Nursing Muslim patients in the Kingdom of Saudi Arabia (KSA) poses challenges for expatriate non-Muslim nurses. Caring for Muslim patients in a cardiac intensive care unit, catering for patients who underwent open heart surgery, poses unique challenges to non-Muslim nurses. Semi-structured interviews were conducted with 63 non-Muslim nurses who cared for Muslim patients who had undergone cardiac surgery. Factors that influenced non Muslim nurses’ experiences of working with Muslim patients in the KSA, included culture shock, language barriers and a lack of understanding of Islam as a religion. In-service education sessions, addressing these issues, could enhance non-Muslim nurses' abilities to render culture competent care to Muslim patients in a cardiac intensive care unit in the KSA. Arabic-English translators could facilitate communication between the expatriate nurses and the Muslim patients. / Health Studies / M.A. (Health Studies)

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)

Darbo tikslas – ištirti neišnešiotų naujagimių tėvų poreikius naujagimių intensyviosios terapijos skyriuje. Uždaviniai: 1.Nustatyti tėvų poreikius, remiantis tėvų ir slaugytojų požiūriu. 2.Palyginti tėvų poreikius atskirose poreikių grupėse, remiantis tėvų ir slaugytojų požiūriu. 3.Palyginti tėvų poreikius atskirose poreikių grupėse, remiantis mamų ir tėčių požiūriu. 4. Nustatyti ryšius tarp neišnešiotų naujagimių tėvų poreikių ir jų socialinių bei demografinių charakteristikų. 5.Atskleisti mamų, gulinčių ligoninėje kartu su savo neišnešiotais naujagimiais, poreikius ir lūkesčius. Hipotezės 1.Tėvų požiūriu, neišnešiotų naujagimių tėvams naujagimių intensyviosios terapijos skyriuje svarbiausi yra informacijos poreikiai. 2.Neišnešiotų naujagimių tėvai naujagimių intensyviosios terapijos skyriuje ir slaugytojai, dirbantys šiame skyriuje, skirtingai vertina visas penkias tėvų poreikių grupes. Kokybinio tyrimo klausimas - Kokie yra mamų, gulinčių ligoninėje kartu su savo neišnešiotais naujagimiais, poreikiai ir lūkesčiai? / The aim of the study was to analyze the needs of parents who have premature newborns in the Neonatal Intensive Care Unit. Objectives of the study: 1.To identify the needs of parents perceived by parents themselves and by nurses. 2.To compare the parents’ and nurses’ perceptions of parental needs in all needs subscales. 3.To compare the mothers’ and fathers’ perceptions of parental needs in all needs subscales. 4.To determine the relation between parental needs and their socio-demographic characteristics. 5.To reveal the needs and expectations of mothers while being hospitalized with their premature newborns. Hypotheses 1.Parents who have premature newborns in a Neonatal Intensive Care Unit identify informational needs as the most important subscale of needs. 2.The perceptions of parental needs by parents who have premature newborns in a Neonatal Intensive Care Unit and by nurses who work in this unit are different in all subscales of needs. Qualitative research question - What are the needs and expectations as expressed by mothers while being hospitalized with their premature newborns?

During mechanical ventilation the diaphragm experiences an extreme case of muscleunloading. In many cases this results in respiratory muscle dysfunctions making it difficult towean the patient off the ventilator. One component in this dysfunction is the accumulation ofintramyocellular lipids (IMCL) in the diaphragm muscle fibres. Using Oil Red O stainingsand confocal microscopy on rat diaphragm sections we have quantified this process. Theresults show a sudden increase in IMCL contents between 18 and 24 hours. No significantdifference between fibre types could be seen.

SAMMANFATTNING Syfte: Att studera föräldrars upplevelse av att kunna tolka sitt barns behov och mående samt upplevda kompetens i föräldrarollen efter att barnet har vårdats på neonatalavdelning. Metod: En jämförande kvantitativ studie med deskriptiv explorativ design som är en del av ett större projekt som genomförts vid två neonatalavdelningar i Sverige. En vecka efter barnets utskrivning från neonatalavdelningen samt vid två månaders korrigerad ålder fick barnets mamma och pappa varsin enkät, innehållande bland annat en föräldra-attitydskala, hemskickad. Insamlade data matades in i Statistical Package for the Social Sciences (SPSS) och redovisades med deskriptiv (md; median och range; minimum och maximum) och jämförande statistik (Chi-2-test och Mann-Whitney U-test). Resultat: En enda signifikant skillnad kunde ses mellan de två neonatalavdelningarna och det gällde föräldrarnas upplevelse att barnet tyckte om kontakt från dem i form av deras doft. På neonatalavdelning 2 svarade föräldrarna i högre grad att detta påstående stämde en vecka efter barnets utskrivning från neonatalavdelningen. Inga andra signifikanta skillnader ses vid jämförelsen av föräldrarnas enkätsvar från de två neonatalavdelningarna. Slutsats: Den enda signifikant skillnad som kunde ses anses av flera orsaker inte vara av särskilt hög betydelse. Följaktligen kan inga väsentliga skillnader ses mellan föräldrarnas upplevelse av sitt barns behov och mående samt upplevda kompetens i föräldrarollen beroende på om barnet vårdats på en neonatalavdelning där föräldrarna fick bo med sitt barn under hela vårdtiden och tidigt involveras i sitt barns vård eller om barnets vårdats på en neonatalavdelning med mindre föräldranärvaro. / ABSTRACT Aim: Studying parents' experience of being able to interpret their child's needs and well-being, and perceived competence in parenting after the child has been cared for in the neonatal unit. Method: A comparative quantitative study with a descriptive exploratory design that is part of a larger project conducted at two neonatal units in Sweden. A week after the child's discharge from the neonatal unit and at two months' corrected age, the child’s mother and father received a questionnaire sent to their home, containing among other things a parental attitude scale. Collected data were fed into the Statistical Package for the Social Sciences (SPSS) and presented with descriptive (md; median and range; minimum and maximum) and comparative statistics (Chi-2 test and Mann-Whitney U test). Results: Only one significant difference was seen between the two neonatal wards and it was regarding the parents' experience that the child enjoyed contact from them in terms of their fragrance. In the neonatal unit 2 parents agreed to a greater extent that this claim was true a week after the child's discharge from the neonatal unit. No other significant differences were seen when comparing the parents' questionnaire responses from the two neonatal wards. Conclusion: The only significant difference that was found was for several reasons not considered to be of very high importance. Consequently, no significant differences was found between the parents perception of their child's needs and well-being, and perceived competence in the parental role, depending on whether the child received care in a neonatal unit where the parents were allowed to stay with their child throughout the whole hospital stay and early get involved in their child's care or if the child was admitted to a neonatal unit with less opportunity for parental presence.

Sammanfattning: I samband med att en patient drabbas av sepsis pågår processer i kroppen som påverkar bland annat hjärnan. Patienterna kan drabbas av ett tillstånd av förvirring som kallas för delirium. Syfte: Syftet med studien var att beskriva intensivvårdssjuksköterskans omvårdnad i samband med sepsisassocierat delirium. Metod: För att genomföra studien valdes systematisk litteraturstudie. Data söktes i tre databaser samt fritextsökningar och manuell sökning i artiklars referenslistor. En integrerad analys genomfördes för att sammanställa resultatet. Resultat: Resultatet baseras på fyra artiklar. I resultatet framträdde tre huvudkategorier: Utföra personcentrerad vård, Utföra målinriktad behandling med läkemedel och Förutsättningar för god omvårdnad. Slutsats: Det råder brist på kunskap om ämnet hos sjukvårdspersonal vilket bidrar till att patienter diagnostiseras sent eller att diagnosen missas, vilket i sin tur leder till ökad morbiditet, mortalitet och förlängda vårdtider. / Introduction: In conjunction with a patient suffering from sepsis, ongoing processes in the body affects the brain. Patients can suffer from a state of confusion known as delirium. Aim: The aim of the study was to describe critical care nursing care associated with sepsis-associated delirium. Method: To conduct the study we selected systematic literature method. To conduct the study were selected systematic literature. Data were searched three databases and free-text search and manual search of reference lists of articles. An integrated analysis was performed to compile the results. Results: The result is based on four articles. The result appeared in three main categories: Perform personcentered care, Perform targeted drug treatment and Conditions for good care. Conclusion: There is a lack of knowledge on the subject of health professionals which leads to patients diagnosed late or missed diagnosis, which in turn leads to increased morbidity, mortality and prolonged hospitalization.

Infectious diseases cause substantial morbidity and mortality, exacerbated by increasing antibiotic resistance. In critically ill patients, recent studies indicate a substantial variability in β-lactam antibiotic levels when standardized dosing is applied. New methods for characterizing nosocomial outbreaks of bacterial infections are needed to limit transmission. The goals of this thesis were to investigate new strategies towards individualized treatment and control of bacterial infections.  In Paper I we confirmed high variability in β-lactam antibiotic levels among intensive care unit (ICU) patients from southeastern Sweden, where 45 % failed to reach treatment targets (100 % fT>MIC). Augmented renal clearance and establishing the minimum inhibitory concentration of the bacteria were important for evaluating the risk of not attaining adequate drug levels. In Paper II a rapid ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method for simultaneous quantification of 11 commonly used antibiotics was developed and tested in clinical samples. Performance goals (CV<15%) were reached. A microbiological method for quantification of β-lactam antibiotics in serum was developed in Paper III. The method could be important for hospitals without access to an LC-MS method. Paper IV and Paper V investigated ligation-mediated qPCR with high resolution melt analysis (LMqPCR HRMA), for transmission investigation of extended spectrum β-lactamase (ESBL)-producing E. coli and other common bacterial pathogens. Results comparable to the reference method (PFGE) could be achieved within one day in a closed system and confirmed a nosocomial outbreak in Kalmar County. In Paper VI whole genome sequencing followed by bioinformatic analysis resolved transmission links within a nosocomial outbreak due to improved discriminatory power compared to LMqPCR HRMA. The high proportion of ICU patients with insufficient β-lactam drug levels emphasizes the need for individualized treatment by therapeutic drug monitoring (TDM). TDM is enabled by a highly sensitive method, such as UPLC-MS/MS, but if unavailable, also by a microbial method. Molecular typing methods used for transmission investigation can detect nosocomial outbreaks. LMqPCR HRMA can be used for screening purposes. For enhanced resolution, whole genome sequencing should be used, but always together with a rigorous epidemiological investigation.

Probiotics are live microorganisms which confer a health benefit to the host. The literature strongly supports the benefits of probiotic therapy in preterm infant populations, specifically in the prevention of necrotizing enterocolitis (NEC) and mortality. To this end, probiotics are routinely given to premature infants in several European and Asian countries. However, in spite of the current evidence and neonatal feeding practices elsewhere, probiotic supplements are rarely prescribed in nurseries in North America. Furthermore, there is little or no literature on factors which affect clinical decision-making regarding probiotic supplementation. The study implemented a cross-sectional descriptive survey. The purpose of this study was to: (i) describe current practices involving probiotic supplementation of preterm infant enteral feeds; and (ii) identify factors that affect willingness of health care professionals to support the use of probiotics. Probiotic use was examined in Neonatal Intensive Care Units (NICUs) in Canada and the United States using two cross-sectional internet-based surveys. Survey #1 focused on current practices and targeted neonatologists who serve as clinical directors or department heads. The results were analysed using descriptive statistics. Survey #2 addressed factors that affect probiotic supplementation of preterm infant feedings, and had two versions: the first version targeted physicians and nurse practitioners whereas version 2 targeted neonatal nurses. The development of Survey #2 was guided by the Theoretical Domain Framework which evaluates factors which may affect the willingness of Health Care Professionals to support the use of probiotics in neonatal practice. The results of survey #2 were analysed using Chi-Square, Fisher’s Exact Test, and One-Way ANOVA. The results of the study indicated that only a small proportion of NICUs are administering probiotics to preterm infants and practices vary. The most significant factors influencing clinical decision-making regarding probiotic supplementation were knowledge about probiotics and the evidence, perceptions about the evidence and safety of probiotics, and knowledge about probiotics and clinical guidelines. Improving knowledge about probiotics, addressing safety issues of probiotics products, expanding the evidence base, and developing clinical guidelines may contribute to increased use of probiotics in NICUs. / October 2016

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Children heart diseases can be divided into congenital and acquired heart defects. The acquired heart defects can be further divided into acquired heart defects, heart rhythm disorders, including hypertension, inflammatory heart diseases and heart failure. Children heart diseases can occur at any age, even if it is a congenital heart defect that is less severe. The goal of this thesis was to find out the specifics of nursing care of children with heart diseases who are hospitalized at ICU and to find out the most common nursing diagnoses according to NANDA II taxonomy, and their treatment in case of children with heart diseases who are hospitalized at ICU. During the realization of the research part, a qualitative research survey was conducted using semi-structured interviews with the nurses, participant observation and the method of content analysis, which provide a more complex view of the composition of the children with heart disease hospitalized at ICU. The interviews were conducted with the nurses at the children's ICU, where the participant observation and the method of content analysis took place as well. The results of the research show that nursing care differs in the case of cardiologic disordered children and otherwise disordered children in some areas, as well as the needs. In the research part it was found out what the most frequent nursing interventions in case of these children are and how much they differ from the interventions of children with other diseases, who are also hospitalized at ICU. Furthermore, the research shows that nurses have a negative opinion on nursing diagnoses, although they are used in the documentation. This was found not only in the semi-structured interviews with the nurses, but also during the participated observation and the content analysis of the documentation. The research also revealed that some nursing diagnoses are specific to cardiologic disordered children, but, for example, the nursing diagnosis of the risk of infection associated with invasive entry is used in case of all children hospitalized at ICU. The diploma thesis should inform nurses about nursing care in case of children with heart disease hospitalized at ICU.