Purpose: To analyze the strategies that Elizabeth Kenny, an Australian nurse, used when trying to obtain medical endorsement for an innovation that was not based on knowledge of pathology, but was empirically demonstrated. Significance: When faced with the need to "Do the best you can with the symptoms presenting themselves," Kenny used keen observation to develop a new treatment for poliomyelitis in the early 1900s. Her innovation was to use hot packs to relieve muscle spasms in people with early symptoms of poliomyelitis when orthodox medical treatment included use of splints or casts to immobilize affected limbs. Method: Historical case analysis. Findings and Conclusions: Sister Kenny made bold assertions, obtained scientific validation, learned from experience, used publicity, and opposed resistance. Although some strategies were unsuccessful (and Kenny faced many obstacles) medical practice changed in a relatively short time. Immobilization of limbs was largely discontinued in the acute stage of the disease. Kenny persisted in caring for children who otherwise might have sustained deformities.

The overall aim of the present thesis was to study aspects of patient safety in critically ill patients with special focus on airway management, respiratory complications and nursing procedures. Study I describes a method called pharyngeal oxygen administration during intubation in an experimental acute lung injury model. The study showed that pharyngeal oxygenation prevented or considerably increased the time to life-threatening hypoxemia at shunt fractions by at least up to 25% and that this technique could be implemented in airway algorithms for the intubation of hypoxemic patients. In study II, we investigated short-term disconnection of the expiratory circuit from the ventilator during filter exchange in critically ill patients. We demonstrated that when using pressure modes in the ventilator, there was no indication of any significant deterioration in the patient's lung function. A bench test suggests that this result is explained by auto-triggering with high inspiratory flows during the filter exchange, maintaining the airway pressure. Study III was a clinical observational study of critically ill patients in which adverse events were studied in connection with routine nursing procedures. We found that adverse events were common, not well documented, and potentially harmful, indicating that it is important to weigh the risks and benefits of routine nursing when caring for unstable, critically ill patients. In study IV, we conducted a retrospective database study in patients with pelvis fractures treated in the intensive care unit. We found that the incidence of respiratory failure was high, that the procedure involved in surgical stabilization affected the respiratory status in patients with lung contusion, and that the mortality was low and probably not influenced by the respiratory condition. In conclusion, the results obtained in the present thesis have increase our knowledge in important areas in the most severely ill patients and have underlined the need for improvements in the field of patient safety.

Made available in DSpace on 2014-12-17T14:47:00Z (GMT). No. of bitstreams: 1 CleideOG.pdf: 288697 bytes, checksum: 0b8e726a67bd9d076f068bfe2b8e42ae (MD5) Previous issue date: 2004-12-08 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / To study the teaching/learning process about the Nursing procedures carried out in the laboratory, and learn both the sapiens and the demens dimensions of such process, is the main purpose of this study. The objectives are to: identify the major laboratory contributions to the teaching/learning process from the point of view of undergraduate students and the feelings they express; describe the difficulties they have identified; and analyze the relevance of the laboratory to this process. As part of the inquiry procedure, four core group meetings were held with 26 undergraduate students who had completed the course on Semiology and Semiotics in Nursing, which is the course where the Nursing laboratory is most needed as a learning space. The analysis, based on a qualitative approach, had as fundamental theoretical support studies made by Friedlander and Hayashida, who deal with learning/teaching in the Nursing laboratory, and by authors who favor humanization in teaching such as, among others, Freire, Maturana, Morin, Assmann. Results point toward the relevance of the Nursing laboratory as a facilitator for the learning/teaching process. In their speech the students repeatedly state that the development of procedures in simulated situations enable them to become more self-assured and technically prepared for caring. In addition, they emphasize that feelings such as fear, lack of confidence, anxiety, anguish and panic become diminished at the time of their clinic experience when they have had previous learning in the laboratory. They have also acknowledged that some difficulties of structural nature have become obstacles to a high-quality learning development. In summary, in spite of the difficulties that have been pointed out by the students concerning the use of the Nursing laboratory in the learning/teaching process, they also recognize that this is the locus par excellence where they can develop their skills and appease their anxieties / Estudar o processo ensino/aprendizagem acerca dos procedimentos de Enfermagem desenvolvidos no laborat?rio, apreendendo as dimens?es sapiens e demens desse processo, ? o prop?sito principal deste estudo. Tem como objetivos identificar as principais contribui??es do laborat?rio de Enfermagem no processo ensino/aprendizagem, a partir da vis?o de estudantes de gradua??o, os sentimentos que eles expressam, descrever as dificuldades identificadas por estes e analisar a import?ncia do laborat?rio nesse processo. Como procedimento de investiga??o, realizamos quatro reuni?es de grupo focal com 26 estudantes de gradua??o que haviam conclu?do a disciplina de Semiologia e Semiot?cnica em Enfermagem, aquela que mais utiliza o laborat?rio de Enfermagem como o principal espa?o de sua aprendizagem. A an?lise, de abordagem qualitativa, teve como aporte te?rico fundamental os estudos de Friedlander e Hayashida, que tratam do ensino/aprendizagem no laborat?rio de Enfermagem, e autores que privilegiam a humaniza??o no ensino como Freire, Maturana, Morin, Assmann, entre outros. Os resultados apontam a import?ncia do laborat?rio de Enfermagem como facilitador do processo ensinar/aprender. Os estudantes, em suas falas, afirmam e reafirmam que a realiza??o de pr?ticas em situa??es simuladas torna-os mais seguros e preparados tecnicamente para o cuidar. Al?m disso, ressaltam que os sentimentos de medo, inseguran?a, ansiedade, ang?stia e p?nico, entre outros, s?o atenuados por ocasi?o da experi?ncia cl?nica quando antes vivenciam a aprendizagem no laborat?rio. Constatam, igualmente, algumas dificuldades de ordem estrutural que constituem obst?culos ao bom desenvolvimento da aprendizagem. Em s?ntese, apesar das dificuldades apontadas pelos estudantes, em rela??o ao uso do laborat?rio de Enfermagem no processo ensino/aprendizagem, os mesmos reconhecem ser este o l?cus por excel?ncia para o desenvolvimento das habilidades e diminui??o de suas tens?es

In the presented diploma thesis I deal with the issue of proper insertion of short-term central venous catheters, adherence to procedures by medical and non-medical staff according to CDC guidelines 2011 during insertion and subsequent treatment in intensive care in a faculty-type medical facility. The aim of the diploma thesis is to determine the occurrence of complications, especially infectious, the level of adherence to recommended procedures in practice according to 2011 CDC guidelines, central venous catheter manipulation, comparison of real activities with recommendations and mapping the level of knowledge of non-medical staff about short-term central venous catheters. The theoretical part deals with the importance of clinical guidelines, central venous catheter in general, complications associated with the central venous catheter and prevention of infectious complications of invasive inputs. For the empirical part of the diploma thesis, a prospective non- randomized observational study of cannulation and possible complications associated with a short- term central venous catheter according to CDC 2011 guidelines was chosen to determine real procedures for insertion, treatment and removal of a short-term central venous catheter. This was supplemented by an exploratory questionnaire survey of...

The development of medicine and technology related to the level of healthcare as a whole is historically accompanied with changes in nursing practices that have increased their demands over the years. This caused a specific need for the diversification of nursing activities and their specialization. The aim of this work is to map out specialized nursing processes of the field of internal medicine from their formation to the present, showing healthcare as a progressive sector, where new knowledge and technologies induce the need for new activities that the medical nursing staff must manage for the benefit of the patient. This basic objective will be documented in selected specialized nursing care activities divided into three professional sections - development of oxygen therapy, catheterization of the bladder and venous blood collection. The basis for the diploma thesis is the development of specialization of nursing practices on the basis of economic, political, cultural or religious influence. The results of the research show that the development of nursing practices has been constantly changing since their inception, not only in connection with the development and availability of quality aids, but also by the effort to create the most effective nursing process with regard to the needs of the patient as well as the non-medical medical staff. The diploma thesis also shows the professional competencies that have been added to the general nurses in the context of time. In the first part, dealing with the development of oxygen therapy, there is considerable interconnection of this process with the war period. There was also a significant difference in the distinctions in competences in the provision of oxygen therapy to nurses in the Czech Republic and abroad. Despite the fact that the non-medical healthcare professionals is currently preparing and subsequently applying Oxygen treatment on their own, they can only do so on the basis of a doctor's office. In contrast, for example, in the 1930s, in the USA, the nurse was regulating the oxygen alone within its competencies. The second part of the diploma thesis was oriented on the characteristics of the development of bladder catheterization. Particularly in this section is the development of nursing competencies, as it was just bladder catheterization, which in history was the sole competence of an experienced physician. The diploma thesis demonstrates not only the development of the procedure, the aids, the reduction of risks accompanying this method, but also the gradual assistance of the non-medical medical staff until the definition of the period when they are fully competent to perform this task. The last part of the diploma thesis is focused on the development of venous blood collection in order to obtain sufficient quantity for blood analysis. In this area, is not onlz the development of the nursing process in connection with the technique or aids, but also the necessity of observing the aseptic approach. The result of the presented work represents a significant contribution, because only with the knowledge of nursing techniques in the whole range, people can avoid mistakes from history. Also, the view of the selected nursing practice in the context of time brings knowledge of the inactivity of development and is thus the undisputed motivation of non-medical health personnel to participate in the constant innovation of nursing practices and thus to deepen the specialization and level of nursing care.

Patienter som genomgår laparoskopiska ingrepp sövs med anestesiläkemedel och behöver administration av intravenösa vätskor och inblåsning av koldioxidgas i bukhålan under operationen. Ju längre anestesitid och ju längre tid det laparoskopiska ingreppet tar desto större är risken att patienter drabbas av perioperativ hypotermi. Icke-invasiva och invasiva uppvärmningsmetoder visar kunna förebygga perioperativ hypotermin och de postoperativa komplikationer som associeras med hypotermiuppkomst vid laparoskopiska ingrepp.Syfte: Syftet är att beskriva omvårdnadsåtgärder som kan förebygga uppkomsten av perioperativ hypotermi och dess postoperativa komplikationer hos patienter som genomgår laparoskopisk kirurgi. Metod: En integrativ litteraturöversikt. Resultat: Studien visar att icke-invasiva och invasiva uppvärmningsåtgärder kan förebygga perioperativ hypotermi och minska de postoperativa komplikationerna associerade med hypotermi vid laparoskopisk kirurgi. Forcerad varmluftsbehandling visar sig vara den mest effektiva metoden för att förebygga perioperativ hypotermi. Andra icke-invasiva och invasiva värmebehandlingar är effektiva när de kombineras med varandra men inte när de administreras enskilt.Uppvärmningsmetoder visar sig förebygga uppkomst av hypotermi, bibehålla intraoperativ normotermi, öka komfort, minska postoperativa komplikationer vilket även leder till bättre återhämtning hos patienter som genomgår laparoskopisk kirurgi. Slutsats: Denna studie belyser att uppvärmnings åtgärder med invasiva och icke-invasiva uppvärmningsmetoder kan behandla och förebygga hypotermiuppkomst under den perioperativa perioden hos patienter som genomgår laparoskopisk kirurgi. Studien även visar att dessa uppvärmningsmetoder förebygger även de postoperativa komplikationer som associeras med perioperativ hypotermin vid laparoskopisk kirurgiuppkomst. / Patients undergoing laparoscopic procedures need anesthetics, intravenous fluids and insufflation of carbon dioxide gas during laparoscopic surgery. The larger the time of the anesthesia and the laparoscopic procedure is, the greater is the risk of the patients being affected by perioperative hypothermia. Non-invasive and invasive warming methods can prevent the onset of perioperative hypothermia during laparoscopic surgery. Purpose: The aim of the study is to describe the nursing interventions that can prevent the onset of perioperative hypothermia and its postoperative complications during laparoscopic surgery. Method: An integrative review. Result: The study indicates that non-invasive and invasive warming methods can prevent the onset of perioperative hypothermia and complications during laparoscopic surgery. Forced air warming turns out to be the most effective treatment to prevent perioperative hypothermia. Invasive and non-invasive warming treatments seem to be more effective in combination with each other to prevent perioperative hypothermia than when administered alone. These treatments prevent intraoperative hypothermia, maintain intraoperative normothermia, increase comfort, decrease postoperative complications and improve patient recovery after laparoscopic surgery. Conclusions: This study illustrates that non-invasive and invasive warming methods can treat and prevent the onset of perioperative hypothermia during laparoscopic surgery. The study even illustrates that these warming methods prevent the postoperative complications associated with perioperative hypothermia during laparoscopic surgery.