Thesis (M.S.)--University of Michigan, 1999. / Includes bibliographical references.

Psychosocial support is said to be an inherent component of nursing care and a major focus of palliative care. Literature exists which outlines perceptions of the psychosocial needs of patients and how psychosocial support should be provided. However, there is a lack of empirical evidence on how psychosocial support is operationalised in practice. This study provides a valuable and substantial new contribution to the evidence on the psychosocial needs expressed by patients in a hospice ward and how nurses immediately respond to these needs within their everyday practice. A study gathering data via observations with matched interviews of patients and nurses, organisational, documentary, and demographic variables, was conducted over an eight month period. Thirty-eight nurses (registered and auxiliary) and 47 patients were included in a maximum variation sampling strategy. Data was analysed using constant comparative qualitative techniques. Patients expressed a wide variety of psychosocial needs, often only signalling them whilst receiving care for other reasons. Considering these needs in relation to Maslow’s (1943) hierarchy of needs suggests that in-patients more commonly express prerequisites to physiological care and ‘lower level’ safety needs rather than the more thoroughly researched and espoused ‘higher’ level psychosocial needs. The nurses reacted to these psychosocial needs with a range of responses which indicated a diminishing level of immediate support: ‘dealing’, ‘deferring’, ‘diverting’ and ‘ducking’. The majority of the nurses were observed using each of these responses at some point during data collection. A variety of the responses were used for each type and context of psychosocial need. These responses were influenced by the ward’s workplace culture. This study demonstrates a requirement for more thorough consideration of the true psychosocial needs of patients, which appear to vary dependent on the context of care. Consideration should be v given to workplace culture and its influence over psychosocial support, with nurses being supported to expand their response repertoire so that patients’ psychosocial needs are acknowledged more. Increasing nurses’ knowledge of the reality of psychosocial support through education and research will encourage formalisation of the place of psychosocial support in the planning, documentation and provision of care. This study shows that ward nurses can offer psychosocial support as an inherent component of their everyday work. Findings derived from this research indicate that developing an understanding of how patients express psychosocial needs in practice, through a consideration of Maslow’s (1943) hierarchy of needs, may increase recognition and support of psychosocial needs and enable nurses to respond more comprehensively.

Bakgrund: Vid svårt skadade patienter alternativt sviktande vitalparametrar dras ett traumalarm nivå ett på sjukhusen. Vid nivå ett larm samlas ett större antal interprofessionella specialister inom vården, bland andra specialistsjuksköterskor för att assistera vid luftvägen. Samma specialistsjuksköterskor deltar även vid hjärtstoppslarm inom sjukhuset. Syfte: Syftet med studien var att beskriva anestesi- och intensivvårdssjuksköterskors upplevelse av deltagande i larmverksamhet hospitalt. Metod: Studien har genomförts med en kvalitativ ansats med fokusgruppsintervjuer (n=2) och dyadiska intervjuer (n=2). Fyra intervjuer genomfördes med totalt 11 stycken specialistsjuksköterskor. Sex anestesisjuksköterskor och fem intensivvårdssjuksköterskor deltog i studien. Materialet från intervjuerna bearbetades genom en manifest innehållsanalys. Resultat: Tre kategorier framkom av innehållsanalysen. Att en god introduktion skapar ett tryggare omhändertagande, att rutiner och tydlig rollfördelning ger bättre omhändertagande och att vid larm tidigt vilja skapa en relation till patienten. Slutsats: Sjuksköterskorna upplever att introduktionen i dagsläget kan bli bättre då det inte känner sig tillräckligt förberedda inför att bära larmsökare. Det framkommer även önskan om mer utbildning kontinuerligt både för den egna tryggheten samt för att förbättra teamsamarbetet vid larmen.

This thesis is focused on the issues linked with providing highly specialized care to critically ill patients with intra-aortic balloon pump (IABP) in intensive care units. IABP helps these patients overcome period of acute phase of heart failure or overcome period of time necessary before definitive intervention or surgical solution. A nurse has an irreplaceable role from the very beginning of patient's preparation before insertion of mechanical support (psychological as well as physical), assumes the assistance and instrumentation during insertion of heart support, observation during counterpulsation to psychological support of the patient leading to disconnection (weaning). This thesis is divided into two parts. Theoretical part is organized in several theme units focused on description and method principles, main indications, contraindications, and complications occuring with counterpulsation. The next part is dedicated to nurse's role in the problematics of saturation of bio-psycho-social needs of IABP patients. And the last part characterizes the specifics of intensive care. The core of practical part was qualitative research as per defined goals. The main objective was to map demand for quality nursing care in connection with IABP. This aim was reached through definition of four sub-aims and five research questions. The research questions were focused firstly on knowledge preconditions of nurses and problematic areas of care for IABP patients. Secondly, research effort was focused on the area of insufficient needs of patients in the bio-psycho-social area and on quality of information provided to patients. Imaginary centerpiece of research investigation consists of analysis of case studies of patiens, graphic visualisation of their thought map was used to survey the specifics of nursing care. For the evaluation of needs and mapping of patient's awareness the technique of individual half-structured interview with open questions was used. Same was used with nurses for mapping of problematic areas of nursing care. At the same time casuistry was formed as classical method of description followed by analysis of nursing case. Its meaning was to clarify optimization of means, processes and nursing interventions, i.e. mapping the specifics of nursing care of IABP patients. Research group consisted of patients selected intentionally with regards to the research problematics. For a complex conseption of the research the group for qualitative investigation consisted of four patients of cardio-surgery unit and one patient of coronary unit. Research investigation was realized in coronary intensive care units in České Budějovice hospital and Faculty hospital Plzeň and in Cardio-surgery unit of FN Plzeň. Research group for investigation of nursing problematic was formed by nurses of coronary units and cardio-surgery units of above mentioned hospitals. Eight nurses participated in the interviews. The selection of nurses was finalized only after the research topics were developed in detail. At that time sample selection was not bringing any new information any more, hence theoretical saturation of factual reality was reached. Based on analysis of research results within the goal defined and focused on the level of nurses' theoretical knowledge of nursing patients during IABP therapy it was observed that even though nurse's knowledge is sufficient, it is also significantly inconsistent. Relatively vast reserves were found especially in the area of communication with patients, hence in complex care for patient's psychological state.

This study sought to describe the challenges of diagnosing pulmonary tuberculosis (PTB) in children under the age of 5 years at clinics under the Prince Mshiyeni Hospital at Ethekwini Health District in KwaZulu-Natal. The study showed that primary health care (PHC) nurses do not have adequate knowledge to effectively diagnose PTB in children and, in addition, that PHC clinics are not adequately equipped to effectively diagnose PTB in children. / Health Studies / M.A. (Public Health)

The literature indicates that treatment by means of elimination methods is extremely challenging for patients, bringing a fundamental change to their lives. The aim of the thesis was to identify and describe the challenges of treatment in patients with renal failure and how a given method of treatment affects the patient's quality of life and needs, as well as to understand the subjective difficulties and problems. A data collection method in the form of non-standardized semi-structured interviews was selected for qualitative research. The surveyed sample consisted of six patients of a dialysis centre. The respondents taking part in the qualitative research were informed in advance of the course, circumstances and ethical aspects of the research. The obtained data was analyzed, colour-coded and then sorted into subcategories. The results were interpreted using the "showdown" technique. The interviewed sample of respondents was subjected to multiple elimination methods in the treatment of their disease. Kidney transplant patients subjectively evaluated the quality of their lives as very high, talking about "a life of a normal man". Peritoneal dialysis patients also evaluated their quality of life as relatively high, highlighting a certain feeling of independence. Haemodialysis patients describe...

Sepsis represents a serious medical, but also social problem. Hundreds of thousands of patients die from serious sepsis and septic shock every year. Patients with serious sepsis are treated at intensive care units and their treatment is long, costly and low efficient. These are the reasons why prevention of sepsis focused on prevention and effective treatment of nosocomial infections or timely solution of another problem, e.g. a shock is so much stressed. Nosocomial infections affect about 30 per cent of patients at intensive care units and may cause serious diseases, sepsis or even death. This thesis deals with the possibilities nurses have to influence sepsis, particularly by adherence to aseptic procedures and prevention of nosocomial infection, which might consequently develop in nosocomial sepsis. Combination of quantitative and qualitative methods was used for the research. There were two goals set for the quantitative research. 1. To find whether obstacles occur in adherence to proper aseptic procedures in nursing work as prevention of nosocomial infection occurrence and subsequent septic conditions in patients hospitalized at intensive medicine workplaces. 2. To map the weak points in adherence to proper aseptic procedures in nursing work in intensive care. The goals led to hypotheses H1 Obstacles obstructing thorough adherence to proper aseptic procedures in nursing work exist in intensive care. H2 Non-adherence to aseptic procedures occurs in nursing work at intensive medicine workplaces as a consequence of lack of time for particular interventions. The research sample consisted of nurses from the intensive care workplaces ARD and ICU from 8 hospitals. Questioning method through the questionnaire technique was used for data collection. 342 questionnaires were distributed in total. Hypothesis 1 was refuted, hypothesis 2 was refuted. We found that no obstacles obstructing adherence to proper aseptic methods occur, we mapped the weak points in adherence to proper aseptic procedures in nursing work in intensive care. There were two goals set for the qualitative research. GOAL 3 To find what measures preventing occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces are taken by department managements. GOAL 4 To find out how department management deals with possible occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces. The following research questions were set. 1. What are the measures preventing occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces taken by department managements? 2. How does department management solve possible occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces? The research sample consisted of 5 departmental nurses and 5 head nurses from intensive care workplaces from the same hospitals where the quantitative research took place. The research was performed by semi-standardized interview. The research questions were answered. A manual for nurses called ?Recommendation for nurses in prevention of nosocomial infection and nosocomial sepsis not only at intensive care units? was elaborated upon study of these issues and the performed research. A thought map for department management illustrating prevention and solution of nosocomial infection and nosocomial sepsis was also elaborated. Both the document and the research results will be provided particularly to the managements of the hospitals that took part in our research. The thesis may also be helpful to nurses, students and other interested people to gain overall insight into the issue.

Självdestruktiva handlingar innebär att medvetet tillfoga sig skada. Hos personer som avsiktligt självskadar sig är suicidtankar vanligt förekommande men syftet kan vara ångestlindring och uttryck för psykiskt illabefinnande. Mellan 2005-2014 vårdades 77371 personer inom slutenvård på grund av avsiktlig självdestruktiv handling och risken för suicid är höjd efter en självdestruktiv handling. Syftet med denna studie var att undersöka intensivvårdssjuksköterskans upplevelse av att vårda patienter som avsiktligt överdoserat läkemedel i självdestruktivt syfte. Fem kvalitativa intervjuer med semistrukturerad intervjuguide analyserades med innehållsanalys och materialet utmynnade i fem kategorier samlade under ett tema: Att vilja men inte alltid kunna. Kategorierna var: Att känna hjälplöshet i den psykiatriska omvårdnaden, Att ha kännedom om patientens sammanhang, Att prioritera bort samtal, Att attityder påverkar samarbetet med kollegor, Att ha behov av samverkan och stöd från psykiatrin. Studien visade att upplevelsen av att vårda patienter som överdoserat läkemedel i självdestruktivt syfte påverkades av patientens bakgrund, social kontext och livssituation. Bakgrund i missbruk, låg ålder och kvinnligt kön medförde att handlingen upplevdes mer impulsartad. Upplevelsen av att vårda var komplex och intensivvårdssjuksköterskan kände sympati, frustration och otillräcklighet i omvårdnaden av patienten. Samarbetet på intensivvårdsavdelningen påverkades av attityder inom personalgruppen där intensivvårdssjuksköterskan kände sig ensam ansvarig för samtal kring självdestruktivitet och mående. Det förelåg svårigheter i det multiprofessionella teamarbetet samt i förmågan att uppnå holistisk och personcentrad vård. Intensivvårdssjuksköterskorna upplevde att samarbetet med psykiatrin var bristfälligt och hade negativ påverkan på upplevelsen. Intensivvårdssjuksköterskans upplevelse var att slitas mellan sympati och frustration. Den moraliska stressen kan leda till att patienten får bristfällig omvårdnad och risken för framtida suicid kan öka.

Bakgrund: Intensivvårdssjuksköterskor utsätts dagligen för stressiga situationer på arbetet. Kritiskt sjuka patienter kräver snabbt omhändertagande och intensivvårdssjuksköterskor måste arbeta snabbt för att rädda liv. Rådande personalbrist leder till att det blir svårt för intensivvårdssjuksköterskor att hantera stressiga situationer på arbetet. Stressiga situationer kan många gånger vara påfrestande för dem och det finns sällan tid för reflektion och återhämtning då stressen är mycket påtaglig. Att ständigt arbeta under stress kan leda till psykisk och fysisk ohälsa samt utbrändhet. Syfte: Att beskriva intensivvårdssjuksköterskors upplevelser av stressiga situationer på arbetet. Metod: En kvalitativ deskriptiv intervjustudie med induktiv ansats valdes. Semistrukturerade intervjuer genomfördes med 8 intensivvårdssjuksköterskor som hade arbetat mellan 1,5 år - 40 år från 2 allmänintensivvårdsavdelningar vid 2 sjukhus i Sverige. Intervjutexten transkriberades och analyserades genom manifest innehållsanalys. Resultat: Analysen resulterade i 6 kategorier; att behöva stöd och uppleva brist på kompetens hos sig själv och andra, att samarbetsklimatet påverkas när det är stressigt, att inte räcka till för både patienter och anhöriga, att känna sig osäker men vara tvungen att arbeta snabbt när det är stressigt, att kunna använda stress och erfarenheter som resurser, att det är jobbigt och stressigt vid HLR situationer. Att vara ny och erfara den egna bristen på erfarenhet upplevdes som påfrestande för intensivvårdssjuksköterskor. Det var viktigt att de fick stöd och hjälp av kollegor för att kunna hantera stressiga situationer. Arbetsklimatet påverkades och de upplevde även att de var tvungna att arbeta snabbt när det var stressigt. Slutsats: Det kollegiala stödet var av stor betydelse för intensivvårdssjuksköterskor när det var stressigt eftersom alla hjälptes åt när det var bråttom och mycket att göra på avdelningen. De upplevde att det var påfrestande att ge stöd till anhöriga samtidigt som de skulle vårda patienter. Lång arbetslivserfarenhet gjorde att intensivvårdssjuksköterskor upplevde att de var mer fokuserade och hade bättre struktur när situationen blev akut. Det var jobbigt och stressigt att utföra HLR på grund av att de upplevde en otillräcklig beredskap när det väl gällde. Fortsatt forskning samt riktade insatser behövs för att förbättra intensivvårdssjuksköterskors arbetsmiljö och förebygga stressrelaterad ohälsa för att öka deras välbefinnande på arbetet. Således kan detta medföra samhälleliga vinster genom färre sjukskrivningar bland intensivvårdssjuksköterskor samt förbättrad vårdkvalitet för patienter och anhöriga.

Bakgrund: Överflyttningar mellan intensivvårdsavdelningar kan leda till negativa konsekvenser för patienten så som minskad patientsäkerhet och försämring under själva transporten med förlängd vårdtid som följd. När resurserna på en intensivvårdsavdelning överstigs kan det bli nödvändigt att överflytta patienter mellan intensivvårdsavdelningarna trots de kända riskerna. Syfte: Syftet med studien var att undersöka intensivvårdssjuksköterskors förhållningssätt till patientöverflyttningar på grund av resursbrist. Metod: En fokusgruppsintervju på en specialistintensivvårdsenhet i Mellansverige genomfördes. En induktiv kvalitativ innehållsanalys användes vid bearbetning av textmaterialet. Resultat: Intensivvårdssjuksköterskornas förhållningssätt kunde kategoriseras i tre domäner: yrkesroll, känslor samt rationell inställning. Dessa tre domäner utgjorde ett tema: Professionellt och känslomässigt förhållningssätt. Konklusion: Intensivvårdssjuksköterskorna har med hjälp av sin yrkeserfarenhet funnit både ett professionellt och känslomässigt förhållningssätt som hjälper dem att hantera etiska dilemman och moralisk stress vid patientöverflyttningar på grund av resursbrist. Intensivvårdssjuksköterskans professionella och känslomässiga förhållningssätt vid patientöverflyttningar på grund av resursbrist påverkas av deras yrkesroll, känslor och rationella inställning. / Background: Transfers between intensive care units can cause negative consequences for the patient, such as decreased patient safety and deterioration during the transport, which leads to a longer time of treatment. When the resources at an intensive care unit are exceeded it may be necessary to transfer patients between the units although the risks are known. Aim: The aim of this study was to examine the approach of critical care nurses towards patient transfers due to lack of resources. Method: Focus group interview at a special intensive care unit was conducted in Central Sweden. Six critical care nurses with at least two years’ experience were included in the study. An inductive qualitative contents analysis was used during material editing. Result: The critical care nurses approach was identified in three domains: profession, emotions and rational attitude. These three domains formed a theme: A professional and emotional approach. Conclusion: Critical care nurses have found with their professional experience a professional and emotional approach that helps them to manage ethical dilemmas and moral distress of patient transfers due to lack of resources. Critical care nurses’ ´professional and emotional approach of patient transfers due to lack of resources are led by their profession, emotions and rational attitude.