Immobility in an Intensive Care Unit (ICU) patient can be extremely detrimental and life-threatening to a person who suffers from a plethora of acute and chronic morbidities. Nurses in the ICU care a great deal about the~ patients, but may not always have the time, the knowledge, or the staffing to mobilize their patients as they should be mobilized. This literature review discusses the importance of mobilizing the ICU patient, what hazards of immobility could occur due to the lack of mobilization and different mobility interventions which are utilized in the ICU. The significance of this is to improve patient outcomes and limit the deconditioning caused by immobility. The writing of this review is an effort to encourage nurses to integrate mobility interventions into their plan of care. Understanding how to use this basic skill in a complex - environment will improve patient putcomes.

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality among young children and adults. This primary injury initiates an inflammatory response that may lead to a secondary brain injury. Nursing care in the critical care setting supports prevention or reduction of secondary injury through control of intracranial pressure (ICP), mean arterial pressure (MAP), and the subsequent cerebral perfusion pressure (CPP). While secondary injury may be preventable, some nursing interventions may contribute to increased ICP and decreased CPP. Patients with increased ICP or decreased CPP are at risk for poor clinical outcomes. This literature review examined the effort of routine nursing care interventions on outcomes of TBI patients in the critical care setting. Eleven research articles studying head of bed elevation, head and neck positioning, turning, and spacing of patient care activities were the focus of the analysis. Results typically showed positive outcomes by elevating the head of the bed to thirty degrees. CPP was also maintained at thirty degrees, but showed varied results. ICP and CPP are best controlled with the head and neck in a neutral position. Turning patients is a routine nursing intervention that contributes to increased ICP in some positions in some patients. Most studies suggest ICP is lowest in the supine position and highest in the left lateral position, but differences in findings were noted. Providing basic nursing care interventions in close succession also may contribute to increases in ICP in some patients. Results from this review provide evidence to support the importance of assessing and planning care for each TBI patient individually. It is hoped that findings from this review will provide guidance for bedside nurses to improve clinical practice and drive future research to support best practices for care of patients who suffer TBI.

Bakgrund Sömnstörningar och fragmenterad sömn förekommer i stor utsträckning bland patienter som vårdas på intensivvårdsavdelningar. Otillräcklig sömn kan leda till längre återhämtningstid och försämrad sömnkvalitet kan kvarstå i flera månader efter utskrivning och till följd av det avsevärt försämra patienters livskvalitet. Syfte Syftet med denna litteraturöversikt var att undersöka vilka omvårdnadsåtgärder som kan främja en god nattsömn för intensivvårdspatienter.  Metod Litteraturöversikt med systematisk ansats baserad på kvantitativa studier. En systematisk litteratursökning gjordes i databaserna PubMed och Cinahl vilket resulterade i 16 artiklar. Artiklarna kvalitetsgranskades sedan och resultatet sammanställdes genom en narrativ analys.  Resultat Totalt inkluderades 16 randomiserade kontrollerade studier som undersökte olika interventioner för att främja sömn. Omvårdnadsåtgärder som sovmask samt öronproppar + sovmask framstod som de mest effektiva interventionerna för att främja god sömnkvalitet. Även aromaterapi och meditation med hjälp av VR ledde till förbättrad sömn. Slutsats För att optimera patienters möjlighet till återhämtning är det viktigt att patienterna får möjlighet till god sömn under vårdtiden. Flertalet omvårdnadsåtgärder som tas upp i litteraturöversikten skulle kunna implementeras på intensivvårdsavdelningar för att förbättra patienters sömnkvalitet.

Bakgrund: Typ 2-diabetes är en kronisk sjukdom som står för 90 procent av alla diabetesfall i världen och beräknas öka de kommande åren, på grund av bland annat ohälsosamma levnadsvanor såsom kost och fysisk aktivitet. Egenvård innebär att patienten tar ansvar och för att hantera det behövs kunskap och stöd från vårdpersonalen. Syfte: att beskriva upplevelser av egenvården vid typ 2-diabetes, med fokus på livsstilsförändringar. Metod: En allmän litteraturöversikt baserad på tolv kvalitativa vetenskapliga artiklar genomfördes. Resultat: Det har framkommit olika upplevelser av egenvården och dessa har kategoriserats i teman med subteman: 1) Känsla av kontroll: Olika uppfattningar av betydelsen av typ 2-diabetes, 2) Upplevelser av livsstilsförändringar: Kostomläggning och Fysisk aktivitet och 3) Upplevelser av omvårdnadsåtgärder: Rådgivning, Motiverande samtal, MI och Gruppbaserad patientutbildning. Slutsats: Att ändra på sin livsstil kan upplevas som krävande och omställningen behöver stödjas och anpassas utefter patientens behov. Klinisk betydelse: Patientens upplevelser av egenvård med behov, krav och brister kan fungera som ett kunskapsverktyg för vårdpersonalen vid omvårdnaden av typ 2-diabetes. / Background: Type 2-Diabetes is a chronic disease that accounts for 90 percent of all diabetes cases in the world and is expected to increase in the upcoming years, due to unhealthy habits such as diet and physical activity. Self-management means that the patient takes responsibility and in order to manage it knowledge is needed and support from caregivers. Objective: To describe the experiences of self-management in Type 2-Diabetes, focusing on lifestyle changes. Method: A literature review based on twelve qualitative scientific articles were conducted. Results: It has turned out that there have been different experiences of self-management and these have been categorized into themes with subthemes: 1) Sense of control: Different views of the importance of Type 2-Diabetes, 2) Experiences of lifestyle changes: Change of diet and Physical activity and 3) Experiences of nursing interventions: Counseling, Motivational interviewing, MI and Group-based patient education. Conclusion: To change the lifestyle may be perceived as demanding and conversion needs to be adjusted to the patient's needs. Clinical significance: Patient’s experiences of self-management with needs, demands and deficiencies can serve as a knowledge tool for the care staff in the care of Type 2-Diabetes.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Purpose: The purpose of this ethnographic study was to describe the culture of care and nonpharmacological nursing interventions performed by NICU nurses for infants with NAS. Background: Infants with NAS are increasingly being cared for in the inpatient hospital setting by NICU nurses. Interventions used for the care of premature and sick infants in the NICU may or may not be the exact interventions that should be used for the care of the fragile infant with NAS. Research studies on the nonpharmacological nursing care of infants with NAS encompass 5 main areas of practice: environment, adequate rest and sleep, feeding, assessment and evaluation using Finnegan scoring by nurses, and nurses as caregivers. Method: Roper and Shapira’s (2000) framework for the analysis of ethnographic data was used for this research and included participant observation, individual interviews, and the examination to existing documents. Data analysis included: (a) coding for descriptive labels, (b) sorting to identify patterns, (c) identification of outliers or negative cases, (d) generalizing constructs and theories, and (e) memoing to note personal reflection and insights. Focused ethnography allows for the articulation of research questions before fieldwork while observing and describing a culture. Results: Five themes emerged from the data: learn the baby (routine care, comfort care, environment, adequate rest and sleep, feeding), core team relationships (support, interpersonal relationships), role satisfaction (nurturer or comforter, becoming an expert), grief, and making a difference (wonderful insanity, critical to them). Implications: The results of this were a description of the culture of care provided to infants with NAS by NICU nurses and provide general recommendations to the nurse caring for an infant with NAS in the areas of environment, adequate sleep and rest, feeding, and the role of the nurse. This study also has implications for future study of evidence-based research strategies to decrease withdrawal symptoms in infants with NAS. Research is needed in the areas of clinical practice guidelines to help the bedside nurse care for these infants using current research and evidence for practice. Nursing theory and nursing education both contribute to nursing research in how to better understand the culture of care provided by nurses.

<p>In addition to all our soldiers and officers who do military services abroad there are a lot of people who are affected by their choice to contribute, namely their next of kin. This report deals only with those who are next of kin to those who perform service abroad. The purpose of this study is to investigate the relatives' need for emotional and social support as well as practical and economical support. The main question is What kind of practical/economical and emotional/social support do close relatives require when a relative does military service abroad? The method used in this paper is a qualitative research interview. Interviews have been made with four women, who are next of kin to soldiers and officers who are or have been abroad for military services during the last two years. The result of this study is that all respondents have a need for emotional / social support linked to their partner’s deployment abroad; however, people require different types of support. Regarding practical / financial support the informants' needs differ, this is due to their different living situations.</p>

In addition to all our soldiers and officers who do military services abroad there are a lot of people who are affected by their choice to contribute, namely their next of kin. This report deals only with those who are next of kin to those who perform service abroad. The purpose of this study is to investigate the relatives' need for emotional and social support as well as practical and economical support. The main question is What kind of practical/economical and emotional/social support do close relatives require when a relative does military service abroad? The method used in this paper is a qualitative research interview. Interviews have been made with four women, who are next of kin to soldiers and officers who are or have been abroad for military services during the last two years. The result of this study is that all respondents have a need for emotional / social support linked to their partner’s deployment abroad; however, people require different types of support. Regarding practical / financial support the informants' needs differ, this is due to their different living situations.

SAMMANFATTNING Bakgrund Traumatisk skallskada drabbar relativt många och leder till personligt lidande och finansiell belastning för individ och samhälle då majoriteten får en svår till medelsvår funktionsnedsättning efter vårdtiden. På 1970-talet påvisades ett signifikant samband mellan högt ICP och sekundära hjärnskador. I studier där ICP &gt;20 mmHg har förekommit kunde signifikant sämre utfall ses. Syfte Syftet med studien var att med hjälp av omvårdnadsprocessen observera intensivvårdssjuksköterskans identifiering och vidtagande av omvårdnadsåtgärder vid ett högt ICP samt utvärdera de utförda omvårdnadsåtgärderna.  Metod Prospektiv tvärsnittsundersökning, där sju intensivvårdssjuksköterskor och fem patienter observerades med hjälp av ett observationsformulär. Resultat 51(73 %) av de höga ICP normaliserades inom en minut och intensivvårdssjuksköterskan uppskattades ha observerat högt ICP i 50(71 %) av tillfällena inom en minut. 19(27 %) tillfällen observerades inte och 11(65 %) av omvårdnadsåtgärderna skedde inom en minut. Omvårdnadsåtgärder som utfördes var administrering av bolusdos med läkemedel (35 %) eller dränera likvor (35 %). Efter utförd omvårdnadsåtgärd normaliserades högt ICP inom en till två minuter, 7(41 %), och 4(24 %) normaliserades inom två till tre minuter. Slutsats Majoriteten av tillfällena med högt ICP uppmärksammades inom en minut och vanligast förkommande omvårdnadsåtgärderna var administrering av bolusdos sederande läkemedel eller dränera likvor. Av de tillfällen med intrakraniell hypertension som inte blev observerade var enbart ett par tillfällen ihållande i längre än en minut och samtliga normaliserades spontant inom två minuter. Intensivvårdssjuksköterskorna identifierade och effektivt åtgärdade intrakraniell hypertension snabbt, vilket kan bidra till ett bättre utfall för patienterna. / ABSTRACT Background Due to traumatic brain injury a financial burden is placed on the individual as well as the society and personal suffering also occurs. A significant correlation between elevated ICP and secondary injury was found in the 1970s. Significantly worse outcome was found in a numerous of studies where ICP &gt;20mmHg occurred. Objective The aim of this study was to observe intensive care nurses nursing interventions and its efficiency to decrease ICP by using Orem’s Self-care deficit theory. Methods A prospective observational study. Seven intensive care nurses and five patients were observed. Results 51(73%) of the observed ICP &gt;20mmHg were normalized within the minute. The intensive care nurses were estimated to have observed an on-going intracranial hypertension in 50(71 %) within the minute. 19(27 %) went unnoticed and 11(65 %) of the nursing interventions were executed within the minute. Nursing interventions executed were administration of a sedative (35 %), drainage of cerebrospinal fluid (35 %). Elevated ICP was normalized in 7(41 %) within two minutes and 4(24 %) within three minutes due to the nursing intervention. Conclusion Intensive care nurses noticed the majority of occasions with elevated ICP within one minute. The most commonly used nursing intervention was to administrate a sedative or to drain cerebrospinal fluid. All of the elevated ICP that went unnoticed normalized spontaneously within two minutes. The fast identification of and treated intracranial hypertension are likely to have contributed positively in the patient’s outcome.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal