Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.S.)--University of Michigan, 1990.

The research objective was: to determine (a) the extent of the present involvement of neonatal intensive care nurses in technology assessment, (b) their perceptions of the technologies with which they worked, and (c) their perceptions of requirements for improvements in the technology assessment process. Nurses and senior staff (nursing s.u perv.i sors, NICU consultants and training officers) ln the neonatal intensive care units (NICUs) of five hospitals in London were included in the study sample. They completed questions regarding new medical technologies in general and NICU technologies in particular. Nurses and senior does not prepare Further, in some training regarding staff believed that nurses' training them adequately for new technologies. instances, nurses had not received a new technology prior to using it. Neither nurses nor senior staff were fully aware of formal processes for technology assessment in their hospitals, but did identify informal processes. While a small minority of the nurses had been directly involved in decisions regarding the new technologies, more than half had made recommendations. The nurses considered their level of involvement unsatisfactory, and believed (as did the senior staff) that their hospital could improve its procedures for purchasing, introducing and using new technologies. Most of the nurses who were planning to remain in neonatal intensive care were dissatisfied with their involvement and with their hospital's methods for adopting new technologies. One-third of the nurses and most of the senior staff identified examples of nurses' having contributed to the development and adaptation of new equipment and procedures, either formally or informally. The impacts considered most significant by nurse participants were: job stress, increased ethical, legal or social concerns, and decreased reliance on clinical judgment or skills of nurses.

Bakgrund: När sjukvården till stor del förlitar sig på medicinsk teknik och läkemedelsbehandling är det lätt att omvårdnadsåtgärder som syftar till att förebygga och lindra lidande inte ges tillräckligt utrymme. Intensivvårdsdelirium är ett förhållandevis outforskat område inom barnintensivvården. Idag finns inga riskskattningsinstrument översatta till svenska.   Syfte: Syftet var att studera barns beteenden när de vårdades på en barnintensivvårdsavdelning. Dessutom undersöktes om dessa beteenden kunde användas för att besvara frågor från ett engelskspråkigt riskskattningsinstrument för delirium.   Metod: Studien utfördes som en fokuserad etnografisk observationsstudie där sju patienter på en barnintensivvårdsavdelning observerades under tre timmar vardera. Utifrån observationernas fältanteckningar gjordes en innehållsanalys med fokus på manifest innehåll. I ett andra steg utfördes en deduktiv analys där kategorierna från fältanteckningarna jämfördes mot frågor från riskskattningsinstrumentet för delirium.   Resultat: Innehållsanalysen av fältanteckningarna resulterade i åtta kategorier som representerade barnens beteende under observationerna: reagerar på vårdhandling, förmedlar fysiska behov, förmedlar smärta, svarar på fråga, sysselsätter sig själv, stimuleras av underhållning, uppmärksammar omgivningen och väcks av stimuli. Den deduktiva innehållsanalysen visade att fyra av de åtta frågorna från riskskattningsinstrumentet kunde besvaras med hjälp av kategorierna.   Slutsats: Urvalet bestod av en homogen subgrupp där inga beteenden med tydlig koppling till risk för delirium kunde observeras. Miljörelaterade riskfaktorer för delirium i form av frekventa vårdhandlingar, höga ljud och störd sömn förekom. Trots att denna grupp patienter inte visade tecken på delirium kan förebyggande av dessa störningar leda till minskat vårdlidande. Barnintensivvården kan ytterligare minska vårdlidande genom att öka föräldrarnas möjligheter att vara hos sitt sjuka barn dygnet runt. / Background: Nursing and preventive measures may be overlooked when health care in large relies on medical technology and medical treatment. Intensive care delirium is a relatively unexplored area in pediatric intensive care. There are currently no risk assessment tools translated to Swedish.   Aim: The objective was to study children's behaviour when they were cared for in a pediatric intensive care unit. In addition, it was questioned whether these behaviours where able to answer questions originating from an English language risk assessment tool for delirium.   Method: Using focused ethnographic observation seven patients were observed during three hours each. Content analysis was performed on the field notes from the observations with focus on manifest content. As a second step, a deductive analysis compared the categories with questions from the risk assessment tool for delirium.   Findings: The content analysis of field notes resulted in eight categories which represented the children’s behavior during the observations: reacting to care, expressing physical needs, expressing pain, answering question, occupying oneself, stimulated by entertainment, observing the surroundings and awakened by stimulus. The deductive analysis showed that four of the eight questions from the risk assessment tool could be answered with the categories.   Conclusion: The selection consisted of a homogenous subgroup where no obvious behaviors related to risk of delirium was observed. Environmental risk factors for delirium such as frequent care related interventions, loud noise and disturbed sleep where observed. Despite that, prevention of these disturbances could reduce health care related suffering even though this group of patients did not show signs of delirium. Pediatric intensive care units can further reduce healthcare related suffering by enabling families to be present with their sick child during all hours of the day and night.

published_or_final_version / Community Medicine / Master / Master of Public Health

This thesis focuses on the explanation of anomalies as an approach to anomaly-driven revision of a theory. An anomaly is identified when a theory (or model of a domain) does not accurately reflect a domain observation, indicating that the theory (or model) requires refinement. In some cases an explanation can be generated for an anomalous observation using existing domain knowledge and hence a revision to the existing theory can be provided. Ontologies have been used in both stages of an investigation presented in this thesis; in the first stage, a domain ontology and expert-acquired strategies have been used as part of a knowledge-based system, EIRA (Explaining, Inferencing, and Reasoning about Anomalies), to generate explanations for an anomaly; in the second stage, domain ontologies have been used to suggest refinements to an incorrect or incomplete domain ontology. In the first stage of the investigation, extensive interviews were held with domain experts; the analysis of which led to the identification of both examples of anomalies encountered in the domain and the strategies used by the domain experts to provide (appropriate) explanations for the anomalies. EIRA is able to replicate these explanations; when EIRA is presented with an anomaly, potential explanations are generated by the application of expert-acquired strategies to the domain knowledge, patient data, and information about the clinical situation. To evaluate this approach, EIRA has been applied in the Intensive Care Unit (ICU) domain and ICU clinicians have evaluated the explanations produced by EIRA. The strategies used by EIRA have been abstracted further to form generic strategies for anomaly resolution. In the second stage, EIRA has been extended to investigate the use of domain ontologies to suggest refinements to an incomplete or incorrect ontology. These additional refinements are generated by reasoning about analogous concepts from the domain ontology. The findings described in this thesis support the belief that ontologies can be used to generate explanations to refine a theory, further, that the extensive domain knowledge contained in an ontology allows for sophisticated refinements of a knowledge base. Previous approaches to theory revision have largely focused on the refinement of an instantiated rule base, in which limited domain knowledge is incorporated in the rules and hence the refinements are essentially captured in a particular knowledge base. In these earlier approaches, refinements to remove the anomaly were generally suggested after applying machine learning techniques on data from the domain; however, this process requires large datasets, the refinements generated are not always acceptable to domain experts, and providing explanations (using an ontology) to account for anomalies have not been investigated. I believe that the findings reported in this thesis are significant and make a number of contributions including a novel approach to anomaly-driven revision of a theory.

Samfattning   Bakgrund: I vår vardag världen över drabbas människor oavsett kön och ålder av olyckor, dödsfall och andra traumatiska händelser. Vissa yrken medför en större risk att utsättas för traumatiska händelser. Exempel på dessa är ambulans, räddningspersonal, polis och vårdpersonal inom främst akutsjukvård. Dessa händelser kan ibland bli personen övermäktigt. Ett sätt att motverka bl.a. utbrändhet och posttraumatiskt stressymptom (PTSD) hos vårdpersonalen är att genomföra debriefingsamtal. Detta genomförs med den vårdpersonal som varit delaktig i en traumatisk händelse.     Syfte: Syftet med denna studie var att beskriva erfarenheten av debriefing hos vårdpersonal inom akutsjukvården i samband med traumatiska händelser i sin yrkesutövning.   Metod: Litteraturstudie som totalt innehåller 10 vetenskapliga artiklar varav fem är kvalitativa och fem är kvantitativa.   Resultat: Studieresultatet påvisar att debriefing uppfattas som ett positiv redskap när det gäller avlastning efter en traumatisk händelse för vårdpersonalen inom akutsjukvården. De främsta faktorerna som lyfts i studien är tid och plats för debriefing, debriefingens inverkan på kommunikationen mellan vårdpersonalen, val av debriefingledare och behovet av väl utformade riktlinjer för debriefingen.   Slutsats: I föreliggande studie påvisas att debriefing bör betraktas som ett effektivt verktyg att motverka psykisk ohälsa hos vårdpersonalen och att debriefing även förstärker kommunikationen mellan de olika professionella yrkesgrupperna inom akutsjukvården. Studien visar även att det är viktigt med väl utformade riktlinjer för att debriefingens syfte skall uppnås. / Abstract Background: In our everyday lives worldwide, people are affected regardless of gender and age by accidents, deaths and other traumatic events. Some professions involve a greater risk of being exposed to traumatic events. Examples of these are ambulance, emergency personnel, police and health care personnel, primarily in emergency care. These events can sometimes become overpowering. One way to counteract burnout and post-traumatic stress symptom (PTSD) in healthcare professionals is to carry out debriefing talks. This is done with the healthcare staff who has participated in a traumatic event.   Aim: The purpose of this study was to describe the experience of debriefing in healthcare professionals in emergency care in connection with traumatic events in their professional practice.   Method: Literature study that contains a total of 10 scientific articles, five of which are qualitative and five are quantitative.   Results: The study results show that debriefing is perceived as a positive tool when it comes to unloading after a traumatic event for the healthcare staff in emergency care. The main factors raised in the study are time and place for debriefing, debriefing impact on the communication between the healthcare staff, the choice of debriefing leader and the need for well-designed guidelines for debriefing.   Conclusion: The present study demonstrates that debriefing should be regarded as an effective tool for counteracting mental illness in the healthcare staff and that debriefing also reinforces communication between the various professional occupational groups in emergency care. The study also shows that well-designed guidelines are important for achieving the purpose of the debriefing.

Thesis submitted in fulfillment of the requirements for the degree of Masters of Science in Nursing, Faculty of Community and Health Sciences, Department of Nursing Education, University of the Witwatersrand Johannesburg, 2012 / Studies generally agree the survival of the mechanically ventilated patient in the ICU is largely reliant upon the competence of the nurse undertaking this highly specialized role (Alphonso,Quinones,Mishra,et al. 2004; Burns 2005) However, an audit undertaken by the Critical Care Society of Southern Africa (2004) revealed that 75 % of nurses working in ICU are inexperienced and do not hold an ICU qualification, and as such are unlikely to have acquired the level of competency required to care for the mechanically ventilated patient (Binnekade 2004). A high index of suspicion exists around the competence levels of nurses‟ currently working in ICU in SA as revealed by local studies (Khoza & Ehlers 1998; Scribante & Bhagwanjee 2003; Moeti, van Niekerk, van Velden, 2004; Morolong & Chabeli 2005; Windsor 2005; Perrie & Schmollgruber 2010). The purpose of the study was to determine and describe the level of competence with regard to mechanical ventilation, of nurses working in ICU, who have varying years of experience and training backgrounds, using study specific designed clinical vignettes, in two tertiary healthcare institutions in Gauteng. A descriptive two phase design was utilized for the study. Phase one comprised the development and validation of three clinical vignettes to determine the level of competence of nurses working in ICU‟s with regard to mechanical ventilation. A modified Delphi technique technique using purposively sampled experts from medical technical and nursing backgrounds was used to validate the three clinical vignettes. Content validity was strengthened by computing CVI of the instrument. In Phase two consecutive sampling was used, and data collection comprised of participants (n=136) completing three validated clinical vignettes in the ICU‟s of two tertiary healthcare institutions in Gauteng. All nurses who participated in the study completed the same three clinical vignettes and demographic data. Nurses‟ perceptions regarding their own level of competence with regard to mechanical ventilation were quantified and compared with actual scores achieved in the clinical vignettes. Descriptive and inferential statistics were used to analyse the data. The level of significance was set at <0,05 and confidence levels at 95%. The competency indicator for the vignettes was set at 75% by the expert group, and nurses‟ level of competence was graded according to vignette score outcomes using a grading scale. Statistical assistance was obtained from a statistician from the Medical Research Council (MRC). Results: Results of the study showed that nurses regardless of training background, age, or experience showed a poor level of knowledge, the average score being 48% for ICU qualified nurses and 31% for non-ICU qualified nurses. There was a small significant difference between ICU qualified and non-ICU qualified nurses‟ competence levels in mechanical ventilation when analysed using a two tailed- t- test (p=0.039). Nurses also experienced a misperception regarding their own competence levels in mechanical ventilation when compared to their actual competence levels as determined by three clinical vignettes.

Cartas al editor / Revisión por pares

Background: Critical care nurses (CCNs) frequently provide end-of-life care for critically ill patients. CCNs may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care. Objective: What are the predominant themes noted when CCNs share their experiences of common obstacles, relating to families in providing EOL care? Methods: A random geographically dispersed sample of 2,000 members of the American Association of Critical-Care Nurses was surveyed. Responses from a qualitative question on the questionnaire were analyzed. Results: Sixty-seven EOL obstacle experiences surrounding issues with families' behavior were analyzed for this study. Experiences were categorized into 8 themes. Top three common obstacle experiences included families in denial, families going against patient wishes and advance directives, and families directing care which negatively impacted patients. Conclusions: In overcoming EOL obstacles, it may be beneficial to have proactive family meetings to align treatment goals and to involve palliative care earlier in the ICU stay.