Bakgrund: Intensivvårdssjuksköterskor utsätts dagligen för psykiskt påfrestande situationer som kan vara svåra att bearbeta utan ett adekvat stöd från arbetsplatsen. Tidigare forskning visar på att intensivvårdssjuksköterskor saknar stöd vid psykiskt påfrestande situationer, men det finns sparsamt med forskning på vilket stöd som kan förbättras. Syfte: Syftet var att beskriva intensivvårdssjuksköterskors upplevelser av psykiskt påfrestande situationer, hur de hanterar dessa situationer och hur de upplever stödet och förslag på förbättringar på arbetsplatsen. Metod: Examensarbetet har en beskrivande design med en kvalitativ ansats.Semistrukturerade intervjuer med åtta informanter. Kvalitativ innehållsanalys tillämpades. Huvudresultat: Intensivvårdssjuksköterskornas upplevelser av psykiskt påfrestande situationer var subjektiva. Det kunde vara svåra situationer med patienter, men också personalrelaterade situationer. Majoriteten använder sig av problemfokuserad coping, de söker aktivt stöd från personer de har förtroende för. Det rådde delade meningar om stödet från kollegorna, cheferna och arbetsplatsen. De gav förslag på hur stödet kunde förbättras. Förslagen handlade om att både chefer och kollegor skulle bli mer uppmärksamma och lyhörda för varandras behov. Slutsats: Situationer som upplevdes som psykiskt påfrestande varierade för varje enskild individ. De flesta använder sig av problemfokuserad coping. Stödet som finns på arbetsplatsen och stödet från cheferna upplevs både som bra och mindre bra. Detta stöd kan förbättras genom att vara lyhörda mot kollegornas behov. Det kollegiala stödet upplevs bra, men att stödet kan förbättras ytterligare i form av en mer medmänsklighet för sina kollegor. / Background: Intensive care nurses are exposed daily to psychologically demanding situations that can be difficult to process without adequate support from the workplace. Previous research indicates that intensive care nurses lack support in these mentally challenging situations. However, there is also a lack in current research on how support can be improved. Purpose: The purposewas to describe the intensive care nurse's experiences of distressingsituations, how they handle these situations,how they experience the support and suggestions for improvements in the workplace. Method: This study has used a descriptive design along with a qualitative approach. Semi-structured interviews were held with 8 intensive care nurses and a content analysis was made. Result: The intensive care nurses experiences of mentally demanding situations were subjective. There could be difficult situations with patients, but also difficulties regarding personnel-related circumstances. The majority of intensive care nurses used problem-focused coping, were they actively sought out support from people they trusted. There were shared opinions regarding the support from colleagues, management and the workplace. Additionally, the intensive care nurses gave suggestions on how this support could be improved. The suggestions included that both the colleagues and the management could be more attentive and responsive to each others needs. Conclusion: Situations that are experienced as mentally demanding showed to vary from each individual. The support at the workplace and the support from management are experienced both as well and less well. The support can be improved by being responsive towards colleagues needs. The collegiate support was experienced as well. However, the support can be improved further by showing more compassion for one and another.

Increased levels of stress in the workplace have led the American Psychological Association to predict a looming public health crisis. Critical care nurses (CCNs) are highly exposed to stressors in the workplace, more than other nurses. Tens of billion dollars were reported lost in productive work time yearly due to ill health from depression alone. An important gap remains in understanding the relationships of stressors with the amount of stress. Supported by the biopsychosocial stress theory, the purpose of this study was to determine the relationship between frequencies of perceived stressors (IVs) as a source of perceived levels of stress (DV) or allostasis. The mixed-methods study included an online questionnaire and an e-mail interview of 400 hospital-based CCNs from professional nurses' associations in the United States. The Nursing Stress Scale was used to determine the kinds and frequencies of IVs, while the Psychological Stress Measure was used to assess the DV. Multiple regression analysis assessed the strength and direction of the relationships between IVs and DV. Interviews fell short of the minimum sample size for saturation and were not analyzed. Quantitative findings indicated workload as the most frequently perceived stressor, correlating positively with allostasis (p = .0005). Death and dying, conflict with other nurses, and lack of support for CCNs were also statistically significant (p < .05). Implications to practice and social change include promoting changes in policy with management support to reduce workload, death and dying, conflict with other nurses, and lack of social support for CCNs. Personal behavior changes like relaxation and physical exercises as coping methods may also reduce levels stress.

Compassion fatigue (CF), also known as secondary traumatic stress (STS), impacts critical care nurses (CCN) through exposure to pain, suffering, and loss of those for whom they provide care and results in a reduction of compassion satisfaction (CS). High incidence of CF and turnover (TO) rates at the project site were identified among CCNs. The institution's CCN TO rate was at 81% in comparison to peers in other areas at 29%–35%. The practice-focused question asked whether leadership education on CF might ameliorate CF at the project site. The purpose of the Doctor of Nursing Practice project was to reduce the incidence of CF and TO among CCN through leadership education. Watson's theory of human caring was used as a framework. Two hundred twenty-nine CCNs completed the Professional Quality of Life survey that measures CS, STS, and burnout (BO). Comparison of 28 nursing leaders' pretest scores to posttest scores indicated a statistically significant improvement (z = -4.625, p < .001) and knowledge acquisition. BO and CF taken together explained 86% (adjusted R2 = .86) of the variance in CS (F [2, 227] = 691.33, p < .001). Identifying the nursing units with the highest CF scores and providing CF education to the leadership provides a path to reduce turnover and provide needed support to CCNs, a positive social change.

Bakgrund: Enligt statistik i Sverige ökar antalet anmälningar av barn som far illa, men endast en liten del av anmälningarna görs av hälso- och sjukvårdspersonal. BVC-sjuksköterskan är en viktig person inom barnhälsovården för att främja barns hälsa och trygghet samt att tidigt identifiera problem. Syfte: Syftet med studien var att beskriva BVC-sjuksköterskors upplevelser av att anmäla barn som far illa till Socialnämnden. Metod: Studien baserades på kvalitativ metod med induktiv ansats. Intervjuer användes som datainsamlingsmetod och materialet analyserades med hjälp av kvalitativ innehållsanalys. Resultat: I resultatet framkom att BVC-sjuksköterskorna ansåg det rätt att göra anmälan då barnet for illa, men att det var känslomässigt engagerande. BVC-sjuksköterskorna satte barnets bästa i centrum vid anmälan men hade samtidigt en önskan om fortsatt förtroende från föräldrarna. Behovet av stöd och samarbete upplevdes viktigt och betydelsefullt för BVC-sjuksköterskorna. Konklusion: Resultatet i denna studie bidrar med ökad kunskap om BVC-sjuksköterskors upplevelser av att anmäla barn som far illa, men kan också öka förståelsen för BVC-sjuksköterskors betydelsefulla och komplexa arbetssituation. Studiens resultat skulle kunna användas inom barnhälsovården för att tydliggöra vikten och behovet av att som BVC-sjuksköterska få adekvat stöd genom hela anmälningsprocessen. / Background: According to statistics in Sweden, the number of notifications of child maltreatment increases, but only a small part is made by health care professionals. The child health care (CHC) nurse is an important person in CHC to promote children´s health and safety, and early identification of problems. Aim: The aim of this study was to describe CHC-nurses´ experiences of reporting child maltreatment to the Social welfare board. Method: The study was based on qualitative method with an inductive approach. Interviews were used as data collection method and the material was analyzed using qualitative content analysis. Result: The result showed that CHC-nurses thought it was right to report child maltreatment, but found it emotionally engaging. CHC-nurses considered children´s best when reporting, but wished at the same time to retain the confidence of the parents. Need for support and collaboration was important and significant. Conclusion: The result of this study contribute to increased knowledge of CHC-nurses´ experiences of reporting child maltreatment, but can also increase understanding of CHC-nurses´ important and complex work situation. The result could be used in CHC in order to clarify the importance and need for the CHC-nurse to receive adequate support throughout the entire notification process.

I samband med att en organdonation ska genomföras görs en uttagsoperation, där organen tas från donatorn. Inför detta ingrepp vårdas patienten på intensivvårdsavdelningen och det finns god tillgång på forskningom hur personalen där upplever vårdandet av en tilltänkt donator. Däremot brister forskningen om hur den perioperativa personalen upplever sitt medverkande vid uttagsoperationen. Syftet med studien var att beskriva perioperativa sjuksköterskors upplevelser av att medverka vid en uttagsoperation från en avliden inför organdonation. Studien genomfördes som en kvalitativ deskriptiv studie och kvalitativ innehållsanalys. Tre anestesi- och tre operationssjuksköterskor på ett västsvenskt sjukhus intervjuades. Resultatet visade att detta ingrepp följer rutinen för en operation, med en preoperativ, en intraoperativ och en postoperativ fas. Tre kategorier framkom: förberedelser inför operationen, teamarbete och återkoppling. Konklusionen blev att förberedelserna inför ingreppet behövde förbättras. Debriefingen efteråt fungerade bra, men kunde bli bättre. Genom att tala mer öppet om etiskt svårhanterliga situationer, såsom uttagsoperationer och den stress dessa kan framkalla ges möjligheterna till att skapa egna copingstrategier. / In according to organ transplantation, a tissue and organ procurement will be completed where organs will be removed from a donor. Prior to this intervention the patient will be taking care of in an intensive care unit, where there is excellent access to research regarding how the intensive care staff would experience their participation and caring of a potential donor. This though is in contrast to the lack of research into how the perioperative staff experiences their participation in the removal of organs from a donor. The aim of the study was to describe the perioperative nurses' experience when participating in the tissue and organ procurement of a deceased person prior to organ transplantation. The study was carried out as a qualitative, descriptive study and content analysis. Three nurse anesthetists and three theatre nurses at a west Swedish hospital were interviewed. The results showed that interventions of this type follow the routine for an operation with a pre- intra- and postoperative phase. Three categories emerged in the study: Preparation before the operation; Teamwork; and Processing of the experience. The conclusion was that the preparation for the procedure ought to be improved. Debriefing after the operation functions well, but could be improved. By discussing more openly about ethically difficult situations, such as tissue and organ procurement and the stress they induce, the perioperative nurses are hereby given opportunities to create their own coping strategies.

Early extubation of cardiac surgery patients has become increasingly important. The assessment of the patient before an early extubation is crucial and the intensive care nurses (ICU nurses) in this estimation is there for very important. The aim of this study was to examine critical care nurses' knowledge of early extubation, and what view ICU nurse has about factors that affect the time to extubation of cardiac surgery patients. A quantitative approach with descriptive and comparative design was used. Selection was all ICU nurses at a thoracic intensive care unit who were clinically active in patient care. The study showed that ICU nurses had good knowledge of why an early extubation was essential. However, the knowledge about the unit’s extubation criteria was low. ICU nurses felt that the criteria for the cardiac surgery patients on the unit was adequate. The time target of 90 minutes was reasonable. No relationship existed between professional experience and knowledge of the extubation criteria or between knowledge of the criteria and need of support from colleagues in early extubation of the cardiac surgery patients. The ICU nurses considered themselves familiar with the unit’s extubation criteria but the knowledge of them was low and the majority was working according to their own criteria. The units criteria was not sufficiently visible in the unit and could contributed to the low level of knowledge and contribute to that the majority of the ICU nurses was working according to their own criteria. / Tidig extubering av hjärtkirurgipatienter har blivit allt mer viktigt, en åtgärd där intensivvårdssjuksköterskan har en viktig roll i dennes bedömning av patienten. Syftet med studien var att belysa intensivvårdssjuksköterskans kunskap om tidig extubering samt vilken syn intensivvårdssjuksköterskan har på faktorer som påverkar tiden till extubering av hjärtkirurgipatienter. Studien har en kvantitativ ansats med deskriptiv och jämförande design. Metoden som användes var en enkätundersökning. Urvalet var alla intensivvårdssjuksköterskor på en thoraxintensivvårdsavdelning som var kliniskt verksamma i patientvården. Studien visade att intensivvårdssjuksköterskor hade bra kunskap om varför en tidig extubering eftersträvas. Däremot var kunskapen låg om avdelningens extuberingskriterier. Intensivvårds-sjuksköterskorna ansåg att kriterierna för hjärtkirurgipatienterna på avdelningen var tillräck-liga och att tidsmålet på 90 minuter var rimligt. Studien visade att inget samband fanns mellan yrkeserfarenhet och kunskap om extuberingskriterierna eller mellan kunskap om kriterierna och behov av stöd av kollegor vid tidig extubering av hjärtkirurgipatienter. Intensivvårdssjuksköterskorna ansåg sig känna till avdelningens extuberingskriterier men kunskapen om avdelningens extuberingskriterier var låg och majoriteten arbetar enligt sina egna kriterier. Avdelningens extuberingskriterier var inte tillräckligt synliga på avdelningen vilket kan bidra till den låga kunskapen och bidra till att majoriteten arbetade efter egna kriterier.

The purpose of this study was to explore and describe the knowledge that a cohort of 40 intensive care unit nurses had of evidence-based practice. It was assumed that they lacked the knowledge to locate, evaluate understand and apply research findings. Quantitative, non-experimental descriptive research was conducted to explore their knowledge and to formulate recommendations for promoting it. Data collection involved administering a structured questionnaire administered to the cohort in an intensive care unit. The findings revealed that, although they were familiar with the basic concept of evidence-based practice, they were reluctant and lacked the skills to adopt it in their practice. It is recommended that they be trained and empowered to develop research expertise from within their own ranks. Finally it is recommended that nursing management should play a more proactive role in identifying cost-effective strategies in overcoming barriers to finding, promoting and integrating evidence-based practice / Health Studies / M.A. (Health Studies)

Bakgrund: Patienter som vårdas inom intensivvården befinner sig ofta i en situation som präglas av snabba fysiologiska förändringar där patientens vitala funktioner kontinuerligt måste övervakas och registreras. I intensivvårdens komplexa miljö utgör dokumentationen en viktig del för att upprätthålla en hög patientsäkerhet. Syfte: Att undersöka intensivvårdssjuksköterskors uppfattning om dokumentation. Metod: En empirisk deskriptiv studie har genomförts. Fokusgruppintervjuer användes för att inhämta data. Materialet analyserades med en kvalitativ innehållsanalys. Resultat: Intensivvårdssjuksköterskor anser att dokumentationen fyller en viktig funktion för patientsäkerhet, som informationskälla samt för den egna professionen. Förutsättningar för dokumentationen kunde härledas till tid och organisation, datasystemens för- och nackdelar samt den kulturella påverkan som fanns på arbetsplatsen. Slutsats: Dokumentationen i omvårdnadsjournalen upplevs ofta som bristfällig. Studiens resultat att visat på ett flertal orsaker till detta; avsaknaden av funktionella datasystem, oklara riktlinjer samt ett lågt engagemang hos intensivvårdssjuksköterskor. Klinisk betydelse: Resultatet kan öka intensivvårdssjuksköterskor förståelse för dokumentationens betydelse. De förbättringsförslag som framkommer i studien kan användas för att utveckla dokumentationen inom intensivvården. / Background: Patients cared for in an intensive care unit often find themselves in a situation of rapid physiological changes where the patient´s vital signs must be continuously monitored and registered. In the complex environment of the intensive care units documentation is an important part of maintaining a high level of patient safety. Objective: To examine the intensive care nurse's views of documentation. Method: A descriptive empirical study has been conducted. Focus group interviews were used to collect data and the material was analysed by a qualitative content analysis. Results: Intensive care nurses consider documentation to play an important role for patient safety, as a source of information and for their own profession. They believe that the documentation is affected by time and organization, computer systems and the culture of the workplace. Conclusion: Documentation in the nursing records is often viewed as inadequate. Result of the study revealed a number of reasons for this; lack of functional computer systems, unclear guidelines and a low engagement of the intensive care nurses. Clinical significance: The result could increase intensive care nurses understanding of the importance of documentation. The suggestions for improvement that emerge from this study can be used to develop documentation within intensive care.

The aim of this study was to determine the knowledge of critical care nurses regarding ventilator waveforms in order to develop an educational programme on this topic. A quantitative, descriptive, contextual research design was used, and convenience sampling implemented. A survey, using a questionnaire as measuring instrument, was conducted among critical care nurses in selected private hospitals in Gauteng. The response rate was 69%. Cronbach’s alpha indicated that the questionnaire was fairly reliable. The total average percentage achieved by the group of 111 respondents was 40,28%, which is 19.72% below the set competency indicator of 60%. Only 15 respondents achieved a percentage of or above the competency indicator. Results proved that the respondents required intensive training on the topic. A user-friendly education programme in the format of a PowerPoint presentation was developed to address knowledge deficiencies in critical care nurses’ interpretation of ventilator graphics. / Dissertation (MCur (Clinical))--University of Pretoria, 2007. / Nursing Science / MCur / unrestricted

Catheter-associated urinary tract infections (CAUTIs) are the most frequently reported hospital-acquired condition, affecting more than 560,000 patients each year. CAUTIs prolong hospital stays and increase health care costs, and they can result in patient morbidity and mortality. Nurses can be empowered by receiving education and knowledge to manage and identify urinary catheters that are not clinically indicated. The purpose of this project was to develop an education program on CAUTI prevention for critical care nurses using the teach-back method. The conceptual framework that guided this project was Knowles's adult learning theory. The theoretical model was based on 4 fundamental assumptions of self-concept development. A total of 32 critical care unit nurses participated in the evaluation of the teach-back method. Demographic data were collected from these 32 participants, and the results of a frequency analysis were obtained. Deidentified CAUTI data were provided by the organization prior to the educational intervention. The postintervention CAUTI rate and increase in nurses' knowledge level were evaluated 1 month after the educational intervention using a 1-sample t test. The finding was statistically significant (p < .001). The incidence of CAUTI was followed, and the outcomes indicated that the overall incidence of CAUTI in these patients was decreased. The education program was effective in improving critical care unit nurses' knowledge of evidence-based practices to prevent CAUTIs. Improving nurses' knowledge to decrease CAUTI rates is a strategy that may be effective in many healthcare settings. This educational intervention may create social change by improving the health of patients and serving as an educational resource for nurses.