Abstract The elderly use drugs more commonly than younger persons. Many studies about drug use have concentrated on institutionalized elders. Knowledge of drug use by the oldest old, aged 85 years or over, is scant. Psychotropics are among the drugs most commonly used by the elderly. Psychotropics have many adverse effects, such as balance impairment, sedation, reduced cognition, depression, and extrapyramidal symptoms. We do not know the extent of sedative drug use, including psychotropics and drugs prescribed for somatic disorders that have sedative properties. Withdrawal of unnecessary drugs appears to be beneficial and to improve the functional capacities of the elderly. The aim of this study was to describe the changes in prescription drug use, polypharmacy, and psychotropic use among home-dwelling elderly Finns in the 1990s by using two cross-sectional community surveys. The specific aim was to classify all drugs used in Finland into four groups based on their sedative properties. Drug use, polypharmacy, and, to some extent, psychotropic use increased within a decade. The oldest old used prescription drugs most commonly. Polypharmacy was independently associated with higher age, and in 1998-99, with at least 3 chronic diseases, poor self-perceived health, and the use of home nursing services. Most psychotropic users were on regular medication. The use of hypnotics and antidepressants increased most. Persons with polypharmacy used significantly more commonly psychotropics compared to other people. Over 84-year-olds used psychotropics more commonly than younger persons. Sedative use was common, as 40 % of drug users used them. Sedative use was significantly more common among persons with polypharmacy than others. According to logistic regression models, the use of many sedatives was independently associated with age 80 years or over, female gender, chronic morbidity, smoking, poor self-perceived health/life satisfaction, and the use of home nursing. Both polypharmacy and abundant sedative use were associated with impaired physical functional abilities. Prescribers need to be aware of the increasing polypharmacy and abundant sedative use. Regular assessment of indications is needed to avoid overuse of drugs. Geriatric knowledge is needed to support health centers and specialized units in this demanding task.

Notre recherche concerne les conditions d'acceptabilité de différents moyens de traiter la douleur dans les soins palliatifs, par les professionnels de santé et le grand public. Deux moyens sont étudiés : l’utilisation d’antalgiques, notamment de palier III ; la mise en œuvre d’une sédation. Notre recherche est basée sur la Théorie Fonctionnelle de la cognition de Norman Anderson (1981). Concernant l'étude portant sur l’utilisation des antalgiques : 192 participants ont jugé du degré d'acceptabilité de chacun des 56 scénarios proposés, résultant de la combinaison de quatre facteurs : « concertation du médecin avec l’équipe de soins », « demande de la personne à être soulagée de sa douleur », « niveau de douleur, exprimé grâce à l’échelle numérique de douleur », « décision du médecin en termes de prescription d’antalgique ». Pour l'étude portant sur la sédation : 192 personnes ont jugé du degré d'acceptabilité des 48 scénarios proposés. Ils sont le résultat de la combinaison des quatre facteurs suivants : « demande de la personne », « type de sédation », « espérance de vie », « concertation du médecin avec l’équipe de soins ». Pour l’étude portant sur l’utilisation des antalgiques, notamment de palier III, il ressort que seuls trois des facteurs manipulés ont joué un rôle dans l’acceptabilité de la décision du médecin. Il s’agit par ordre croissant des facteurs « niveau de douleur », « décision du médecin » et « concertation du médecin ». Le facteur le moins influent puisque n’ayant pas eu d’effet significatif est le facteur « demande de la personne ». L’analyse en clusters nous a également permis de discriminer 6 groupes de participants, ayant chacun leur propre politique de jugement. Concernant l’étude sur la sédation, nous retrouvons également que trois des quatre facteurs manipulés ont eu une influence sur le jugement d’acceptabilité. Par ordre croissant, il s’agit des facteurs « demande de la personne », « type de sédation » et « concertation du médecin ». Le facteur « espérance de vie » n’a pas eu d’effet significatif. L’analyse en clusters nous a permis de différencier 4 classes de participants, se regroupant selon leur politique de jugement. L'acceptabilité des différents moyens utilisés pour soulager la douleur en fin de vie est largement influencée par les facteurs intervenant dans les scénarios. / Our research concerns the conditions of acceptance of different ways to treat pain in palliative care by health professionals and laypeople. Two ways are studied: the use of analgesic, including strong opioids ; implementation of sedation. Our research is based on the Functional Theory of Cognition by Norman Anderson (1981). On the study on the use of analgesics : 192 participants rated the degree of acceptability of each of the 56 proposed scenarios, resulting from the combination of four factors: « decision-making process », « request of the person to be relieved of his pain », « pain level, expressed through digital pain scale », « decision of the physician in terms of painkiller prescription ». For the study of sedation : 192 people judged the acceptability of the 48 proposed scenarios. They are the result of four factors combination: « request for sedation », « type of sedation », « life expectancy », « decision-making process ». In the study on the use of painkillers, especially strong opioids, it appears that only three of the manipulated factors played a role in the acceptability of the doctor's decision. The result by ascending order of the factors is: « pain level », « decision » and « decision-making process ». The less influential factor, since having no significant effect, is the factor « request ». The analysis in clusters also allowed us to discriminate 6 groups of participants, each with their own political judgment. Regarding the study on sedation, we also find that three of the four manipulated factors had influenced the judgment of acceptability. In ascending order, these factors are « request », « type of sedation » and « decision-making process ». The « life expectancy » factor had no significant effect. The analysis in clusters enabled us to distinguish 4 classes of participants, coming together according to their political judgment. The acceptability of the various means used to relieve pain in later life is largely influenced by the factors involved in the scenarios.

Bakgrund och syfte: Anestesiologisk omvårdnad utförs av anestesisjuksköterskan perioperativt. Anestesisjuksköterskan ansvarar för att i samråd med patient och närstående identifiera perioperativa vårdbehov, upprätta en omvårdnadsplan, leda och utvärdera omvårdnadsåtgärder. Vid all vård av patienter ska patientjournal föras. Anestesisjuksköterskan ska både muntligen och skriftligen rapportera, dokumentera och utvärdera den perioperativa vården. Sedering har lugnande effekt, ökar acceptansen av obehag och ger viss amnesi. Sedering är ett utmärkt komplement till regionalanestesi och lokalanestesi. Människor reagerar inte likadant på samma mängd läkemedel. Därför måste både dosen som ges och effekten av denna observeras och utvärderas. Vid administrering av sedativa läkemedel är övervakning av patientens mycket viktig. Pilotstudiens syfte var att beskriva anestesisjuksköterskans uppfattningar om och tillvägagångssätt vid sedering. Metod: En kvantitativ empirisk studie genomfördes med en enkät konstruerad för studiens syfte, 63 anestesisjuksköterskor tilldelades enkäten. Resultat: Sederingspraxis beskrevs på olika sätt. Det fanns även en uppfattning om att någon sederingspraxis eller riktlinjer inte existerade på avdelningen. Vid övervägande lokal och regional anestesi ordinerades och användes sedering på avdelningen. Övervägande delen av anestesisjuksköterskorna kontrollerade nivån via vitalparametrar då det ansågs att ingen sederingsskala fanns tillgänglig. Vitalparametrar ansågs också vara det viktigaste att dokumentera. Anestesisjuksköterskorna hade mål med sederingen, tog hänsyn till patientens önkemål och ansåg sig kunna styra sederingsnivån. Det uppfattades av de allra flesta som om det skulle vara bra med ett instrument eller skala för gradering och dokumentering av sedering och det skulle vara bra för nya kollegor och även kunna bidra till ett gemensamt språk vid överrapportering. De vanligast upplevda komplikationerna var ofri luftväg och motorisk oro och förvirring. Slutsatser: Ett gemensamt instrument för gradering och dokumentation av sedering kan ge ökad medvetenhet och beredskap vid komplikationer då riskerna med sedering kvarstår. / Background and purpose: Anaesthetic nursing care is performed by a nurse anaesthesia perioperative. The nurse anaesthesia is responsible in consultation with patients to identify needs for perioperative care, prepare a care plan, direct and evaluate nursing actions. Journals should be kept regarding all care of patients. Sedation has a calming effect, it increases the acceptance of discomfort and provides some amnesia. Sedation is an excellent complement to regional anaesthesia and local anaesthesia. Each individual responds differently to drugs. Reactions to drugs differ between each individual. Therefore, both the given dose and the effect of this dose need to be observed and evaluated. When administrating sedative drugs monitoring the patient is very important. The aim of this pilot study was to describe nurse anaesthetists perceptions of and approach to sedation. Method: A quantitative empiric research was conducted. A questionnaire, constructed to answer the aim of the study was distributed to 63 nurse anaesthetists. Results: Sedation practices were described in different ways. But there was also a perception that no sedation practices or guidelines existed in the department. Predominantly local and regional anaesthesia was sedation prescribed and used in the department. No scale for sedation was used. The majority of nurses’ anaesthesias considered to be able to control the level and had a goal of with the sedation, taking the patients wishes into account. The majority felt that no sedation scale was available and instead looked to vital parameters, that was also believed to be important to document. A predominant part of nurse anaesthetists felt it would be good with an instrument or scale for grading and documenting sedation. It would be especially good for newer colleagues and could contribute to a common language in reporting. The most commonly experienced complications were obstructed airway, restlessness and confusion. Conclusions: A common instrument for grading and documenting can increase the awareness and preparedness for complications although the risks of sedation remain.

Objectives: The objective of this thesis is to identify and understand communication and information exchange events and their influencing factors that are precursors to medical errors. Methods: Palliative Sedation Therapy is used as a case study to understand how communication and information sharing occur on an in-patient palliative care unit. Data sources were non-participant observation and interviews. Directed content analysis was used to analyze the data, with previously published conceptual models of communication acting as the guides for this analysis. Results/Discussion: Results identified several communication issues that have the potential to act as precursors to medical error at different points in the communication act. A model identifying the points where these precursors can impact communication was created. Conclusion: These results can be used to identify how improvements to communication and information exchange can increase the effectiveness of communication and reduce the likelihood of medical errors occurring.

O presente estudo objetivou determinar um protocolo para sedação de veados-mateiros (Mazama americana) que permitisse procedimentos comumente utilizados no manejo dessa espécie em cativeiro. Foram utilizados seis animais adultos, pesando 38,4 ± 5 Kg, pertencentes ao Núcleo de Pesquisa e Conservação de Cervídeos (UNESP - Jaboticabal). Os animais foram submetidos a dois tratamentos, com um intervalo mínimo de 30 dias entre eles, a saber: AX-0,5 - associação de 1 mg/kg de azaperone e 0,5 mg/kg de xilazina via intramuscular (IM) e AX-1,0 - associação de 1 mg/kg de azaperone e 1 mg/kg de xilazina (IM). A partir da administração do tratamento (0 minuto) foram avaliados os tempos para latência da sedação, para decúbito esternal, para a manipulação segura e para a manipulação sem segurança. Ainda, foram avaliados a qualidade da contenção química por meio da somatória de pontos obtida com a utilização de uma escala descritiva adaptada, a cada 10 minutos, por até 90 minutos, parâmetros fisiológicos (FC, fR, PAM e To) a cada 10 minutos, durante 60 minutos, perfil ácido-base e eletrolítico (pH, PaCO2, PaO2, HCO3-, EB, SaO2, Na+ e K+) aos 10, 30 e 60 minutos e lactato sérico aos 30 e 60 minutos pós-tratamentos. As diferenças foram consideradas significantes quando P < 0,05. O período de latência da sedação e período para os animais apresentarem decúbito esternal foram maiores em AX-0,5 (7 ± 6,6 e 12 ± 9,7 minutos, respectivamente) em relação a AX-1,0 (5 ± 2,0 e 6 ± 3,1 minutos respectivamente), porém não houve diferenças entre os grupos para os demais tempos avaliados. A qualidade da contenção química diferiu entre os grupos a partir de 60 minutos, observando-se possibilidade de manipulação sem segurança a partir de 60 minutos para AX-0,5 e de 90 minutos para AX-1,0. Não houve diferenças entre FC, fR, PAM e To e o lactato sérico entre os momentos nem entre os grupos. Em relação ao perfil ácido-base e eletrólitico, AX-0,5 apresentou diferenças em pH, HCO3-,, EB e K+, com valores aos 60 minutos superiores aos valores em 10 minutos, e AX-1,0 apresentou diferenças apenas para EB também com valores aos 60 minutos superiores aos 10 minutos. Diante dos resultados conclui-se que os dois protocolos promoveram sedação adequada e que a escolha entre eles deve ser pautada pela índole do animal. Embora não tenham ocorrido alterações fisiológicas consideráveis em nenhum dos grupos, sugere-se a suplementação de oxigênio nos primeiros 30 minutos de contenção química. / The aim of this study was to determine a sedation protocol for red brockets (Mazama Americana) that allows common handling procedures for captive individuals of this species. Six adult animals, weighing 38.4 ± 5 kg, from Núcleo de Pesquisa e Conservação de Cervídeos (UNESP - Jaboticabal) were used in the study. They underwent two treatments with a 30 days washout period: AX-0.5 with 1 mg/kg azaperone and 0.5 mg/kg xylazine, intramuscularly (IM), and AX-1.0 with 1 mg/kg azaperone and 1 mg/kg xylazine, IM. From the moment of drug administration (0 minute) latency periods for sedation, sternal recumbency, safe handling and unsafe handling were recorded. The quality of chemical restraint was quantified every 10 minutes, for up to 90 minutes, through a descriptive scale, and the physiological variables (FC, fR, PAM and To) every 10 minutes, up to 60 minutes. Acid base status and blood electrolytes (pH, PaCO2, PaO2, HCO3-, EB, SaO2, Na+ e K+) were assessed at 10, 30 and 60 minutes, while blood lactate was assessed at 30 and 60 minutes after treatment. Differences were considered significant when P < 0.05. Sedation latency periods and period for sternal recumbency were longer in AX-0.5 (7 ± 6,6 e 12 ± 9,7 minutes, respectively) in comparison to (AX-1.0 5 ± 2,0 e 6 ± 3,1 minutes respectively), however no other significant differences in periods between groups were observed. Quality of chemical restraint was significantly different between treatments after 60 minutes, when safe handling of the animals was no longer possible in AX-0.5, but only after 90 minutes in AX-1.0. No differences between FC, fR, PAM, To and blood lactate levels were observed between groups or between moments. Regarding the acid base status and blood electrolytes, animals from AX-0,5 showed significant differences in pH, HCO3-,, BE and K+ between 10 and 60 minutes, being values at 10 minutes higher. Same tendency was also observed in AX-1.0, however only for BE. In conclusion, both protocols led to adequate sedation and predilection between them should be based on the animal\'s behavior. Even though no alterations in physiological parameters were detected in any of the experimental groups, oxygen therapy is recommended for the first 30 minutes of chemical restraint in all animals.

External beam radiation therapy is often used as a form of treatment for individuals diagnosed with cancer. However, because staying completely still can often be difficult for children, sedation is often used daily to remedy the need for stillness. In this document, we introduce the development, implementation, and testing of a technology designed to teach healthy children to self-monitor and control their movements. This technology monitored a child's body movement and created a continuous feedback loop, playing a preferred movie based on the amount of body movement observed. Study 1 compares the amount of body movement observed when children were instructed to remain still (instructions alone) to access to a movie contingent on maintained low rates of movement (contingent movie). Study 2 compares the amount of body movement observed in the instructions alone condition with two other conditions: non-contingent access to a movie (non-contingent movie) and contingent movie. Study 3 compares the amount of body movement observed in the instructions alone condition to the contingent movie condition over an extended period of time. Lastly, Study 4 compares the amount of body movement observed when children have previously been taught to stay still using the technology described above across various days throughout various conditions. Generally, we found three things: a) instructions alone were insufficient to produce the level of control over motion required; b) some control over motion was established in the non-contingent movie condition relative to the instructions alone condition; and c) the combination of movies and feedback contingent on movement was necessary to gain the level of control over body motion necessary to adhere to the medical protocol.

Introduction: Prevention and treatment of pain or discomfort is an integral part of modern intensive care. Insufficient or, conversely, excessively deep sedation and analgesia are associated with a number of risks, such as prolonged hospitalization. For this reason, the use of scoring systems to monitor agitation and pain is currently recommended. Objectives and methodology: The aim of the work was to obtain data on the use of scoring systems to assess the pain and depth of sedation in intensive and resuscitation care workplaces in the Czech Republic and to evaluate the satisfaction of nurses with their use. The research was carried out using a quantitative method in the form of a semi-structured questionnaire of my own creation. The research sample consisted of station nurses and head nurses from anesthesiology and resuscitation departments and intensive care units. Results: The research survey involved 62 workplaces of intensive and resuscitation care in the Czech Republic. The existence of a sedation protocol was reported by 26 workplaces (42 %), the use of standardized scales to assess the depth of sedation was reported by 46 workplaces (74 %). Pain in ventilated patients is evaluated in all 62 workplaces (100 %). The most frequently used scale for assessing the depth of sedation is RSS, which...

SAMMANFATTNING Titel: Sederingens betydelse för utvecklingen av ventilator associerad pneumoni hos intensivvårdspatienter. Fakultet: Hälsa, natur- och teknikvetenskap Kurs: Examensarbete - omvårdnad, 15 hp Författare: Sanna Willford Handledare: Anna Nordin Examinerande lärare: Inger James Examinator: Jan Nilsson Sidor: 32 Datum för examination: Juni 2022 Nyckelord: Pneumoni, ventilator associerad, Sedering, Intensivvård Introduktion: Ventilator associerad pneumoni (VAP) är en vårdrelaterad infektion som klassas som en vårdskada och som skapar ett vårdlidande för patienten. Vårdskador kan undvikas om rätt åtgärder vidtas av hälso- och sjukvården. Sedering är grundläggande för säkerhet och bekvämlighet hos respiratorbehandlade patienter. Utvecklingen av VAP förekommer oftare hos patienter som får kontinuerlig sedering än hos patienter som har en daglig sederingspaus. Även andra interventioner i sederingen kan ha betydelse för utvecklingen av VAP. Syfte: Syftet med denna studie var att undersöka sederingens betydelse för utvecklingen av VAP hos respiratorbehandlade patienter på IVA. Metod: I denna systematiska litteraturstudie har en narrativ sammanställning av kvantitativa studier genomförts. En induktiv innehållsanalys enligt Bettany-Saltikov och McSherrys niostegs modell samt SBUs riktlinjer för litteraturstudier har använts. Litteraturstudiens resultat har bedömts med GRADE. Resultat: Flera av de inkluderade studierna såg en statistisk signifikant minskning i antalet patienter som utvecklade VAP, trots att de använde sig av olika interventioner i sederingen. Förändringar i sederingsstrategi, sederingsgrad, val av sederande läkemedel och personalens följsamhet i de VAP preventiva interventionerna var av betydelse. Konklusion: Olika interventioner gällande sederingen har betydelse för utvecklingen av VAP. Att minska förekomsten av VAP kan förkorta tiden för respiratorbehandling, förkorta vårdtiden, minska mortaliteten och minska vårdkostnader. / ABSTRACT  Title: The significance of sedation for the development of ventilator-associated pneumonia in intensive care patients. Faculty: Health, Science and Technology  Course: Degree project - nursing, 15 ECTS  Authors: Sanna Willford Supervisor: Anna Nordin Examiner: Inger James Examiner: Jan Nilsson Pages: 32 Date for the examination: June 2022 Key words: Pneumonia, ventilator-associated, Sedation, Intensive care Introduction: Ventilator associated pneumonia (VAP) is a healthcare-associated infection that is classified as a healthcare injury and that creates a patient suffering. Healthcare injuries can be avoided if the right measures are taken by the health service. Sedation is essential for the safety and comfort of respiratory patients. The development of VAP occurs more often in patients who receive continuous sedation than in patients who have a daily sedation break. Other interventions in sedation can also be important for the development of VAP. Aim: The aim of this study was to investigate the significance of sedation for the development of VAP in ventilator-treated patients at IVA. Method: In this systematic literature study, a narrative compilation of quantitative studies has been conducted. An inductive content analysis according to Bettany-Saltikov and McSherry's nine-step model and SBU's guidelines for literature studies have been used. The results of the literature study have been assessed with GRADE. Results: Several of the included studies saw a statistically significant reduction in the number of patients who developed VAP, despite the fact that they used different interventions in sedation. Changes in sedation strategy and degree of sedation affected the presence of VAP. The choice of sedative drugs and the staff's compliance in the VAP preventive interventions were also important. Conclusion: Various interventions regarding sedation are important for the development of VAP. Reducing the incidence of VAP can shorten the time of ventilator treatment, shorten the care time, reduce mortality and reduce care costs.

Bakgrund Målet med intensivvård är att uppnå det bästa medicinska samt omvårdnadsmässiga resultatetutan komplikationer. Det har tidigare varit standard att djupt sedera patienter som erhållermekanisk ventilation. Intensivvårdspatienter kan idag vårdas på en intensivvårdsavdelningmed lättare sedering än tidigare vilket bidrar till kortare vårdtid på intensivvårdsavdelning samt minskad respiratortid för patienter. En lätt sedering underlättar för patienter och sjuksköterskan att kommunicera samt bygga en relation till varandra vilket bidrar till enbättre vård för patienter. Syfte Att undersöka patienters upplevelse av att vara intuberade samt lätt sederade på en intensivvårdsavdelning utifrån perspektivet vårdlidande. Metod En litteraturöversikt med systematisk ansats användes för att söka, kritiskt granska samtsammanställa data från tidigare genomförda studier. Totalt inkluderades 19 vetenskapligaartiklar som kvalitetsgranskades med hjälp av SBU:s granskningsmall för kvalitativa studier. Analysen gjordes utifrån Katie Erikssons teori om vårdlidande. Resultat Resultatet redogjordes utifrån fyra förutbestämda kategorier; Kränkning av patientersvärdighet, fördömelse och straff, makt och utebliven vård samt en femte kategori; Lindratvårdlidande. 10 subkategorier framkom ur resultatet som svarade på syftet. Slutsats Vårt resultat visar att vårdlidande är konstant närvarande. Brister i kommunikation, delaktighet och känslan av maktlöshet fortsätter att skapa vårdlidande för patienter. Närvaro av familj och att bli sedd som en individ framkom vara viktigt för patienter för att minska vårdlidandet. Ökad kunskap och förståelse kring ämnet gör att behov kan förutses och tillgodoses, vilket resulterar i minskat vårdlidande och ökad komfort för patienter. Intensivvårdssjuksköterskan kan genom att vara lyhörd för patienters individuella behov tillsammans med standardiserade omvårdnadsrutiner minska vårdlidandet. / Background The goal with intensive care is to achieve the best medical and nursing care result without complications. It has previously been standard to deeply sedate mechanically ventilated patients. Intensive care patients can today receive care with lighter sedation than ever before which results in shorter time spent on a ventilator and at the intensive care unit. A lighter sedation helps patient and nurse to communicate and build a relationship with each other which leads to a better care for the patient. Aim To explore the patient experience of being intubated and lightly sedated in an intensive care unit from the perspective of suffering from care. Method A literary review with a systematic approach was used to search, critically analyse and comprise data from previous studies. In total 19 articles were included, and quality checked with SBU template for qualitative research. The analysis was based on Katie Ericsson’s theory of suffering from care. Result The findings emerged from four previously decided categories: Violation of patient's dignity, condemnation and punishment, control, lack of care and a fifth category that emergedduring the process, relived suffering. 10 subcategories were created from the result and answer the aim of the literary review. Conclusion The result show that suffering from care is constantly present. Lack of communication, participation and the feeling of being powerless continues to create suffering from care for patients. Having family present and being seen as an individual were helpful in easing the suffering of care. Greater knowledge and understanding about the subject makes it possible to foresee and fore fill needs, which would result in less suffering of care and a higher level of comfort for the patients. The intensive care nurse can trough being responsive for the patients individual needs, together with standardised care actions decrease the suffering of care.

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