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Audit and Feedback to Improve Laboratory Test and Transfusion Ordering in Critical Care: A Systematic Review & Assessment of Adherence to Best PracticesFoster, Madison 10 May 2019 (has links)
Audit and feedback (A&F), provision of performance data, can be an effective means to change behaviour. We hypothesize that A&F may be useful in the complex environment of critical care to address routine ordering behaviours. This thesis describes a systematic review assessing the use and effectiveness of A&F for the improvement of intensive care unit laboratory test and transfusion ordering and an analysis of how these interventions adhere to recent suggestions for best practice. The review identified relatively few published studies, almost all of which involved multi-component interventions; these were generally found to be moderately effective. Through development of an evaluation tool, we found recent suggestions for best practice may be underutilized in existing A&F interventions. This work has identified several priorities for future research to aid in the optimization of critical care A&F interventions aimed at improving test and transfusion ordering.
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Parents’ Experience of the Transition with their Child from a Pediatric Intensive Care Unit (PICU) to the Hospital Ward: Searching for Comfort Across TransitionsBerube, Kristyn M. 28 February 2013 (has links)
The pediatric intensive care unit (PICU) has been described as a stressful place for parents of critically ill children. Research to date has examined parents’ needs and stressors with a child in PICU. There is a paucity of research examining the experience for parents of a child who is transferred from the PICU to the hospital ward. Open-ended interviews were conducted with 10 parents within 24-48 hours after transfer from a PICU to a hospital ward at a children’s hospital in Canada to understand this experience. Parents revealed that the experience involved a search for comfort through transitions as expressed through the themes of: ‘being a parent with a critically ill child is exhausting’, ‘being kept in the know’, ‘feeling supported by others’, and ‘being transferred’. The findings from this study can help nurses and other health professionals working with parents to support them through the transition from PICU. Recommendations are made for the inclusion of family-centered care practices to assist parents through transitions.
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Healing design: a phenomenological approach to the relation of the physical setting to positive social interaction in pediatric intensive care units in the United States and TurkeyOzcan, Hilal 12 April 2006 (has links)
This study examines the impact of the physical setting in the care and healing process of hospitalized children, their families, and the caregivers in two selected pediatric intensive care units (PICUs) in the U.S. and Turkey. A holistic, cross-cultural, comparative, and naturalistic approach emphasized the importance of the total (i.e., physical, social, cultural, spiritual, organizational, political) environment and quality of life to health and healing. Information was gathered through qualitative methods such as participant observations, behavioral maps, in-depth interviews, and floor plan analysis. Despite some universal features of the PICU atmosphere, the value and place ascribed to pediatric critical care in Turkey and the U.S. present different worldviews. Field studies revealed social interaction as a universal healing function despite its cultural specificity stemming from socio-cultural, ethnic, economic, and religious differences between different groups.
Crowding, parental absence, and over-stimulation, which stem from the lack of individual patient rooms, and organizational problems related with human resources and staffing shortage play against the critically ill childÂs deep need to heal in the Turkish PICU. Despite spatial limitations, informal social interactions and cooperative relationships among caregivers, their devotion, and their ability to adapt to the existing physical and social environment enable care delivery. While staffing shortage continues to be a crucial problem in the U.S. model, specialization of labor and the systemic organization in general support care delivery, reducing the importance of informal social interactions and cooperation among caregivers. However, emphasizing the role of the family in the childÂs care, social interaction is also identified as a healing function in this setting. Therefore, despite the significant role the physical setting may play in healing, social interaction is found to be more important for improving patient outcomes and the well-being of families and caregivers. The study focuses on six healing design interventions to increase the chances for positive social interaction and collaboration. These are programmatic (provisional, scale, locational), functional, ambient, symbolic, social and psychological interventions.
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Mi chiquito (my little one) : mothers of Mexican heritage in the neonatal intensive care unit (NICU) / Mothers of Mexican heritage in the neonatal intensive care unit (NICU)Cleveland, Lisa Marie 18 December 2012 (has links)
The admission of an infant to the Neonatal Intensive Care Unit (NICU) has the potential to produce significant stress for the mothers of these infants. Researchers suggest that this may contribute to difficulties with coping following discharge. Past research on this topic has been primarily focused on Caucasian women. Approximately 9% of the U.S. population is of Mexican heritage; therefore, this population is significantly underrepresented in the existing literature. For this reason, the purpose of this grounded theory study was to identify the basic social processes used by English-speaking mothers of Mexican heritage who have experienced the admission of an infant to the NICU.
Maximum variation sampling was utilized to recruit 15 English-speaking mothers of Mexican heritage who were at least 18 years of age and had experienced the admission of an infant to the NICU. The women were recruited from various locations in San Antonio, Texas. Data collection was conducted through audio-taped, semi-structured individual interviews and transcribed field notes. Data analysis consisted of constant comparison, open coding of data, and theoretical coding.
This investigation resulted in the substantive theory making sure my baby is cared for by being there for my baby. The process began with the unexpected event of having an infant in the NICU and played out in the context of opposing forces: trying to be the mother or making meaningful connections. The mothers developed strategies for managing this situation by balancing responsibilities, leaving part of me with my baby, and watching over. The process concluded with one of two consequences: bringing my baby home or losing my baby.
The theory that emerged from this study offers insight for researchers, nurse educators, and neonatal nurses who provide care for English-speaking, Mexican-heritage mothers and their infants as well as for the care of all NICU mothers and their infants. / text
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The lived experience of family-centred care by primary caregivers of critically ill children in the pediatric intensive care unitBrown, Devon 26 January 2012 (has links)
The unexpected admission of a child to the pediatric intensive care unit (PICU) creates feelings of uncertainty, distress, and fear and is a devastating experience for primary caregivers. Health care providers must address primary caregivers` concerns to enhance primary caregivers’ coping abilities. While a family-centred approach to care can assist in diminishing uneasy feelings experienced by primary caregivers, this philosophy of care is not consistently used in everyday practice. The PICU is a unique area of care that focuses on restoring the health of critically ill children with the use of machines and equipment. However, the use of technology for life sustaining measures creates additional responsibilities for health care providers, potentially compromising the quality of patient care. There is evidence to support that the involvement of the primary caregiver in the care of the critically child can address the gap that commonly exists between technology and holistic patient care. Furthermore, involvement in care increases primary caregivers’ satisfaction with the care their child receives and may also improve patient outcomes. Most importantly, the involvement of primary caregivers in the care of the critically ill child encompasses a family-centred approach to care.
By increasing health care provider’s awareness of family-centred care within the PICU, primary caregiver’s needs may be more effectively addressed during this devastating and vulnerable time. Health care providers are key players in the promotion of family-centred care in the PICU; however, they are often faced with multiple challenges and barriers. Increasing health care providers’ awareness around the components of family-centred care can facilitate its implementation into practice by understanding how primary care givers define and experience
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family-centred care. Accordingly, a qualitative study guided by the philosophy of hermeneutic phenomenology was conducted to elicit a detailed description of the lived experience of family-centred care from the perspective of the primary caregiver.
Participants in this study consisted of those primary caregivers who had previously had a child admitted to the PICU. Participants were recruited from a large mid-western hospital. In total nine primary caregivers ranging in age from 33 to 44 years with the mean age being 37 years participated in the study. Nine of the participants were mothers and two were fathers. All participants took part in semi-structured, open-ended interviews. A total of nine interviews were conducted with two of the interviews involving both parents. Demographic data and field notes were recorded. All field notes and interview data were transcribed. The transcripts were reviewed repeatedly for significant statements in an attempt to find meaning and understanding through themes. The data analysis revealed the essence of the lived experience of family-centred care to be being present. Three themes communicated the essence and included: (a) physical presence, (b) participation in care and, (c) advocating. Three themes from the data emerged around how primary caregivers defined family-centred care and included: (a) collaboration, (b) being updated and, (c) continuity of care. Finally, primary caregivers identified four conditions that needed to be in place to experience family-centred in the PICU which included: (a) being present for rounds, (b) caring behaviours, (c) feeling welcomed and, (d) support. The findings from this study may be used to guide policy around family-centred care and improve on, or bring new insights around interventions related to family-centred care. Future recommendation for nursing practice, education and research are presented.
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Jag behöver få sova! : Interventioner för att främja sömn hos patienter som vårdas på intensivvårdsavdelningar / I need to sleep! : Interventions to promote sleep for patients cared for in intensive care unitsFrendin, Jessica, Jonsson, Diana January 2013 (has links)
Bakgrund: Sömn är ett mänskligt grundläggande behov och bör därför tillgodoses hos patienter som vårdas på sjukhus. Patienter som vårdas på intensivvårdsavdelningar upplever dock ofta upprepade avbrott på sömnen och sömnbrist vilket kan leda till både fysiska och psykiska negativa konsekvenser. Intensivvårdsmiljön med dess oljud, starka belysning och frekventa vårdrelaterade interaktioner leder ofta till oförmåga hos patienterna att få en adekvat sömn. Syfte: Att belysa olika interventioner sjuksköterskan kan tillämpa för att förbättra sovmiljön och sömnkvaliteten hos patienter som vårdas på en intensivvårdsavdelning. Metod: En litteraturöversikt med grund i analys av kvantitativ forskning. Resultat: I resultatet framkom sju interventioner som delades in i tre olika kategorier: skapa en bättre sovmiljö, avskärmning från ljud och ljus samt förbereda patienten för sömn. De sju interventionerna som identifierades var: tysta/störningsfria perioder, riktlinjer/ramverk innefattande aktiviteter för att kontrollera yttre störande faktorer, utbildning, öronproppar och ögonmask, adderat "white noise", musik samt akupressur. Slutsats: Genom att tillämpa en eller fler av de sju interventionerna kan sovmiljön och sömnkvalitet förbättras för patienter som vårdas på intensivvårdsavdelningar. Dock krävs ytterligare forskning inom området då vissa interventioner ger motstridiga resultat. Klinisk betydelse: Sömn är ett nödvändigt behov och har en stor betydelse för återhämtning från sjukdom och bör därför tillgodoses av sjuksköterskan. Resultatet i denna litteraturöversikt kan ge en ökad förståelse för vilka interventioner sjuksköterskan kan tillämpa i sitt omvårdnadsarbete för att förbättra sovmiljön och sömnkvalitet för patienter som vårdas på intensivvårdsavdelningar. / Background: Sleep is a basic human need and should be addressed in patients being treated in hospital. Patients cared for in intensive care units often experience repeated interruptions of sleep and sleep deprivation, which can lead to both physical and psychological adverse consequences. The intensive care environment with its noise, strong lighting and frequent care-related interaction often leads to the inability of patients to get adequate sleep. Aim: To illustrate the various interventions the nurse can implement to improve the sleep environment and quality of sleep in patients who are cared for in an intensive care unit. Methods: A literature review with its basis in an analysis of quantitative research. Results: The result emerged in seven interventions that were divided into three different categories: creating a better sleep environment, shielding from light and sound, and preparing the patient for sleep. The seven interventions identified were: quiet/non-disturbance periods, guidelines/framework including activities to control disturbing environmental factors, education, ear plugs and eye mask, added "white noise", music and acupressure. Conclusion: By applying one or more of the seven interventions the sleep environment and sleep quality for patients cared for in intensive care units may improve. However, as some interventions produced conflicting results, further research in the area is required. Clinical significance: Sleep is an essential requirement and has great importance in the recovery from illness and should therefore be carefully understood by the nurse. Findings from the literature review can provide a better understanding of which interventions nurses can apply in their work to improve the sleep environment and sleep quality for patients cared for in intensive care units.
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Parents’ Experience of the Transition with their Child from a Pediatric Intensive Care Unit (PICU) to the Hospital Ward: Searching for Comfort Across TransitionsBerube, Kristyn M. 28 February 2013 (has links)
The pediatric intensive care unit (PICU) has been described as a stressful place for parents of critically ill children. Research to date has examined parents’ needs and stressors with a child in PICU. There is a paucity of research examining the experience for parents of a child who is transferred from the PICU to the hospital ward. Open-ended interviews were conducted with 10 parents within 24-48 hours after transfer from a PICU to a hospital ward at a children’s hospital in Canada to understand this experience. Parents revealed that the experience involved a search for comfort through transitions as expressed through the themes of: ‘being a parent with a critically ill child is exhausting’, ‘being kept in the know’, ‘feeling supported by others’, and ‘being transferred’. The findings from this study can help nurses and other health professionals working with parents to support them through the transition from PICU. Recommendations are made for the inclusion of family-centered care practices to assist parents through transitions.
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The lived experience of family-centred care by primary caregivers of critically ill children in the pediatric intensive care unitBrown, Devon 26 January 2012 (has links)
The unexpected admission of a child to the pediatric intensive care unit (PICU) creates feelings of uncertainty, distress, and fear and is a devastating experience for primary caregivers. Health care providers must address primary caregivers` concerns to enhance primary caregivers’ coping abilities. While a family-centred approach to care can assist in diminishing uneasy feelings experienced by primary caregivers, this philosophy of care is not consistently used in everyday practice. The PICU is a unique area of care that focuses on restoring the health of critically ill children with the use of machines and equipment. However, the use of technology for life sustaining measures creates additional responsibilities for health care providers, potentially compromising the quality of patient care. There is evidence to support that the involvement of the primary caregiver in the care of the critically child can address the gap that commonly exists between technology and holistic patient care. Furthermore, involvement in care increases primary caregivers’ satisfaction with the care their child receives and may also improve patient outcomes. Most importantly, the involvement of primary caregivers in the care of the critically ill child encompasses a family-centred approach to care.
By increasing health care provider’s awareness of family-centred care within the PICU, primary caregiver’s needs may be more effectively addressed during this devastating and vulnerable time. Health care providers are key players in the promotion of family-centred care in the PICU; however, they are often faced with multiple challenges and barriers. Increasing health care providers’ awareness around the components of family-centred care can facilitate its implementation into practice by understanding how primary care givers define and experience
ii
family-centred care. Accordingly, a qualitative study guided by the philosophy of hermeneutic phenomenology was conducted to elicit a detailed description of the lived experience of family-centred care from the perspective of the primary caregiver.
Participants in this study consisted of those primary caregivers who had previously had a child admitted to the PICU. Participants were recruited from a large mid-western hospital. In total nine primary caregivers ranging in age from 33 to 44 years with the mean age being 37 years participated in the study. Nine of the participants were mothers and two were fathers. All participants took part in semi-structured, open-ended interviews. A total of nine interviews were conducted with two of the interviews involving both parents. Demographic data and field notes were recorded. All field notes and interview data were transcribed. The transcripts were reviewed repeatedly for significant statements in an attempt to find meaning and understanding through themes. The data analysis revealed the essence of the lived experience of family-centred care to be being present. Three themes communicated the essence and included: (a) physical presence, (b) participation in care and, (c) advocating. Three themes from the data emerged around how primary caregivers defined family-centred care and included: (a) collaboration, (b) being updated and, (c) continuity of care. Finally, primary caregivers identified four conditions that needed to be in place to experience family-centred in the PICU which included: (a) being present for rounds, (b) caring behaviours, (c) feeling welcomed and, (d) support. The findings from this study may be used to guide policy around family-centred care and improve on, or bring new insights around interventions related to family-centred care. Future recommendation for nursing practice, education and research are presented.
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Sederingsnivå hos ventilatorbehandlade intensivvårdspatienterThörn, Ulrika January 2013 (has links)
Bakgrund Djup sedering är associerat med förlängd vårdtid och ett flertal komplikationer för intensivvårdspatienten. Även för ytlig sedering medför komplikationer, stress och lidande. Studier visar på vikten av adekvat sedering, samt att skalor och protokoll används. Syftet med denna studie var att beskriva sederingsnivå, andel optimalt, över- och undersederade patienter, vårdtid i ventilator och vårdtid inom intensivvården för patienter på en svensk intensivvårdsavdelning. Metod Studien, med deskriptiv design, inkluderade konsekutivt sederade, ventilatorbehandlade patienter, 18 år och äldre, på en svensk intensivvårdsavdelning under nio månader. Primära utfallsvariabler var sederingsnivå, utifrån Motor Activity Assessment Scale och andel optimalt, över- och undersederade patienter. Sekundära variabler var vårdtid i ventilator och vårdtid på intensivvårdsavdelningen. Resultat Studien omfattade 34 patienter. Under vårdtid i ventilator med endotrackealtub hade 28 patienterna optimal sedering mer än två tredjedelar av vårdtiden. Medianvärdet för sederingsnivå under vårdtid med endotrackealtub var MAAS 2 (kvartilavstånd 2-2,25) jämfört med medianvärdet för sederingsnivån med trackealkanyl som var MAAS 3 (kvartilavstånd 2-3) (P < 0,001). Trettio patienter (88,2 %) var optimalt sederade med ett MAAS-värde på 2-3 (md) sett till hela vårdtiden. Fyra patienter (11.8 %) var översederade med ett MAAS-värde på 0-1,5 (md). Ingen patient var undersederad sett till hela vårdtiden. Konklusion Studien visar att majoriteten av intensivvårdspatienterna var optimalt sederade under större delen av vårdtiden i ventilator. Endast ett fåtal patienter var översederade och ingen patient var undersederad större delen av vårdtiden. Patienter vårdade med trackealkanyl var ytligare sederade än de med endotrackealtub.
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InfecÃÃo Relacionada à AssistÃncia à SaÃde Precoce em Unidade Neonatal de Alto Risco / Infection related to early health care in a neonatal unit at high risk.VÃnia Maria de Oliveira Dias 15 February 2013 (has links)
nÃo hà / InfecÃÃes relacionadas à assistÃncia à saÃde (IRAS), em neonatologia, contemplam as infecÃÃes relacionadas à assistÃncia, e as relacionadas à falha na assistÃncia, prevenÃÃo, diagnÃstico e tratamento, a exemplo das transplacentÃrias e precoce neonatal de origem materna. As IRAS afetam mais de 30% de neonatos e, comparados à populaÃÃo pediÃtrica, os Ãndices sÃo atà cinco vezes maiores. Estima-se que no Brasil, 60% da mortalidade infantil ocorram no perÃodo neonatal, sendo a sepse neonatal uma das principais causas. A pesquisa tem como objetivo caracterizar as infecÃÃes neonatais precoces relacionadas à assistÃncia à saÃde, de recÃm-nascidos em Unidades de Terapia Intensiva Neonatal da Maternidade Escola Assis Chateaubriand (MEAC). Trata-se de um estudo transversal, de natureza descritiva e exploratÃria com abordagem quantitativa. Os dados foram coletados no perÃodo de janeiro a marÃo de 2012, nos registros da ComissÃo de Controle de InfecÃÃo Hospitalar (CCIH). Participaram do estudo 545 recÃm-nascidos com infecÃÃo precoce admitidos no perÃodo de janeiro de 2010 a dezembro de 2011. Fez-se anÃlise bivariada e multivariada com desfechos: prematuridade, baixo peso ao nascer e Ãbito. Dos recÃm-nascidos pesquisados, a maioria à de baixo peso, e 81% prematuros. Na anÃlise com variÃvel dependente prematuridade, a variÃvel sexo mostra associaÃÃo estatÃstica significante com desfecho RC= 1,67. Ser do sexo feminino hà risco de quase duas vezes mais em nascer prematuro em comparaÃÃo ao sexo masculino. Utilizando como variÃvel dependente baixo peso < 2.500 g, a variÃvel sexo tem associaÃÃo estatÃstica significante com desfecho RC= 1,94. Ser do sexo feminino o risco à de quase duas vezes mais em nascidos com peso menor que 2.500 g. Outra associaÃÃo estatÃstica à a idade gestacional e baixo peso ao nascer com RC= 60,3. RecÃm-nascido prematuro apresenta quase 60 vezes mais chances de nascimento com baixo peso em comparaÃÃo aos nascidos a termo. Na anÃlise de regressÃo logÃstica bivariada, Ãbito e variÃveis independentes, para os nascidos com idade gestacional < 37 semanas mostra-se associaÃÃo estatÃstica significante com desfecho RC= 4,14 e baixo peso ao nascer RC= 3,94. Conclui-se que as infecÃÃes neonatais precoces tem alta incidÃncia em recÃm-nascidos. SÃo de difÃcil controle por estar na dependÃncia da qualidade dos cuidados durante a assistÃncia prÃ-natal, perinatal e neonatal. / Infections related to Health Care (IRAS), neonatology, include both the care-associated infections, and those related to failure to care, prevention, diagnosis and treatment, the example of transplacental and early neonatal of maternal origin. The IRAS affect more than 30% of neonates, and when compared to the pediatric population, their rates can be up to five times higher. It is estimated that in Brazil, 60% of infant mortality occur in the neonatal period, neonatal sepsis is a major cause. The research aimed to characterize the early neonatal infections related to health care occurred in newborns of Neonatal Intensive Care Units of Maternity School Assis Chateaubriand (MEAC). This is a cross-sectional study, descriptive and exploratory in nature with a quantitative approach. Data were collected in the period from January to March 2012, through the records of the Committee on Infection Control (HICC). The study identified 545 infants with early infection admitted to the units in the period January 2010 to December 2011. It was performed bivariate and multivariate outcomes (prematurity, low birth weight and death). Newborn surveyed, most were born underweight, and 81% were preterm. In the analysis using as dependent variable prematurity, the gender variable shows a statistically significant association with the outcome OR = 1.67. Being female is a risk almost twice as in preterm birth compared to males. Using as dependent variable low weight < 2.500 g, the gender variable was statistically significant association with outcome OR = 1.94. Being female is a risk almost twice as being born weighing less than 2.500 g. Another statistical association is low gestational age and low birth weight OR = 60.3 Premature infant has nearly 60 times more likely to be born underweight compared those born at term. In bivariate logistic regression analysis, death, and independent variables, for those born with a gestational age < 37 weeks showed statistically significant association with outcome OR = 4.14 and low birth weight OR = 3.94. We conclude that early neonatal infection has a high incidence in newborns. They are difficult to control because it is dependent on the quality of nursing during the prenatal, perinatal and neonatal care.
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