Este trabalho é um estudo de caso, cujos objetivos foram caracterizar os recém-nascidos prematuros de muito baixo peso (RNP/MBP) admitidos na Unidade de Terapia Intensiva Pediátrica e Neonatal (UTIP/N) do nascimento ao seguimento ambulatorial no primeiro ano de vida, e compreender a experiência dos pais. Sendo assim, optou-se pela realização da pesquisa em dois momentos: o primeiro, na abordagem quantitativa, com uma população de 60 RNP/MBP do Hospital Universitário da Universidade de São Paulo (HU-USP) no período compreendido entre 1999 - 2000. Os dados foram coletados dos prontuários por meio de um formulário. Os resultados mostraram que as mães eram na sua maioria primíparas (50,9%), com idade média de 27,5 anos e que 80,0% realizaram o pré-natal. Em relação aos neonatos, a média de peso ao nascer foi 1.084g e a idade gestacional de 30 semanas; 23,0% foram a óbito e a média de peso foi de 688g. Quanto ao tempo de permanência na terapia intensiva, dos 46 sobreviventes, a mediana foi 10 dias e a de internação hospitalar 49,5 dias. Foram submetidos à intubação e à ventilação mecânica (69,6%), à cateterização central (78,3%) e à nutrição parenteral (98,7%). Dos egressos do Berçário, 75,0% realizaram seguimento no Ambulatório Neonatal. O segundo momento, na abordagem qualitativa, os dados foram obtidos pela observação participante e entrevista com os pais de bebês egressos da UTIP/N do HU-USP. Adotou-se como referencial teórico-metodológico a Antropologia Cultural e a Etnografia. Da análise das narrativas, emergiram seis categorias culturais e subcategorias que evidenciaram dois temas: \"A capacidade para tornarem-se pais de um RNP/MBP: momentos de luta e crescimento\" e \"O cuidar e conviver com o filho\". Os pais vivenciaram todo o processo permeado pela ambivalência de sentimentos em que o medo e a esperança predominaram. Relataram que essa experiência foi marcante e transformadora, atribuíram à religiosidade, aos profissionais de saúde e à assistência especializada a sobrevida do filho. Sentiram-se capacitados para cuidar da criança após a alta hospitalar, embora tenham reconhecido a existência de obstáculos que emergiram do contexto sociocultural para desempenharem os papéis de pai e mãe. / This paper is a case study, it has the purpose of characterizing the preterm newborn with very low weight admitted in Neonatal and Pediatric Intensive Care Units by birth until the first year of life, as an Out Patient, and to understand the parents experience. I opted to do the research in two moments: the first one as a quantitative approach with sixty preterm newborn with very low weight, which were in the of the University Hospital at Sao Paulo University during the period 1999-2000. The data has been collected using the dossier with a specific instrument. The results showed that (50.9%) of mothers were primiparous, the average age was 27.5 years, 80.0% did prenatal. Reporting newborn, the average of birth weight was 1.084g and the pregnancy age was thirty weeks; 23.0% died, the average of birth weight was 688g. The median of permanence of the 46 survivors in ICU was 10 days and in hospital was 49.5 days. 69.6% were submitted to intubation and mechanical ventilation; 78.3% used a central catheter and 98.7% to parenteral nutrition. 75.0% of the babies from Nursery were accompanied in the Out Patient Neonatal Unit at University Hospital during the first year of life. The second moment, with a qualitative approach, the data were collected using the participant observation and the interview with ICU preterm newborn parents. We adopted Cultural Anthropology and Ethnography as theoretical reference methodologies. From this analysis emerged six cultural categories and subcategories that showed two cultural themes: \"The capacity to be parents of a very low weight preterm newborn: fighting moments and growth\" and \"Caring and living together with a child\". Parents lived all the process with fear and hope. They said this experience was very intense and transforming, attributing child\'s life to religion, health professionals and specialized care. They felt capable to take care of the child after hospital discharge, although recognized new obstacles in the social-cultural context to carry out the responsibility of being parents.

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-25T17:49:46Z No. of bitstreams: 1 danieleCristinydaSilva_dissert.pdf: 1056431 bytes, checksum: 6877500017e2679bab83b81b583362f9 (MD5) / Made available in DSpace on 2018-10-25T17:49:46Z (GMT). No. of bitstreams: 1 danieleCristinydaSilva_dissert.pdf: 1056431 bytes, checksum: 6877500017e2679bab83b81b583362f9 (MD5) Previous issue date: 2017-09-19 / Intensive Care Unit can generate a highly stressful environment where patients experience experiences of physical and psychological discomfort such as pain, which when untreated can contribute to an unfavorable outcome and increased mortality. The identification of pain through validated scales is indispensable for its proper management. The use of sedatives and analgesics in critical patients is necessary, providing analgesia, anxiolysis, amnesia, and comfort, but these drugs are not free of side effects and require vigilance. Objectives: To associate pain, sedoanalgesia and mortality; Describe the clinical profile, self-report and behavioral pain intensities and sedation levels; To verify the efficiency of the Sequential Organ Failure Assessment as a prognostic index and to identify the validity of pain and its intensities as predictive of mortality. Methods: A cross-sectional and prospective study in a general / neurological clinical / surgical intensive care unit of a tertiary-level hospital, with a sample of 240 patients. Results: Prevalence of non-elderly, male, neurological, surgical patients with deep sedation. There was higher mortality in patients with deep sedation, intense pain, surgical and elderly, and longer hospitalization time in those with moderate sedation. The sedoanalgesia did not suppress the pain, but it controlled its intensity, being Fentanil the drug more used. The Sequential Organ Failure Assessment did not act as a good prognostic index, since the intense pain proved to be a good predictor of mortality. Conclusion: It is concluded that the identification of pain intensities and sedation performed by nurses through validated scales, assists in decision making and bases the appropriate management of sedoanalgesia in intensive care. / A Unidade de terapia intensiva pode gerar um ambiente altamente estressor onde os pacientes vivenciam experiências de desconforto físico e psicológico como, por exemplo, a dor, que quando não tratada pode contribuir para um desfecho desfavorável e aumento da mortalidade. A identificação da dor através de escalas validadas é indispensável para seu adequado manejo. O uso de sedativos e analgésicos em pacientes críticos é necessário, proporcionando analgesia, ansiólise, amnésia, e conforto, porém esses fármacos não são isentos de efeitos colaterais e necessitam de vigilância. Objetivos: Associar dor, sedoanalgesia e mortalidade; descrever o perfil clínico, intensidades de dor por autorrelato e comportamental e níveis de sedação; verificar a eficiência do Sequencial Organ Failure Assessment como índice prognóstico e identificar vigência de dor e suas intensidades como preditivas de mortalidade. Métodos: Estudo transversal e prospectivo em unidade de terapia intensiva clínica/cirúrgica, geral/neurológica de um hospital de nível terciário, com uma amostra de 240 pacientes. Resultados: Prevaleceram pacientes não idosos, masculinos, neurológicos, cirúrgicos, com sedação profunda. Houve maior mortalidade em pacientes com sedação profunda, dor intensa, cirúrgicos e idosos e maior tempo de internação naqueles com sedação moderada. A sedoanalgesia não suprimiu a dor, mas controlou sua intensidade, sendo o Fentanil a droga mais utilizada. O Sequencial Organ Failure Assessment não atuou como bom índice prognóstico, já a dor intensa mostrou-se como boa preditora de mortalidade. Conclusão: Conclui-se que a identificação das intensidades de dor e sedação realizada por enfermeiros através de escalas validadas, auxilia nas tomadas de decisão e baseia o adequado manejo da sedoanalgesia em unidade de terapia intensiva.

Orientador: Marlene Castro Waideman / Banca: Maria Luisa Louro de Castro Valente / Banca: Manoel Antonio dos Santos / Resumo: O objetivo desta pesquisa consistiu em estudar aspectos da psicodinâmica familiar de mães acompanhantes de bebês prematuros, a partir de seu ponto de vista. Para tanto, foram realizados encontros com quatro mães que estavam acompanhando seus bebês num hospital público de Assis (SP), aplicando entrevista semi-estruturada e aberta, a partir de alguns itens norteadores previamente definidos. Constitui-se uma pesquisa de caráter qualitativo, desenvolvida através do Método Psicanalítico, tomando-se como referencial teórico os conceitos psicanalíticos e as contribuições da Teoria de Família para análise dos dados. Os resultados sugeriram a prevalência de sentimentos ambíguos quanto à prematuridade, tanto para as mães como para o grupo familiar em geral. Da mesma forma, a vivência do papel materno diante da prematuridade sugeriu ligações com a história familiar de cada uma das mães na relação com suas próprias mães. O prematuro pareceu assumir um papel regulador dentro da família. Tanto o nascimento prematuro como a vivência do processo de hospitalização, representaram fatores que podem contribuir para a continuidade do sentimento de coesão e grupalidade e para o resgate da identidade familiar. O presente estudo aponta para a importância dos processos de humanização no ambiente hospitalar, bem como para a necessidade de ampliação da atuação do psicólogo hospitalar junto à equipe multiprofissional, ao paciente e à família também na prevenção dos sofrimentos decorrentes dos processos de hospitalização. / Abstract: The objective of this research consisted in study the aspects of familiar psychodynamic of mothers accompanying premature infants, as of they point of view. Thereunto, it was performed appointments with four mothers accompanying their children in a state hospital in Assis (SP, Brazil), having an open and semi-structured interview, starting from some directional items defined previously. It was a qualitative research, developed through Psychoanalytic Method, having as theoretical reference the psychoanalytical concepts and the contributions of Family Theory in order to analyze the data. Results suggested that ambiguous feelings prevail as related to prematurity, as for mothers and for the familiar group in general. Thus, the experience of mother role before prematurity suggested bounds with familiar history of each mother in the relationship with their own mothers. The premature infant seemed to take a regulated role inside the family. The premature birth, as well as the experience of hospitalization process, represents factors which can contribute to continue the group and cohesion feeling and to rescue the familiar identity. This study indicates the importance of humanization processes in the hospital environment, as well as the need of increase hospital psychologist acting upon multi-professional team, upon the patient and the family, also as related to avoid the suffering arising from hospitalization processes. / Mestre

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A pele do bebà quando internado em uma Unidade de Terapia Intensiva Neonatal (UTIN), apresenta predisposiÃÃo a ser lesionada, diante da necessidade de muitos procedimentos especÃficos, acabando por expÃ-lo a manipulaÃÃes necessÃrias, mas um tanto desgastantes para o mesmo. Objetivou-se avaliar as lesÃes de pele que acometem recÃm-nascidos internados em uma UTIN. Estudo prospectivo, quantitativo, exploratÃrio descritivo, realizado no perÃodo de marÃo a maio/2007, numa instituiÃÃo pÃblica em Fortaleza-CE. ConstituÃram o universo e a amostra 137 recÃm-nascidos, que estiveram internados nas UTIN, os quais todos foram autorizados à participaÃÃo nesta pesquisa pelos pais. Destes, 36 apresentaram lesÃes de pele. Na coleta de dados, utilizou-se um instrumento que permitiu o registro das lesÃes atravÃs da observaÃÃo direta dos recÃm-nascidos durante a higiene corporal, trocas: de fralda, de sonda, de venda ocular; retiradas: de membrana semipermeÃvel, bandagem adesiva elÃstica e/ou micropore, eletrodos, hidrocolÃide que estavam fixados diretamente na pele destes, durante as punÃÃes, dentre outros procedimentos. Investigou-se 137 recÃm-nascidos, a maioria prematuro (80%), sexo masculino (63%), nascido de parto abdominal (61%), apgar de 7 a 10 no 1 minuto (40%), diagnosticados com prematuridade moderada (49%), baixo peso ao nascer (39%), adequado para a idade gestacional (74%), medindo entre 41 e 47cm (44%). Destes, 36 recÃm-nascidos (26%) apresentaram lesÃes de pele, totalizando 51 lesÃes. Foram identificadas: hematomas (46%), eritemas (18%), escoriaÃÃes (12%), equimoses (10%), pÃstulas (6%), descamaÃÃes (4%), mielomeningocele (2%) e gastrosquise (2%). Quando ocorreram as lesÃes, os recÃm-nascidos estavam em uso de hidrataÃÃo venosa (84%), antibiÃtico (78%), ventilaÃÃo mecÃnica (53%), fototerapia (33%), nutriÃÃo parenteral (27%), hemotransfusÃo (8%), oxihood (8%), cpap nasal (6%) e O2 circulante (4%); acomodados em incubadora aquecida (86%), incubadora de transporte (10%) e em berÃo de calor radiante (4%). Predominaram lesÃes nos membros (52%), no tronco (24%), na cabeÃa (16%) e em outros (8%). As associaÃÃes realizadas foram: punÃÃo arterial (32%), extravasamento (14%), assadura (14%), punÃÃo venosa (8%), impetigo (4%), indeterminada (4%), mà formaÃÃo congÃnita (4%), retirada da membrana transparente (4%), retirada da bandagem adesiva (4%), ressecamento da pele (4%), infecÃÃo (2%), retirada da fita hipoalergÃnica (2%) e tocotraumatismo (2%). Quanto a Ãrea da lesÃo (40%) eram < 1cm2, no tamanho 68% eram lesÃes entre 1 e 2cm. A maioria tinha a forma geogrÃfica (38%) e distribuiÃÃo localizada (92%). Os recÃm-nascidos que desenvolveram lesÃes tinham diagnÃsticos de âprematuridadeâ (92%), âsÃndrome do desconforto respiratÃrioâ (43%), âasfixiaâ (24%), ârecÃm-nascido a termoâ (8%); ârisco de infecÃÃoâ (6%), ârisco de hipoglicemiaâ (6%), âgastrosquiseâ (2%) e âmielomeningoceleâ (2%). A maioria nasceu com peso entre 550 - 999g, (47%), sendo o peso destes no dia em que ocorreu a lesÃo entre 455 - 999g, (47%). A maioria eram neonatos (84%) e as lesÃes (47%) surgidas antes do 7 dia de vida. Ao associar: tipos de lesÃes, diagnÃsticos, PN e IG dos RNâs, somente o diagnÃstico âprematuridadeâ apresentou associaÃÃo estatÃstica significante: âp de Fisher-Freeman-Halton = 0,496â. Consagra-se na trajetÃria deste estudo o cuidado de enfermagem ao RN que, indiscutivelmente, deve ser holÃstico e diferenciado, considerando suas peculiaridades. / Infants in the Neonatal Intensive Care Unit (NICU) often get skin lesions on account of the many stressful procedures they are exposed to. This prospective, quantitative and descriptive study was carried out at a public health facility in Fortaleza (Northeastern Brazil) from March to May 2007, in order to investigate skin lesion patterns in infants in the NICU setting. The study population consisted of 137 hospitalized infants. Informed written consent was obtained from the infantsâ caretakers. The data collection instrument registered skin lesions through direct observation during bathing, change of diapers, catheters and eye patches and during removal of semi-permeable membranes, elastic adhesive bandages and/or micropores, electrodes and hydrocolloid dressings applied to the skin during punction, among other procedures. Eighty percent of the infants were premature, 63% were male, 61% were caesarean births, 40% presented first-minute apgar scores of 7-10, 49% were diagnosed with moderate prematurity, 74% were full-term, 39% had low birth weight and 44% measured 41â47cm. Thirty-six infants had skin lesions (total 51 lesions) in the form of bruises (46%), erythema (18%), excoriation (12%), ecchymosis (10), pustulas (6%), scaling (4%), myelomeningocele (2%) or gastroschisis (2%). The lesions were inflicted while the infants were being treated with intravenous hydration (84%), antibiotics (78%), mechanical ventilation (53%), phototherapy (33%), parenteral nutrition (27%), blood transfusion (8%), oxygen hood (8%), nasal cpap (6%) or circulating oxygen (4%), or were in a heated incubator (86%), transport incubator (10%) or heated crib (4%). Lesions were observed most often on limbs (52%), torso (24%), head (16%) and other sites (8%). The causes identified were arterial puncture (32%), leaking (14%), contact dermatitis (14%), vein puncture (8%), impetigo (4%), undetermined (4%), congenital malformation (4%), removal of the caul (4%), removal of adhesive bandage (4%), skin dryness (4%), infection (2%), removal of hypoallergenic tape (2%) and birth traumatism (2%). Forty percent of lesions measured < 1cm2 and 68% measured 1-2cm. Most were well defined (38%) and/or localized (92%). Infants with lesions presented prematurity (92%), syndrome of respiratory distress (43%), asphyxia (24%), full-term delivery (8%); risk of infection (6%), risk of hypoglycemia (6%), gastroschisis (2%) or myelomeningocele (2%). Most (47%) weighed 550-999g at birth, with lesions occurring at 455-999g in 47%. Most were newborn (84%) and lesions appeared before the seventh day of life in 47% of cases. Among the parameters lesion type, diagnosis, PN, IG and prematurity, only the latter presented a statistically significant association (p=0.496, by the Fisher-Freeman-Halton test). The study shows the importance of providing the newborn with good-quality holistic nursing care with a view to the special needs of this patient population.

As lombalgias têm influenciado no absenteísmo e no presenteísmo de trabalhadores de enfermagem. O objetivo geral deste estudo foi identificar os fatores do trabalho associados à lombalgia não específica, caracterizada no âmbito da resistência da musculatura extensora lombar, em trabalhadoras de enfermagem de Unidades de Terapia Intensiva. Trata2se de um estudo exploratório do tipo transversal com abordagem quantitativa dos dados, realizado em Unidades de Terapia Intensiva. A amostra foi composta por 48 trabalhadoras (enfermeiras, técnicas e auxiliares de enfermagem) atuantes há mais de seis meses na Unidade de Terapia Intensiva de um hospital público (HA) (n=32) e um hospital privado (HB) (n=16) da cidade de Ribeirão Preto2SP. Os instrumentos utilizados para coleta dos dados foram: Questionário de caracterização dos sujeitos (características sociodemográficas e ocupacionais), Questionário Nórdico de Sintomas Osteomusculares - adaptado (caracterização dos sintomas osteomusculares, segundo as regiões do corpo), Fatores do trabalho que podem contribuir para os sintomas osteomusculares 2 adaptado, Teste de Sorensen (identificação da resistência da musculatura extensora lombar) e Escala RPE de Borg (identificação do esforço percebido). Os dados foram coletados em 2011, nos hospitais, pelo pesquisador, após a aprovação do projeto de pesquisa pelo Comitê de Ética em Pesquisa (Processo 122/2011) e permissão dos chefes dos serviços. Resultados: as participantes do estudo eram mulheres, na faixa etária entre 20 e 56 anos, a maioria se declarava branca, solteira (58,3%), com filhos (52,1%), sedentária (64,6%), com acúmulo de trabalho profissional e doméstico (89,6%). As enfermeiras executam tarefas gerenciais e assistenciais, com predomínio das gerenciais, e os técnicos e auxiliares de enfermagem executam o cuidado direto aos pacientes, tarefas que são consideradas desgastantes. O sintoma lombar foi a principal queixa osteomuscular (66,7%), seguido dos segmentos ombros (54,2%), pescoço (47,9%) tornozelos (41,7%) e região dorsal (41,7%). As trabalhadoras com sintoma lombar atingiram um tempo menor (93,06 s.) de resistência da musculatura extensora da coluna no teste de Sorensen, em comparação às trabalhadoras assintomáticas (116,30 s), e o esforço percebido após o teste foi intenso (15) para todos os sujeitos. Os principais fatores do trabalho que contribuem para os sintomas lombares identificados pelas trabalhadoras de enfermagem foram relacionados a aspectos posturais (torção e flexão de coluna, curvar as costas, postura estática) e organizacionais (repetitividade, horas extras, falta de descanso e velocidade do trabalho). Concluímos que os sintomas lombares são frequentes entre as trabalhadoras de enfermagem das unidades estudadas, embora a resistência da musculatura extensora da coluna não tenha apresentado diferenças estatisticamente significativas entre os grupos de sujeitos sintomáticos e assintomáticos. Os resultados obtidos e os fatores identificados pelas trabalhadoras como contribuintes aos sintomas lombares são indicadores da inadequação das condições de trabalho e de que ações de intervenção no ambiente e na organização do trabalho são necessárias. O estudo contribuiu para o avanço do conhecimento das áreas de Saúde do Trabalhador, Fisioterapia e Enfermagem. / Low back pain is a condition that has influenced absenteeism and presenteeism of nursing workers. The overall goal of the present study was to identify the work2related factors associated to nonspecific low back pain characterized by the resistance of lumbar extensor muscles among female nursing workers of Intensive Care Units. This is an exploratory cross2 sectional study under a quantitative approach held in Intensive Care Units. The sample consisted of 48 workers 2 nurses, nursing technicians and assistants2 who had been active for over six months in the Intensive Care Unit of a public hospital (HA) (n=32) and a private hospital (HB) (n=16) in the city of Ribeirão Preto, São Paulo, Brazil. The tools used for data collection were; Subject characterization questionnaire (sociodemographic and occupational), Nordic Musculoskeletal Questionnaire - adapted (characterization of musculoskeletal symptoms according to body regions), Job risk factors that may contribute to musculoskeletal symptoms - adapted, Sorensen test (identification of resistance of lumbar extensor muscles) RPE on Borg scale (perceived exertion rating).The data were collected in 2011 in hospitals, by the researcher, thereafter the Research Ethics Committee had approved the project (petition 122/2011) and Chief Service Officials had granted their permission. Results: The participants in the study were females aged between 20 to 56 years old, self reported as Caucasian, single (58.3%), with children (52.1%), sedentary (64.6%), both professionally and housework overloaded (89.6%). Tasks Performed: Nurses perform both care and, predominately, managerial activities. Nursing technicians and assistants perform direct care of patients. These latter tasks are considered more overwhelming. The major musculoskeletal complaints relied on the Lower back system (66.7%), followed by shoulder segments (54.2%), neck (47.9%) and dorsal region (41.7%).The workers presenting low back symptoms reached a shorter resistance time on the spinal extensor muscles when compared to asymptomatic workers using the Sorensen test (93.06 s. versus 116.30 s). All subjects (15) perceived intense exertion after the test. The main job factors that contribute to low back symptoms identified by the subjects were related to both postural (spine torsion and bending, back bending, static posture) and organizational (repetitiveness, excessive work hours, lack of rest, and work pace) aspects. Conclusion: We conclude that lumbar symptoms are frequent among the female nursing workers of the studied units. In addition, although spinal extensor muscles resistance has not shown significant statistical differences between the symptomatic and asymptomatic groups, the obtained results and factors identified by the workers as contributing to low back symptoms are indicators of inadequate labor conditions. Therefore, interventions on the work organization and environment are needed. Finally, the present study contributes to the progress of knowledge in the areas of Occupational Health, Physiotherapy and Nursing.

The purpose of this research was to determine if significant differences exist between the APACHE II scores of intubated mechanically ventilated patients who ultimately received a tracheostomy and those who did not. In addition to this inquiry, the study also investigated the possibility of a range of APACHE II scores, a particular age group, and the presence of chronic organ insufficiencies and their relationship to the tracheostomy result. Methodology was non-experimental, quantitative, and retrospective. It was observational in that the goal was to simply record and quantify the potential association between these variables. Data was obtained from patients at Bristol Regional Medical Center from January 1- August 31, 2011. Information was calculated using descriptive statistics and the t-test for independent samples. Participants included all intubated mechanically ventilated patients who were at least eighteen years of age with a documented APACHE II score in the allotted time frame. There were 468 total patients, 79 (16.9%) of which received a tracheostomy. The mean APACHE II score for patients who received a tracheostomy was 21.8354 as compared to the mean APACHE II score of 21.6735 for those who were extubated. There was no significant difference between the APACHE II scores of these groups. The tracheostomy group had the highest frequency of patients with APACHE II scores of less than 25 and a range of 20-29. 84.8% of tracheostomy patients had some form of chronic organ dysfunction. Respiratory failure was the most frequent admitting diagnosis for all 468 patients and respiratory insufficiency was the most prevalent co-morbidity for the tracheostomy patients. The age range that included more tracheostomy patients was 65-74. 40% of re-intubated patients eventually received a tracheostomy and 69.6% of tracheostomy patients had the procedure performed early (within the first seven days of intubation). The managerial team of this respiratory therapy department decided to stop calculating the APACHE II score on all intubated patients in an attempt to save time and staff resources.

Ineffective pain management in the post anesthesia care unit (PACU) increases patients' risk of adverse effects including decreased mobility, infection, chronic pain, depression, cardiopulmonary complications, increased length of stay, insomnia, fatigue, and overall decrease in quality of life. The PACU in a community hospital did not provide an evidence-based pain management guideline for nurses treating postoperative patients, resulting in nurses' concerns about providing pain management. The purpose of this project was to translate evidence on pain management into an evidence-based guideline for improved nursing practice in a PACU. Evidence was obtained from a detailed literature search using multiple databases and professional organizations' guidelines. Nursing practice guidelines were developed and evaluated by 3 expert panelists using the Agree II guidelines. The panelists selected included; Two anesthesiologists, one who is trained in pain management and is also a pharmacist. The third expert is a practicing nurse practitioner in an acute setting who is also a surgical first assist and the associate director of robotics. The panel endorsed the guidelines for advancement through the hospital's review committees. Implementation of the evidence-based pain management guideline in the PACU might provide nurses with tools to guide their interventions and improve patient outcomes. Social changes resulting from the use of evidence-based pain management guidelines include decreased time to opiate administration, decreased adverse effects, improved assessment of pain, and an increase in the number of patients who receive proper pain management.

The purpose of the study was to identify NANDA - I diagnoses, NOC outcomes, and NIC interventions used in nursing care plans for ICU patient care and determine the factors which influenced the change of the NOC outcome scores. This study was a retrospective and descriptive study using clinical data extracted from the electronic patient records of a large acute care hospital in the Midwest. Frequency analysis, one-way ANOVA analysis, and multinomial logistic regression analysis were used to analyze the data. A total of 578 ICU patient records between March 25, 2010 and May 31, 2010 were used for the analysis. Eighty - one NANDA - I diagnoses, 79 NOC outcomes, and 90 NIC interventions were identified in the nursing care plans. Acute Pain - Pain Level - Pain Management was the most frequently used NNN linkage. The examined differences in each ICU provide knowledge about care plan sets that may be useful. When the NIC interventions and NOC outcomes used in the actual ICU nursing care plans were compared with core interventions and outcomes for critical care nursing suggested by experts, the core lists could be expanded. Several factors contributing to the change in the five common NOC outcome scores were identified: the number of NANDA - I diagnoses, ICU length of stay, gender, and ICU type. The results of this study provided valuable information for the knowledge development in ICU patient care. This study also demonstrated the usefulness of NANDA - I, NOC, and NIC used in nursing care plans of the EHR. The study shows that the use of these three terminologies encourages interoperability, and reuse of the data for quality improvement or effectiveness studies.

A pediatric intensivist in the University of Iowa Hospitals and Clinic's (UIHC) Pediatric Intensive Care Unit (PICU) was concerned about antimicrobial use in the unit. However, no one had quantified antimicrobial use in the UIHC's PICU or described the patterns of antimicrobial use in this unit. To address the intensivist's concern, the principal investigator (PI) conducted a retrospective study to determine the percentage of patients who received antimicrobial treatments, to determine the indications for antimicrobial use, and to identify antimicrobial agents used most frequently in the unit. On basis of our data, we hypothesized that empiric antimicrobial use, particularly the duration of therapy, could be decreased. We implemented a six-month intervention during which we asked the pediatric intensivists to complete an antimicrobial assessment form (AA) to document their rationale for starting antimicrobial treatments. We postulated that this documentation process might remind physicians to review antimicrobial therapies, especially empiric therapies, when the microbiologic data became available. In addition, we utilized the AA form to identify factors pediatric intensivists considered when deciding to prescribe empiric antimicrobial treatments. Data from the AA forms suggested that pediatric intensivists in the UIHC's PICU often considered elevated C-reactive protein, elevated white blood cell counts, and elevated temperatures when deciding to start empiric antimicrobial therapy. Data from the three nested periods showed that the median duration of empiric and targeted treatments decreased during the intervention and remained stable during the post-intervention period. The PI estimated that 193 days of empiric antimicrobial therapy and 59 days of targeted antimicrobial therapy, respectively, may have been saved by the decreased durations of therapy. Time series analysis assessing the trend in use of piperacillin-tazobactam, cefepime, and ceftriaxone (measured in mg/wk) did not reveal a significant change over time. On the basis of our results, an intervention strategy using an AA form alone may not be an effective strategy for antimicrobial stewardship in PICUs. Additional measures such as automatic stop orders and computer decision support may be useful for reducing the duration of empiric therapy in PICUs.

<p>The role of information technology within health care is getting more central and prominent. The purpose of this change is both to make the health care more efficient and to heighten patient safety. This exploratory case study of four care units aims to provide a glimpse into the clinical work of nurses, and to indentify and describe their communication and information needs. The analytical framework used in this study is distributed cognition and the research method used is cognitive ethnography. The study provides a peek into the complex system of health care, and how the central artifacts such as patient records, whiteboards and different alarm systems are used in this context. The result of the study describes the current work practices and information flows in the studied care units. From these results general system design implications are made.</p>