Sammanfattning Bakgrund Multiresistenta bakterier ökar över hela världen och är enligt WHO ett av de 10 största globala hoten för mänsklig överlevnad. Från att ha varit ett mindre förekommande problem i Sverige förekommer nu multiresistenta bakterier allt oftare inom vården. Ett viktigt arbete som intensivvårdssjuksköterskan har är att motverka smittspridning och förebygga vårdskador. Syfte Syftet var att beskriva intensivvårdssjuksköterskors upplevelser av att vårda patienter med multiresistenta bakterier.  Metod I studien har kvalitativ ansats med deskriptiv design använts. Data samlades in via semistrukturerade intervjuer, 10 intensivvårdssjuksköterskor deltog. Materialet analyserades med kvalitativ innehållsanalys enligt Graneheim och Lundman. Huvudresultat Resultatet av intervjuerna med intensivvårdssjuksköterskorna och deras upplevelse av att vårda patienter med multiresistenta bakterier resulterade i tre olika kategorier: Eftertanke och noggrannhet, Upplevelsen av okunskap och Risken att sprida smitta. Två subkategorier identifierades, Utmaningar i att skydda patienterna vid samvård och Svårigheter att vårda patienter på grund av brister i vårdmiljön. Temat Osäkerhet bildades som var övergripande för kategorierna. Slutsats Intensivvårdssjuksköterskor behöver mer kunskap om multiresistenta bakterier för att känna sig säkra i vården av patienter som är bärare av multiresistenta bakterier. Intensivvårdssjuksköterskorna behöver få kunskap genom utbildning och förståelse över vad som väntar om bakterierna får fortsätta utveckla resistens mot antibiotika. Vårdmiljön har betydelse för upplevelsen av vården kring patienter med multiresistenta bakterier.

Introduktion: Intensivvårdsavdelningen är en högteknologisk miljö, vilket ställer höga krav på intensivvårdssjuksköterskan som vårdar kritiskt sjuka patienter. Intensivvårdspatienter är i behov av att transporteras inom sjukhuset. Dessa transporter är riskfyllda och ställer krav på intensivvårdssjuksköterskan. Syfte: Att beskriva intensivvårdssjuksköterskors upplevelser av patientsäkerheten vid intrahospitala transporter. Metod: Studien genomfördes som en integrativ litteraturstudie enligt Whittemore & Knafl (2005) med induktiv ansats. Totalt inkluderades tre kvalitativa studier, tre mixade metoder och tre kvantitativa studier samt en observationsstudie. Resultat: Baserades på 10 artiklar som berör intensivvårdssjuksköterskans upplevelser av patientsäkerheten vid intrahospitala transporter. Utifrån studiernas resultat identifierades faktorer som hotar och främjar patientsäkerheten under intrahospitala transporter som presenteras i de tre teman: Att samarbeta i teamet, Att arbeta förebyggande och Ökad arbetsbelastning. Konklusion: Forskningsområdet inom intensivvårdssjuksköterskors upplevelser av patientsäkerhet under intrahospitala transporter var begränsat. Intensivvårdssjuksköterskor upplevde att intrahospitala transporter var riskfyllda och krävande, där patientsäkerheten var hotad. Intrahospitala transporter kräver kompetens och förberedelser för att kunna utföra intrahospitala transporterna på ett patientsäkert sätt. Där fungerande utrustning, samarbete inom teamet, patientens kliniska status och vårdmiljö hade en betydande roll för att kunna utföra säkra intrahospitala transporter. / Introduction: The intensive care unit is a high-tech environment, which places high demands on the intensive care nurse who cares for critically ill patients. Intensive care patients need to be transported within the hospital. These transports are fraught with risk and place demands on the intensive care nurse. Aim: To describe intensive care nurses' experiences of patient safety during intrahospital transport. Method: The study was conducted as an integrative literature study according to Whittemore & Knafl (2005) with an inductive approach. In total, three qualitative studies, three mixed methods and three quantitative studies and one observational study were included. Results: Was based on 10 articles concerning the intensive care nurse's experiences of patient safety during intrahospital transport. Based on the results of the studies, factors that threaten and promote patient safety during intrahospital transport were identified, which are presented in the three themes: Working together in the team, Working preventively and Increased workload. Conclusion: The research area within intensive care nurses' experiences of patient safety during intrahospital transport was limited. Intensive care nurses felt that intrahospital transport was risky and demanding, where patient safety was threatened. Intrahospital transports require competence and preparation to be able to carry out the transports in a patient-safe way. Functioning equipment, collaboration within the team, the patient's clinical status and care environment played a significant role in being able to carry out safe transports.

Ionizing radiation is applied in healthcare for diagnostics or cancer therapy in various human populations, including pediatric patients. To ensure children's stillness during radiological procedures, they are usually sedated/anesthetized with anesthetics, such as ketamine. Previous studies have shown that exposure to ketamine, ionizing radiation, or a combination of both during critical periods of brain development can result in cognitive impairment later in life.The purpose of the project is to investigate developmental neurotoxic effects of ketamine and low-dose ionizing radiation.Female NMRI-mice were exposed on postnatal day 10 to ketamine (7.5 mg/kg), low-dose ionizing radiation (200 mGy), or co-exposure. Then, gene expression patterns in hippocampusfor Jagged1, Hes5, Nrf2, Keap1, Bdnf and Grin2b were studied by qPCR.Two primers were designed for the mouse genes Cat, Sod2, Tia1 and G3bp1 respectively. Subsequently, efficiency of each primer was investigated using qPCR to generate a standard curve.The gene expression of Grin2b showed/displayed statistically significant downregulation in all exposed groups. No statistically significant change in the gene expression of Jagged-1, Hes5, Nrf2, Keap1 and Bdnf were observed.Due to appearance of secondary peaks, primers for Tia1:1, G3bp1:2 and Sod2:1 were excluded from the study. The efficiency of Cat1, Cat2, Sod2-2, Tia1-2 and G3bp1-1 did not meet the criteria (90–110%) for further work.Exposure to ketamine, low-dose ionizing radiation or a co-exposure may affect Grin2bexpression in children and consequently result in cognitive impairment. More studies are required to determine the underlying mechanism. Additional aspects to consider when designing primers should be implemented.

Bakgrund: Oro är vanligt hos patienter som ska opereras, oavsett om det är en elektiv eller akut operation. Studier har visat att en bra relation mellan anestesisjuksköterskan och patienten preoperativt minskar oron hos patienten. En akut operation upplevs som stressande för patienten då denne inte kan påverka sin situation. Anestesisjuksköterskan är den som inför en akut operation ansvarar för patientens trygghet och säkerhet. Syfte: Syftet är att beskriva anestesisjuksköterskors erfarenheter av att vårda en orolig patient vid en akut operation. Metod: En kvalitativ intervjustudie med ändamålsenligt urval utfördes. Urvalskriterierna innefattade anestesisjuksköterskor med minst ett års erfarenhet på en operationsavdelning som bedriver akut verksamhet. Datainsamlingen genomfördes i form av semistrukturerade intervjuer och analyserades med en kvalitativ innehållsanalys med induktiv ansats. Resultat: Fyra kategorier framkom i resultatet; Att ha kunskap om patientens tidigare erfarenheter, Att ta över ansvar för patient som är utelämnad, Att undvika felaktig och otillräcklig information och Att utforma personcentrerad information. Slutsats: Anestesisjuksköterskan behöver vara lyhörd och inkännande för att kunna anpassa sig till den unika individen. Med denna kunskap kan anestesisjuksköterskan bemöta oro genom att informera patienter på ett personcentrerat sätt utifrån deras villkor och önskemål.

Para determinar o desempenho cognitivo de médicos residentes de Anestesiologia relacionado a características afetivo-motivacionais, 60 residentes completaram, com intervalos de 6 meses, questionários sobre Qualidade de Vida, Ambiente Educacional, Estratégias de Ensino e Aprendizado e um teste de progresso. Análises de conglomerados classificaram os residentes de acordo com as variáveis afetivo-motivacionais e cognitivas. Grupos resultando de combinações dos conglomerados foram obtidos. Gráficos de progresso cognitivo foram obtidos pelo cálculo de médias móveis exponencialmente ponderadas. Somente os grupos com perfil afetivo-motivacional mais positivo demonstraram ganho significativo de conhecimento / To determine residents' cognitive achievements related to differential characteristics in affective-motivational variables, 60 anesthesia residents completed at four 6-month intervals World Health Organization Quality of Life Inventory, the Dundee Ready Educational Environment Measure, the Learning and Study Strategies Inventory, and a Rasch modeled progress test. Cluster analyses classified residents according to affective-motivational and cognitive measures. Groups resulting from combinations of clusters were obtained. Exponentially weighted moving average charts assessed cognitive progress. Only groups exhibiting more positive affective-motivational profiles demonstrated significant knowledge-gain

Bakgrund: Intensivvårdspatienter utsätts för konstant ljud då miljön innebär kontinuerlig övervakning av medicinsk utrustning. Enligt WHO’s rekommendationer ska ljudnivån inom intensivvården inte överstiga 30–40 dB. När patienterna utsätts för larm och ljud blir sömnen påverkad, vilket förhindrar återhämtning och läkning hos den kritiskt sjuka patienten. Syfte: Syftet med studien var att beskriva ljudet från medicinsk utrustning på IVA och hur detta påverkar patienterna och deras sömn. Metod: En integrativ litteraturstudie. Resultat: Ljudet från medicinsk utrustning inom intensivvården översteg ljudnivån för optimal sömn och vila. Patienterna uppfattade ljudet både positivt och negativt. Sömnen kunde bli bättre genom sömnfrämjande åtgärder. Resultatet presenteras utifrån två huvudkategorier; Miljö och Sömnkvalitet med tillhörande subkategorier; Ljudets intensitet, Patienternas tolkning av ljudet, Sömnstörning och Sömnfrämjande åtgärder. Slutsats: Ljudet från medicinsk utrustning påverkade patienterna i olika grad och bidrog till sömnstörning. Genom en ökad kunskap hos intensivvårdssjuksköterskan samt riktlinjer för sömnfrämjande åtgärder kan patienterna få en bättre sömn och vila. I litteraturstudien kartläggs det nuvarande kunskapsläget, vilket visar på kunskapsluckor. Vidare forskning behövs för att öka kunskapsläget inom ämnet. / Background: Intensive care patients are constantly subjected to noise because of the continuously monitoring of medical equipment in a hospital environment. According to WHO’s recommendations the noise levels within the intensive care should not exceed 30-40 dB. When the patients are subjected to alarm and noise their sleep is affected and as a result recovery and healing is negatively affected for the critically ill patient. Aim: The aim of the study was to describe the noise from the medical equipment at the ICU and how it affects the patients and their sleep. Methods: An integrative literature study. Result: The noise from the medical equipment in the intensive care exceeded the noise level for optimal sleep and rest for patients. The patients experienced the noise both positively and negatively. The quality of sleep could be improved by sleep-aiding measures. The result is presented by using two main categories: Environment and Quality of sleep including the following subcategories; Noise intensity, Patient’s interpretation of the noise, Sleep disturbance and Sleep-aiding measures. Conclusion: The noise from the medical equipment affects the patients to different degrees and contributes to their sleep being disturbed. Through improving the knowledge of the intensive care nurse and by introducing clear guidelines for sleep-aiding measures, the patients sleep and rest can be improved. In the literature study the current knowledge levels are mapped out, which shows a lack of knowledge with the intensive care nursing staff. Further research is needed to improve and increase the level of knowledge of the topic.

Associations between patient and procedural factors on the nature and quality of the immediate in-home recovery from anesthesia following ambulatory orthopedic surgery are unknown. Further, there is a paucity of outcomes research quantitatively categorizing in-home patient recovery and safety following discharge from same-day orthopedic procedures. Tools are available, however, to shed light on outcomes in this population, and integration of such available measures is critical. Ambulatory orthopedic surgery is a burgeoning specialty, with growth expected over the foreseeable future. The expected increased patient caseload subsequent to implementation of the Affordable Care Act and aging Baby Boom generation suggests greater morbidity and mortality is on the horizon unless aggressive measures are taken at mitigating risk. Similarly, as the obesity epidemic expands, obesity-related comorbid conditions including obstructive sleep apnea (OSA) are likely to grow. The purpose of this research was to explore the relationship between ambulatory orthopedic patient-reported activities (quality of life metrics) and diagnostic factors (physical and perioperative care data) in the immediate postoperative period that are predictive of arterial oxygen desaturation. Data was obtained using a novel patient journal exploring sleep, pain, nausea, tobacco use, alcohol use, and appetite in conjunction with a valid and reliable portable, wrist-worn pulse oximeter. Additional assessment data was taken from the preanesthetic assessment. All participants were scored according to the STOP-Bang questionnaire, an accepted survey of OSA risk. Patients were recruited from a busy metropolitan ambulatory surgery center in Richmond, Virginia that sees approximately 500 cases monthly, and a 309-bed tertiary care hospital in West Burlington, Iowa. The target sample included 52 individual patients with data collected over the first two post-operative nights following discharge. Two patients were excluded. Negative binomial regression, log10 transformation, and least-squares regression examined the relationships the STOP-Bang questionnaire, quality of life data, and physical perioperative data had on postoperative desaturation events. Results suggested the STOP-Bang score predicted desaturation events and that age and BMI were significant individual predictors. Opiate pain medication treatment, a happy mood, and home CPAP use were associated with decreased events. This study provided a unique perspective in patient safety research, relating human behaviors and experiences with postoperative oxygen desaturation. Future research projects aligned with postoperative monitoring, pulse oximetry, patient safety, and obstructive sleep apnea are potential following the findings of this study.

ABSTRACT ASSESSING BASELINE AND POST-DISCHARGE RISK FACTORS IN SUBJECTS WITH AND WITHOUT SLEEP APNEA UNDERGOING ENDOSCOPY WITH DEEP SEDATION Background: Outpatient procedures encompass over 60% of all surgeries in the United States, and the prevalence of obstructive sleep apnea (OSA) remains high among adult surgical ambulatory patients. Ambulatory surgery poses problems for patients with OSA because narcotics and anesthetics used during surgery can complicate the negative effects of OSA, leading to cardiac events, brain hypoxia, and even death. This study was designed to evaluate the prevalence of cardiopulmonary risk factors among post endoscopic patients with diagnosed and undiagnosed sleep apnea. Methods: The study involved a prospective, descriptive cross-sectional design and incorporated a pre-test or post-test data collection approach, using Actigraphy, pulse oximetry and 24-hour ECG monitoring via Bluetooth technology to monitor outpatients undergoing endoscopy with deep Propofol sedation. Patients were recruited pre-procedure to obtain a resting baseline ECG, and pre-procedure values were then monitored post procedure continuously for 24 hours. A p-value less than 0.05 was considered to be statistically significant. A target sample included 50 adult outpatients from a Florida suburban endoscopy center. Results: Pulse oximetry and Actigraph scores revealed no difference based on OSA. The ANOVA for oxygen desaturation events and sleep quality indices reflected no differences across groups. Sleep quality had no measurable influence on adverse events and was similar across groups; participants diagnosed with OSA slept longer than those in the untreated or no OSA group. Regressions for sleep quality indices reflected no differences among groups. Conclusions: There remains a lack of literature on cardiopulmonary and ECG indicators of cardiac risks in patients with OSA in the 24 hours following discharge from ambulatory surgery. This dissertation characterized the ECG at baseline and post-discharge among post-endoscopy outpatients with OSA and without OSA. Further research is recommended.

Anesthesia is a health care specialty fraught with high workload demands, stressful work environments, increased production pressure, work areas with many distractions, an increasing use of advanced technology, and the constant need to prioritize work actions. Effective clinical judgment in this dynamic environment necessitates that the provider demonstrate the ability to project what may occur secondary to actual or potential condition changes. These key elements operationalize situation awareness (SA). High level SA is an important characteristic for the successful development of student registered nurse anesthetists (SRNAs). With Endsley’s “Theory of Situation Awareness” as the foundation, the goal of this study was to adapt and validate the “Situation Awareness Global Assessment Technique” (SAGAT), to quantify SRNAs' SA during a specific simulated anesthesia event. With IRB approval, purposeful sampling identified a group of CRNA, nurse educator subjects and an exploratory sequential mixed methods design utilized. Delphi methods during qualitative data collection and validation used a seven-member sample. Content analysis resulted in items for the adapted SAGAT. Quantitative methods utilized data collected from a second 40-member sample yielding item content validity and scale content validity indices (S-CVI/Ave. 0.92). Additionally, exploratory factor analysis provided further reliability with a Cronbach’s alpha of 0.937. Findings revealed that a SAGAT specific to the anesthesia domain and the SRNA subgroup was amenable to adaptation and validation, providing positive implications in SRNA education and training. Additionally, results support the further adaptation, validation, and use of this instrument in other anesthetic content areas, as well as other health care domains.

Abstract The aim of the study was to describe factors of nurse’s experiences when they give NIV treatment to patients with acute respiratory failure in a lung department. Semi structured interview questions about how nurses experience to give NIV treatment on a ordinary lung department was done on 10 nurses, who work in a lung department were NIV treatment is given. Data were analyzed with content analysis. In the result there was shown two themes. The two themes were knowledge and cooperation during NIV treatment and time and support accomplish NIV treatment easier to give. The first themes were knowledge and cooperation during NIV treatment. The theme was created by four categories: “specific knowledge about NIV treatment”, “cooperation with doctors” ”documentation about the treatment”, and ”teamwork between nurses”.  The theme time and support accomplish NIV treatment easier to give, was also created by four categories:” support for next of kin” satisfaction when the treatment is helping, “the patients need of support” and “time for the patient”. NIV treatment is a treatment that is god but in need of development, according to the nurses on the lung department, but there is a lot around the treatment that could be better. For example: getting more time with the patient and further educate doctors and nurses, so that NIV treatment can be given under assured requirements and to more patients.   Key words: nurses, experiences, NIV treatment, COPD patients, technological equipment / Sammanfattning Syftet med studien var att beskriva allmänsjuksköterskors upplevelser av att ge noninvasiv ventilation (NIV) behandling till patienter med akut andningssvikt på en lungavdelning. Halvstrukturerade intervjufrågor ställdes till tio allmänsjuksköterskor som arbetade på en lungavdelning där NIV behandling bedrivs. Intervjuerna analyserades med kvalitativ innehållsanalys. I resultatet framkom två teman: ”Kunskap och samarbete underlättar NIV behandling” och ”Tid och stöd till patienten underlättar NIV behandling”. Det första temat ”kunskap och samarbete underlättar NIV behandling” bildades av fyra kategorier; ”specifika kunskaper om NIV behandling”, ”samarbete med läkare”, ”dokumentation om behandlingen” och ”teamarbete mellan sjuksköterskor”. Temat ”tid och stöd till patienten underlättar genomförandet av NIV behandling” bildades också av fyra kategorier; ”anhörigstöd till patienten”, ” tillfredsställelse när behandlingen hjälper”, ”patientens behov av stöd” och ”tid för patienten”. NIV behandling är en behandling som är bra men behöver utvecklas enligt sjuksköterskorna på avdelningen, mycket runt om kring behandlingen behövde bli bättre t.ex. att få mer tid till patienten och mer utbildning för både läkare och sjuksköterskor så att behandlingen kan ges under tryggare förutsättningar och till fler patienter.   Nyckelord: sjuksköterskor, upplevelser, NIV behandling, KOL patienter, teknologisk utrustning