The aim of this study was to determine the knowledge of critical care nurses regarding forensic and liability issues in the critical care environment in order to design an education programme on the 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 South Africa. The response rate was 85%. Validity and reliability of the research was ensured. The total average percentage achieved by the group of 171 respondents was 38.46%, which was 21.54% below the set competency indicator of 60%. Only nine respondents achieved a percentage of or above 60%. Results proved that the respondents required intensive training on the topic. The outline of an education programme to address knowledge deficiencies regarding forensic and liability issues in the critical care environment was presented in PowerPoint presentation format. / Dissertation (MCur (Clinical))--University of Pretoria, 2007. / Nursing Science / MCur / unrestricted

Thesis advisor: Susan . Kelly-Weeder / Thesis advisor: Judith . Shindul-Rothschild / BACKGROUND: The influenza virus is uniquely capable of creating pandemic illness in our population. The unpredictability of pandemics necessitates plans that will allow registered nurses to expand current capacity to care for ill individuals. It has been documented that personnel resources, often nurses, are a limiting factor in the health care system’s ability to care for large influxes of patients. Prior research has shown that an outbreak of an infectious disease, such as influenza, may lead to healthcare workers (HCWs) intentionally staying out of work. The potential increase in patient demand coupled with a decrease in the number of critical care nurses reporting to work will strain the ability of healthcare systems to meet the needs of patients. To date, research has not studied critical care nurses’ intentions to report to work during a pandemic influenza. PURPOSE: The purpose of this study was to examine the percent of critical care nurses that intend to report to work during an influenza pandemic. Covariates that may influence CCNs intention to report included personal, professional, and employer characteristics. Additionally, the impact of threat (perceived susceptibility to influenza and perceived severity of an influenza pandemic) and efficacy (perceived self-efficacy and perceived efficacy of the overall response) on intentions were analyzed. METHODS: A cross-sectional and descriptive design was utilized. Participants were recruited through the American Association of Critical Care Nurses. The final sample totaled 245 critical care nurses from across the United States. The participants completed an adapted version of the Johns Hopkins Public Health Infrastructure Response Survey Tool (JH~PHIRST) as well as personal demographics and information on their primary employer. Data were analyzed using bivariate methods and logistic regression. RESULTS: This study found that nearly 87% of CCNs intend to report during a pandemic flu, but this number drops to 78% if severity of the pandemic is factored in and further declines to 63% if the CCNs are asked to work extra. Perceived self-efficacy is a primary factor in explaining CCNs intend to report to work. CCNs with high perceived self-efficacy were6.221 (95% CI: 2.638-14.673) times more likely to report than those with low perceived self-efficacy. Perceived self-efficacy continues to significantly impact intentions to report to work when the severity of the pandemic is considered as well as when CCNs are asked to work extra. CCNs with high perceived self-efficacy are consistently, significantly more likely to intend to report than those with low perceived self-efficacy. CONCLUSION: Perceived self-efficacy is related to CCN intentions to report to work during a pandemic flu emergency. Future research should examine methods for increasing CCN perceived self-efficacy, including professional, educational and employment factors. / Thesis (PhD) — Boston College, 2020. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

BACKGROUND: Nurses working in intensive care units (ICUs) frequently care for patients and their families at the end-of-life (EOL). Providing high quality EOL care is important for both patients and families, yet ICU nurses face many obstacles that hinder EOL care. Researchers have identified various ICU nurse-perceived obstacles, but no studies have been found addressing the progress that has been made over the last 17 years.OBJECTIVE: To determine the most common and current obstacles in EOL care as perceived by ICU nurses and then to evaluate whether or not meaningful changes have occurred since data were first gathered in 1998.METHODS: A quantitative-qualitative mixed methods design was used. A random, geographically dispersed sample of 2,000 members of the American Association of Critical-Care Nurses was surveyed.RESULTS: Five obstacle items increased in mean score and rank as compared to 1999 data including: (1) family not understanding what the phrase "life-saving measures" really means; (2) providing life-saving measures at families' requests despite patient's advance directive listing no such care; (3) family not accepting patient's poor prognosis; (4) family members fighting about use of life support; and, (5) not enough time to provide EOL care because the nurse is consumed with life-saving measures attempting to save the patient's life. Five obstacle items decreased in mean score and rank compared to 1999 data including (1) physicians differing in opinion about care of the patient; (2) family and friends who continually call the nurse rather than calling the designated family member; (3) physicians who are evasive and avoid families; (4) nurses having to deal with angry families; and, (5) nurses not knowing their patient's wishes regarding continuing with tests and treatments.CONCLUSIONS: Obstacles in EOL care, as perceived by critical care nurses, still exist. Family-related obstacles have increased over time and may not be easily overcome as each family, dealing with a dying family member in an ICU, likely has never experienced a similar situation. Based on the current top five obstacles, recommendations for possible areas of focus may include (1) improved nursing assessment regarding the health literacy of families followed with directed, appropriate, and specific EOL information, (2) improved care coordination between physicians and other health care providers to facilitate sharing care plans, (3) advanced directives that are followed as written by patients, (4) designated family contact communicating with family and friends regarding patient information, and, finally, (5) earlier, transparent discussions of patient prognoses as disease processes advance and patient conditions deteriorate.

Bakgrund: Patienter inlagda på sjukhus behöver näringstillförsel för att kunna återhämta sig. Enteral nutrition är troligen att föredra framför parenteral nutrition, och bör sättas in så tidigt som möjligt. Enteral nutrition kan administreras på olika sätt. Den kan ges intermittent och innehålla nattvila, eller ges kontinuerligt för att undvika plötsliga sänkningar i blodsockernivåer. En oönskad komplikation är lösa avföringar hos patienten. Frågan är om administrationsformen av enteral nutrition kan påverka frekvensen av diarré. Syfte: Att med hjälp av en registerstudie jämföra antal lösa avföringar per dygn mellan två olika administrationsformer av enteral nutrition: intermittent med nattvila jämfört med kontinuerlig tillförsel över hela dygnet. Metod: En kvantitativ retrospektiv registerstudie har genomförts på totalt 50 intensivvårdspatienter med traumatisk skallskada vid Norrlands Universitetssjukhus. Journaler från 2007 till 2012 har använts i studien. Resultat: Ingen signifikant skillnad kunde påvisas mellan grupperna i antal lösa avföringar per dygn, p=0.5. Däremot visade denna studie att de patienter som fick intermittent enteral nutrition fick signifikant större mängd enteral nutrition (699±249 ml) per dygn jämfört med patienter som fick sin enterala nutrition kontinuerligt (505±278 ml/dygn), p = 0.008. Slutsats: Resultatet från studien visar att antalet lösa avföringar inte verkar bero på administreringsformen av enteral nutrition. Mängden tillförd enteral nutrition skiljer sig dock statistiskt signifikant varav betydelsen av det borde studeras vidare för att avgöra vilken administreringsform som är att föredra. / Background: Patients admitted to hospital need nutrition to recover. Enteral nutrition is probably preferable to parenteral nutrition should be initiated as early as possible. Enteral nutrition may be administered in various ways, it can be intermittent and include night rest, or given continuously to avoid abrupt reductions in blood sugar levels. An unwanted complication is loose stools of the patient. The question is whether the form of administration of enteral nutrition can affect the frequency of diarrhea. Aim: With the help of a retrospective registry study comparing number of loose stools per day between two different forms of administration of enteral nutrition: intermittent with night sleep compared with continuous supply throughout the day. Method: A quantitative retrospective registry study has been carried out on a total of 50 ICU patients with traumatic head injury at Norrlands University Hospital. Records from 2007 to 2012 were used in the study. Results: No significant difference was detected between the groups in the number of diarrhea per day, p = 0.5. However, this study demonstrated that patients receiving intermittent enteral nutrition was significantly greater amount of enteral nutrition (699 ± 249 ml) per day compared with patients who received their enteral nutrition continuously (505 ± 278 mL / day), p = 0008. Conclusion: The results from the study show that the number of loose stools do not seem to depend on the form of administration of enteral nutrition. Quantities of enteral nutrition differ statistically significantly significance of which it should be further studied to determine which form of administration is preferred.

The trend towards patient-and family-centered care (PFCC) invites families of critically ill patients to participate more fully in the care and recovery of their loved ones through partnerships with the medical team and personalized care that respects the values, beliefs and experiences of the individual. In response to the growing needs of families, healthcare institutions are re-designing the way patient and family care is delivered in terms of policy, culture and the physical environment. Despite the many benefits that come with closer collaboration, nurses report that "challenging" families are a key source of workplace stress. This exploratory case study documents some of these challenges as perceived by staff nurses at Emory University Hospital's Neuro ICU while examining the role the built environment plays in shaping such perceptions. Through a series of ethnographic interviews and observational methodologies, the study identifies some of the challenges and benefits that come with balancing patient and family needs. Nurse strategies developed to reassert spatial and temporal control over work environments are also identified. The second phase of research compares communication patterns generated from two different ICUs to explore the link between unit design and the frequency and quality of nurse-family interactions. Findings suggest that space plays a role in moderating the degree of nurse exposure to the often unstructured and unpredictable aspects of family interactions. These encounters, set within a highly charged critical care setting, may contribute to these perceived challenges. Healthcare stands at an important moment of transition in which attitudes, behaviors and expectations are changing. Together these results reinforce the need for adequate tools, training and education to further support nurses in the transition to this new care culture.

Bakgrund: Intensivvårdspatienter utsätts för en påfrestande situation, vilket kan bidra till utvecklandet av iva-delirium. Iva-delirium är en form av hjärndysfunktion som leder till ökad sjuklighet, ökad mortalitet och ökade vårdkostnader i form av förlängd vårdtid. Studier visar att trots att iva-delirium är vanligt förekommande inom intensivvården så missas tillståndet ofta. Bedömningsinstrument för att identifiera iva-delirium finns men används vanligen i liten utsträckning inom svensk intensivvård. Detta kan leda till att intensivvårdssjuksköterskor, utifrån personlig erfarenhet, utvecklar olika strategier för att vårda patienter med iva-delirium. Syfte: Att beskriva intensivvårdssjuksköterskors personliga erfarenheter av att bedöma patienter som riskerar att drabbas av iva-delirium samt hur syndromet identifieras och förebyggs. Metod: En kvalitativ studie innehållande sex intervjuer genomfördes och analyserades utifrån en deskriptiv innehållsanalys. Resultat: Resultatet visade att intensivvårdssjuksköterskorna med hjälp av personliga erfarenheter skapade en framförhållning genom att förutse riskfaktorer och att identifiera kliniska tecken. Vidare visade intensivvårdssjuksköterskorna en förmåga att förebygga och resonera kring utförda åtgärder. En förståelse för vården av patienter med iva-delirium skapades genom etiska reflektioner. Slutsats: Intensivvårdssjuksköterskornas erfarenheter utgjordes av tre domäner; att se, att göra och att känna. Dessa olika erfarenheter interagerade med varandra, skedde simultant och skapade ett expertkunnande hos intensivvårdssjuksköterskorna. Trots denna förmåga framkom det att intensivvårdssjuksköterskornas kunskaper om iva-delirium och deras strategier varierade beroende på personlig erfarenhet. Klinisk betydelse: Genom att belysa intensivvårdssjuksköterskornas erfarenheter kan en ökad medvetenhet kring iva-delirium skapas och därmed förhoppningsvis medföra minskad prevalens. / Background: Critical care patients are exposed to a stressful situation, which could contribute to the development of icu-delirium. Icu-delirium is a form of brain dysfunction leading to higher morbidity, higher mortality and higher cost of care due to extended hospital stays. Even though studies show that icu-delirium is common within critical care the syndrome is often unrecognized. Delirium screening tools exist but are rarely used within Swedish critical care. The low implementation of screening tools could lead to that critical care nurses, based on personal experience, develop individual strategies for care of patients with icu-delirium. Aim: To describe experiences of assessing patients with risk for developing icu-delirium and how the syndrome is identified and prevented by critical care nurses. Methods: A qualitative study with six interviews was conducted and analyzed based on a descriptive qualitative content analysis. Results: The results showed that critical care nurses, based on earlier experiences, created an anticipation by discerning risk factors and identifying clinical signs. The critical care nurses showed an ability to perform preventive measurements while reasoning about already performed measurements. Through ethical reflections an understanding for the care of patients with icu-delirium was created. Conclusions: The experiences by critical care nurses was based on three domains; to see, to do and to feel. These domains occurred simultaneously and created the expertise of the critical care nurse. Despite this ability the knowledge of critical care nurses and their clinical assessment methods varied depending on earlier experiences. Relevance to clinical practice: By illuminating the experiences of critical care nurses hopefully a higher awareness regarding icu-delirium is created which will hopefully result in a lower prevalence.

Bakgrund Mobila Intensivvårds Grupper (MIG) är idag etablerade på flera svenska sjukhus. MIG bidrar till att minska antalet hjärtstopp och till att patienter som är på väg att försämras upptäcks tidigare. MIG innebär också en trygghet för avdelningspersonalen. Delaktighet i MIG är en naturlig del i intensivvårdssjuksköterskans arbetsuppgifter. Syfte Att beskriva intensivvårdssjuksköterskors erfarenheter av interaktionen med avdelningspersonalen vid MIG-uppdrag. Metod En kvalitativ studie med semistrukturerade intervjuer har utförts vid två sjukhus. Resultatet har analyserats med kvalitativ innehållsanalys. Resultat Två teman framkom vid analysen, Betydelsen av interaktion för en sammanlänkad och säker vård samt Samspelsbefrämjande faktorer. Respondenterna anser avdelningspersonalens närvaro och engagemang som väsentlig vid MIG-uppdraget för att patienten ska få en sammanlänkad och säker vård. Respondenterna upplever att avdelningspersonalen ibland inte förstår vikten av deras närvaro och att MIG då behöver arbeta aktivt för att få avdelningspersonalen mer engagerad. Det interprofessionella samarbetet gagnar inte enbart patienten utan gynnar även den professionella utvecklingen genom utbyte av kunskap. För att interaktionen ska fungera optimalt krävs att MIG bekräftar avdelningspersonalen och att alla involverade vid MIG-uppdraget har en gemensam bild av situationen och delar samma mål med vården. Resultatet diskuterades utifrån den teoretiska referensramen Relationship Centered Care. Slutsats Interaktionen vid MIG-uppdrag fungerar väl när MIG och avdelningspersonalen samarbetar och kompletterar varandra. Välfungerande samarbete och sammanlänkad vård i samband med MIG-uppdrag leder till ökad patientsäkerhet. Klinisk betydelse Samarbetet vid MIG-uppdrag stärks genom utbildning och praktisk träning i interprofessionellt samarbete. Genom mer utbildning, tydligare kommunikation från MIG och ökad återkoppling kan avdelningspersonalen få en större förståelse för vikten av deras delaktighet vid MIG-uppdragen. / Background Mobile Emergency Teams (MET) are established at several Swedish hospitals. MET helps to reduce the number of cardiac arrest and patients who are about to deteriorate are detected earlier. MET also means security for the staff at general wards. Being involved in the MET is a natural part of the critical care nurse's work assignments. Aim To describe the critical care nurses' experiences of interaction with the staff at general wards during MET- assignments. Method A qualitative study using semi-structured interviews was carried out at two hospitals. The collected data were analyzed by qualitative content analysis. Results Two themes emerged from the analysis, The importance of interaction for an interconnected and safe healthcare and Teamwork promoting factors. Respondents believe attendance and commitment from the staff at general wards as important in MET- assignments for the patient to get interconnected and safe care. Respondents experience that ward staff sometimes don´t understand the importance of their presence and that MET then need to work actively to get the ward staff more committed. The interprofessional collaboration is not only beneficial for the patient but it also promotes the professional development through the exchange of knowledge. For the interaction to work optimally it requires MET to confirm the staff at general wards and that everyone involved in the MET-assignment has a mutual perception of the situation and the goal with the treatment. The results were discussed using the theoretical framework Relationship Centered Care. Conclusion The interaction in MET-assignments works well when MET and the staff at general wards work together and complement each other. Effective collaboration and interconnected healthcare during MET-assignments increases patient safety. Clinical significance The collaboration during MET-assignments can be strengthened through education and practical training in interprofessional collaboration. Through more training, clearer communication from MET and increased feedback can the staff at general wards gain a greater understanding of the importance of their participation in MET-assignments.

The public’s demand for competent and safe health care obligates the profession to meet the challenges of high quality care with current knowledge and skills. The maintenance of competence and the participation in continuous professional development (CPD) has firmly been established as a professional standard with the purpose of ensuring the safety of the public. The enhancement and maintenance of knowledge and skills can be obtained through participation in CPD programmes. Despite the importance of CPD, not many critical care nurse practitioners avail themselves of the opportunity to attend CPD programmes. The overall aim of this research was to reach consensus regarding the reasons for the unsatisfactory attendance of a CPD programme developed for critical care units in a private hospital in Gauteng. A consensus methodology was used to involve the critical care nurse practitioners in planning and prioritising strategies for a future continuous professional development programme. Using the nominal group technique the critical care nurse practitioners reflected on their experience related to the current CPD programme and provided inputs and ranked priorities. Fourteen critical care nurse practitioners participated in the nominal group session. Consensus was reached regarding five priorities that should be implemented as strategies to enhance attendance of future CPD programmes. In rank order these priorities were communication, continuous professional development, clinical training, time constraints and financial implications. A central theme “attitude” was included as attitude has a powerful effect on all of the above mentioned priorities. In conclusion the study focussed on identifying and discussing the reasons for unsatisfactory attendance of a CPD programme. Based on the reasons identified priorities were set and strategies were collaboratively developed to enhance future attendance of a CPD programme. / Dissertation (MCur)--University of Pretoria, 2013. / gm2015 / Nursing Science / MCur / Unrestricted

Background: Critical care nurses (CCNs) provide end-of-life (EOL) care for critically ill patients. CCNs face many obstacles while trying to provide quality EOL care. Some research has been published focusing on obstacles CCNs face while trying to provide quality EOL care; however, research focusing on family behavior obstacles is limited.Objective: To determine if magnitude scores (obstacle item size x obstacle item frequency of occurrence) have changed since previous magnitude score data were first gathered in 1999.Methods: A random geographically dispersed sample of 2,000 members of the American Association of Critical-Care Nurses (AACN) was surveyed. Responses from quantitative Likert- type items were statistically analyzed for mean and standard deviation for size of obstacle and how frequently each item occurred. Current data were then compared to similar data gathered in 1999.Results: Six items’ magnitude scores significantly increased over time. Four of the six items related to issues with families including families not accepting poor prognosis, interfamily fighting about continuing or stopping life-support, families requesting life-sustaining measures contrary to the patients’ wishes and, families not understanding the term “life-saving” measures. Two other items included nurses knowing patients’ poor prognosis before families knows and unit visiting hours that were too liberal.Seven items significantly decreased in magnitude score over time, including two items specifically related to physician behavior such as physicians who would not let patients die from the disease process or physicians who avoid talking to family members. Other items which significantly decreased were poor design of units, visiting hours that were too restrictive, no available support personnel, and when the nurse’s opinion regarding direction of care was not valued or considered.Conclusions: EOL care obstacles emphasized in 1999 are still valid and pertinent. Based on magnitude scores, some EOL obstacles related to families increased significantly, whereas, obstacles related to ICU environment and physicians have significantly decreased. Based on this information, recommendations for areas of improvement include improved EOL education for families and nurses.

Bakgrund: I Sverige infördes Donation after Circulatory Death (DCD) under år 2020 för att kunna öka antalet organdonationer. Sedan dess har antalet donationer av denna typ succesivt ökat. Internationellt finns forskning i begränsad omfattning kring hur processen erfars av intensivvårds och operationssjuksköterskor. Både intensivvårds- och operationssjuksköterskor har en betydelsefull funktion i DCD-processen. Syfte: Syftet var att beskriva intensivvårds- och operationssjuksköterskors erfarenheter av DCD-processen. Metod: En kvalitativ innehållsanalysmed induktiv ansats användes, där fyra intensivvårdssjuksköterskor och fem operationssjuksköterskors intervjuades. Resultat: Resultaten visade att intensivvårds- och operationssjuksköterskorna upplevde både utmaningar och positiva känslor i samband med DCD processen.De fann trygghet i tydliga rutiner och gemenskap i samarbetet i DCD-teamen. Samtidigt kände de ansvar gentemot både donatorn och mottagarna av organen. Konklusion: Implementering av DCD-team har skapat en ny gemenskap och engagemang hos intensivvårds- och operationssjuksköterskorna. Trots att resultaten indikerar positiva upplevelser av DCD-processen är det viktigt att fortsätta utvärdera implementeringen och undersöka hur närstående och olika yrkesgrupper upplever processen för att få en mer heltäckande bild av dess effekter ochupplevelser. / Background: Donation after Circulatory Death (DCD) was introduced in 2020 to increase the number of organ donations in Sweden. The number of donations of this type has gradually increased. Internationally, there is limited research on how critical care and perioperative nurses perceive this method. Both critical care and perioperative nurses play a significant role in the DCD process. Aim: The aim was to describe critical care and perioperative nurses´ experiences of the DCD process. Method: A qualitative content analysis with an inductive approach where four critical care nurses and five perioperativenurses were interviewed. Results: The results showed that the critical care and perioperative nurses experienced both challenges and positive emotions associated with the DCD process. They found security in distinct routines and companionship incollaboration within DCD teams. At the same time, they felt responsibility towards both the donor and the recipients of the organs. Conclusion: The implementation of DCD teams has created a new sense of community and commitment among intensive care and perioperative nurses. Although the results indicate positive experiences of the DCD process, it is important to continue evaluating the implementation and investigating how family members and medical health professionals perceive the process to gain a more comprehensive understanding of its effects and experiences.