une association entre la thrombopénie et la durée de séjour, les saignements, les transfusions et la mortalité. Les facteurs qui prédisent une thrombopénie varient selon les populations étudiées. Les médicaments sont souvent suspectés, mais peu ont été indépendamment associés à la thrombopénie aux SI. Les études publiées à ce jour souffrent de plusieurs limites. Les objectifs de cette thèse étaient de décrire l’épidémiologie, identifier les facteurs de risque associés, d’évaluer l’impact sur la morbidité et la mortalité et d’évaluer les causes indépendantes médicamenteuses de thrombopénie aux SI. Une cohorte rétrospective a été créée à partir de données administratives et cliniques afin de décrire l’épidémiologie, et d’évaluer les facteurs prédictifs et les conséquences de la thrombopénie aux SI. Par la suite, une étude cas-témoin a été entreprise en sélectionnant les patients qui ont souffert d’une thrombopénie de cause indéterminée afin de déterminer les associations entre les médicaments fréquemment utilisés aux SI et la thrombopénie. Un total de 20 711 patients a été inclus dans l’analyse. La prévalence et l’incidence de thrombopénie ont été de 13,3% et 7,8%, respectivement. La thrombopénie a été indépendamment associée à une augmentation des saignements majeurs (aRC 1,32 95% CI 1,20-1,46). Après des ajustements statistiques, la thrombopénie était associée à une augmentation de mortalité (aRC 1,25 IC95% 1,20-1,31). L’impact sur la mortalité a été le plus important dans les catégories d’admission suivantes: cancer, respiratoire, digestif, génito-urinaire et infectieuses. Les facteurs de risque indépendants suivants ont été identifiés: l’âge, le genre masculin, la ventilation mécanique, l’alcoolisme, la cirrhose hépatique, le décompte plaquettaire à l’admission, l’hypersplénisme, le ballon intra-aortique, le choc septique, l’hépatite aiguë, la chirurgie de pontage coronarien et les maladies thromboemboliques. Dans l’étude cas-témoin, 200 cas de thrombopénie ont été identifiés après l’exclusion des maladies fortement associées. Ces cas ont été appariés à 200 témoins admis dans la même année. Parmi les 15 classes de médicaments évalués, seules les quinolones 1,67 (IC95% 1,00-2,87) ont été indépendamment associées à la thrombopénie dans le modèle final. En conclusion, la thrombopénie est indépendamment associée à une hausse de la mortalité qui varie grandement selon la catégorie d’admission. Les facteurs de risque sont nombreux et incluent des facteurs modifiables. Bien que les médicaments soient fréquemment soupçonnés, seules les quinolones semblent être associées à la thrombopénie aux SI. // Abstract : In the intensive care unit, a reduction in platelet counts can have a major impact on patient outcomes. Studies have showed an association between thrombocytopenia and length of stay, bleeding, blood product administration and mortality. Predictors of thrombocytopenia in the intensive care setting vary according to studies. Although medications are often suspected as potential causes, few have been independently associated with thrombocytopenia. In addition, published studies have many limits including small sample sizes, probable residual confounding, and inclusion of invasive interventions. The objectives of the thesis are to describe the epidemiology of thrombocytopenia, identify its risk factors, evaluate its impact on morbidity and mortality, and evaluate the drug-induced causes of thrombocytopenia. A retrospective cohort was created using administrative and clinical data. In the first study, multivariate analysis was used to identify risk factors. In the second study, a case control strategy was used to determine the association between thrombocytopenia and drugs commonly used in the intensive care unit previously associated with thrombocytopenia. A total of 20 711 patients were included in the analysis. The prevalence and incidence of thrombocytopenia defined as a platelet count below 100 x 10[superscript 9]/L were 13.3% and 7.8%, respectively. Thrombocytopenia was independently associated with an increase in the risk of major bleeding (aOR 1.32 95% CI 1.20-1.46). After adjusting for confounders, thrombocytopenia was associated with an increased risk of hospital mortality (aOR 1.25 IC95% 1.20-1.31). The impact of thrombocytopenia on mortality was the most important in the following diagnostic categories: cancer, respiratory, digestive, genitourinary, and infectious. The following independent risk factors were identified: age, male gender, admission platelet counts, mechanical ventilation, alcoholism, liver cirrhosis, hypersplenism, intra aortic balloon pumps, septic shock, acute hepatitis, coronary bypass surgery and venous thromboembolism. In the case control study, 200 cases were identified after exclusion of patients with diseases strongly associated with thrombocytopenia and paired with 200 controls admitted in the same year. Among the 15 medication classes evaluated, only quinolones 1.67 (IC95% 1.00-2.87) were independently associated with thrombocytopenia. In conclusion, thrombocytopenia is independently associated with an increased risk of mortality, which varies according to diagnostic admission categories. Risk factors are numerous and some are modifiable. Although medications are often suspected, only quinolones were statistically associated with thrombocytopenia.

Background: Intrahospital transfers of intensive care patients involves multiple risks where patient safety is challenged. Aim: The aim of this study was to investigate intensive care nurses’ experiences and perceptions of patient safety during intrahospital transfers. Method: A qualitative, explorative design was utilized with a phenomenographic approach. Ten intensive care nurses with varying work experience in intensive care were interviewed. The interviews were transcribed and analysed according to the phenomenographic method. Results: The analysis of the intensive care nurses’ experiences and perceptions resulted in four categories: routines, risks, support and job allocation. Patient safety was, according to the intensive care nurses, lower during intrahospital transfers compared to the intensive care ward but perceived as good in general. Their preparations and their ability to predict risks were mostly based on their experience level. They solved emerging problems depending on the situation. According to the intensive care nurses, being new in the profession poses a greater risk. Times when the doctors are on call and night time were especially risky times for transfers. They considered good routines important for patient safety and saw possibilities for improvement. The intensive care nurses expressed both confidence and a lack thereof with regards to the transfers and perceived it as easy to ask for help. Cooperation and communication were, according to the informants, crucial for patient safety. Conclusion: The intensive care nurses’ perceptions of patient safety during intrahospital transports were mainly based on their earlier experiences. A possibility for improvement exists through the implementation of a checklist and team training in simulated scenarios. It is important to ensure that patient safety is high during intrahospital transfers irrespective of the experience level of the staff. / Bakgrund: Intrahospitala transporter av intensivvårdspatienter innebär många risker som leder till att patientsäkerheten kan sättas på spel. Syfte: Studiens syfte var att undersöka intensivvårdssjuksköterskors erfarenheter och uppfattningar av patientsäkerhet vid intrahospitala transporter. Metod: En kvalitativ, explorativ design tillämpades med fenomenografisk ansats i form av semistrukturerade intervjuer. Tio intensivvårdssjuksköterskor med varierande arbetslivserfarenhet inom intensivvården intervjuades. Intervjuerna transkriberades och analyserades enligt fenomenografisk metod. Resultat: Analysen av intensivvårdsjuksköterskornas erfarenheter och uppfattningar resulterade i fyra kategorier: rutiner, risker, stöd och arbetsfördelning. Enligt intensivvårdssjuksköterskorna var patientsäkerheten vid intrahospitala transporter sänkt jämfört med intensivvårdsavdelningen men uppfattades trots detta generellt som god. Förberedelserna intensivvårdssjuksköterskorna gjorde och förmågan att se risker berodde mycket på hur erfarna de var. De löste de problem som uppstod utifrån situationen. Enligt intensivvårdssjuksköterskorna innebar det en extra risk att vara ny i sin profession. Jourtid och nattetid var riskfyllda tidpunkter och förflyttningar av patienterna som ett speciellt riskfyllt moment. De ansåg att bra rutiner var viktigt och de såg möjligheter till förbättringar för att öka patientsäkerheten. Intensivvårdssjuksköterskorna uttryckte både en trygghet och otrygghet i samband med transporterna men uppfattade att det var lätt att be om hjälp. Samarbete och kommunikation var enligt dem avgörande för patientsäkerheten. Slutsats: Intensivvårdsjuksköterskornas uppfattningar av patientsäkerheten under intrahospitala transporter berodde till stor del på deras tidigare erfarenheter. Ett utrymme till förbättringar finns genom ett införande av en checklista samt teamträning i simulerade scenarion. Det är viktigt att säkerställa att patientsäkerheten är hög oberoende av hur erfaren personalen är.

Uppmärksamhet och stöd till intensivvårdspatienters anhöriga kan ibland bli begränsad då sjuksköterskan ofta fokuserar på patientens behov och glömmer bort de anhöriga. Eftersom möten med anhöriga sker frekvent inom sjuksköterskeyrket är det därför viktigt att sjuksköterskan har insikt och förståelse för vad anhöriga upplever som stödjande. På en intensivvårdsavdelning är tillståndet hos patienten ofta kritiskt och de anhöriga behöver stöd för att hantera, förstå och anpassa sig till situationen. Syftet med den strukturerade litteraturstudien är att belysa anhörigas upplevelser av sjuksköterskans stöd inom intensivvård. Sammanlagt har 10 vetenskapliga artiklar såväl med kvalitativ och kvantitativ ansats analyserats tematiskt och analysen gav fyra kategorier, Tillit och förtroende, Närvaro och delaktighet, Tröst och empati samt Tillgänglighet och kontinuitet. Sammanfattningsvis finns det ett stort behov av att få stöd som anhörig. De anhöriga är i allmänhet nöjda med stödet de får av sjuksköterskan inom intensivvården men det behövs ytterligare forskning om vad för stöd som behövs samt hur stödet upplevs av de anhöriga. / The attention and support given to family members at the Intensive Care Unit can sometimes be limited due to that the nurses often focus on the patient's needs and forget about family members needs. Since nurses meet family members on a daily basis it is important for them to know what family members find supportive. The condition of patients at the intensive care unit is often critical and family members need support to cope, understand and adapt to the situation. The aim of the study was to highlight family members´ experiences of support from nurses at the intensive care unit. A structured literature review was conducted in which 10 articles with both qualitative and quantitative design underwent thematic analysis. The analysis gave four categories: Trust and reliance, Presence and participation, Comfort and empathy and Availability and continuity. To sum up; family members at the Intensive Care Unit have a great need of support. Family members are in general satisfied with the support, but there is need for more research in what kind of support they require and how family members experience the support.