Att vårdas i respirator innebär att den verbala kommunikationsförmågan förloras, vilket kan medföra känslor av frustration och maktlöshet hos patienter. För att uppnå en vårdande relation är samtalet av stor betydelse, vilket försvåras om kommunikationsförmågan är nedsatt. Syftet är att beskriva intensivvårdssjuksköterskors upplevelser av kommunikation med lätt sederade, respiratorbehandlade patienter. En kvalitativ ansats har använts. Halvstrukturerade forskningsintervjuer utfördes med åtta intensivvårdssjuksköterskor från två sjukhus. En kvalitativ innehållsanalys användes för att analysera materialet, vilket resulterade i två kategorier med tre subkategorier vardera. Intensivvårdssjuksköterskors upplevelser av kommunikation med lätt sederade respiratorbehandlade patienter beskrivs som att finnas där och att nå fram. Genom att finnas där bjuder intensivvårdssjuksköterskor in patienter, erhåller känslomässiga gensvar samt förmedlar budskap genom sitt kroppsspråk och sin personlighet. För att nå fram måste intensivvårdssjuksköterskor skapa gynnsamma förhållanden för kommunikation och hitta ett gemensamt språk med patienter, vilket är beroende av både intensivvårdssjuksköterskans och patientens bagage. Intensivvårdssjuksköterskors egna kroppar är centrala i kommunikationen med dessa patienter. Kroppsspråk och beröring används för att bekräfta intensivvårdssjuksköterskors närvaro, förmedla närhet och trygghet samt för att utveckla en vårdande relation till patienter. Att lära sig läsa patienter, då de responderar ljudlöst, är en annan stor del av kommunikationen. Även här är kroppen central, då intensivvårdssjuksköterskors förmåga att läsa patienters kroppar och dess signaler är väsentligt för att nå fram, vilket underlättas av att lära känna patienten. Erfarenhet och utbildning kan medföra att intensivvårdssjuksköterskor känner trygghet i sig själva, vilket bidrar till att de har modet att finnas där hos patienter och därmed utveckla en vårdande relation. / Program: Specialistsjuksköterskeutbildning med inriktning mot intensivvård

Både över- och undersedering kan öka riskerna för både morbiditet och mortalitet. Genom att ge rätt sederingsnivå till patienterna kan intensivvårdssjuksköterskor medverka till ett snabbare tillfrisknande och mindre vårdrelaterade komplikationer. Sedering är en viktig del i vården av respiratorpatienter och kräver stor kunskap hos intensivvårdssjuksköterskor. Syftet med studien var att undersöka hur intensivvårdssjuksköterskor upplevde omvårdnaden kring lätt sederade intensivvårdspatienter under respiratorbehandling. Uppsatsen är en kvalitativ studie och datainsamling genomfördes med hjälp av intervjuer med sex intensivvårdssjuksköterskor på en intensivvårdsavdelning i Västra Sverige. Intervjuerna har analyserats med kvalitativ innehållsanalys. Resultatet presenteras med hjälp av kategorier och subkategorier. Kategorierna var: Sederingsgrad, Kommunikation och information, Upplevelser av ångest, oro, rädsla, smärta och stress, Vårdmiljö och behov av normal dygnsrytm, Förändringar i sederingsrutiner, Närståendes betydelse, och Minnen och behov av bearbetning efter intensivvårdstiden. De flesta sjuksköterskorna upplevde att lätt sedering hos intensivvårdspatienter under respiratorbehandling var positivt, men det fungerade inte på alla patienter. Med individuellt anpassad omvårdnad, en adekvat sederingsnivå och smärtlindring anser vi att intensivvårdssjuksköterskor kan bidra till en bättre vård för patienterna, och förhoppningsvis även påverka patienternas minnen av tiden på IVA positivt. Kontinuitet och att skapa tillit och förtroende ses som betydelsefullt för patienternas tillfrisknande och sjuksköterskor har en viktig roll i att ge stöd och information till både patienten och de närstående. / <p>Program: Specialistsjuksköterskeutbildning med inriktning mot intensivvård</p><p>Uppsatsnivå: D</p>

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Ao longo dos últimos anos, apesar de todo desenvolvimento e pesquisa, a mortalidade na sepse permanece elevada. Na área de microcirculação foram realizados estudos em modelos experimentais de sepse ao longo das últimas duas décadas, quando se observou, através de técnicas invasivas, alterações como redução expressiva da densidade capilar funcional. A técnica denominada sidestream dark field (SDF) imaging, recentemente desenvolvida, permite a avaliação da microcirculação de forma transcutânea. A utilização desta técnica permitiu evidenciar a redução da densidade capilar funcional em pacientes com sepse grave quando comparado a um indivíduo saudável. Posteriormente, foi demonstrado que alterações persistentes na microcirculação de pacientes sépticos, mesmo com sinais vitais estabilizados, estão associadas com pior prognóstico.Evidentemente, os pacientes com sepse grave ou choque séptico sofrem uma grande quantidade de intervenções terapêuticas, aonde muitas delas alteram a microcirculação. Estudos analisando a microcirculação em pacientes em uso de nitroglicerina, corticóide, recebendo hemotransfusão ou ainda infusão de noradrenalina foram publicados recentemente.Entretanto, até o presente momento, não existem publicações que descrevam a influência dos sedativos na microcirculação de pacientes com choque séptico. As drogas mais comumente utilizadas para sedação de pacientes em ventilação mecânica são o sedativo midazolam e o anestésico propofol. Os objetivos do estudo foram: avaliar o efeito dos principais agentes sedativos utilizados na prática clínica na microcirculação de pacientes com choque séptico utilizando a técnica de sidestream dark field imaging, comparar os efeitos na microcirculação do midazolam com o propofol em pacientes com choque séptico e verificar se existe relação das alterações microcirculatórias provocadas pelos sedativos com as variações de diferentes parâmetros hemodinâmicos, gasométricos ou metabólicos como pressão arterial, índice cardíaco, lactato e saturação venosa central de oxigênio. Foram estudados (estudo prospectivo) 16 pacientes internados no Centro de Terapia Intensiva da Casa de Saúde São José. Os pacientes internados com diagnóstico de choque séptico e que possuíam indicação clínica de ventilação mecânica e de suspensão diária da sedação foram submetidos ao estudo da microcirculação na mucosa sublingual utilizando a técnica de sidestream dark field imaging. Estes pacientes foram sedados conforme orientação do protocolo já existente de sedação, inicialmente com propofol e posteriormente com midazolam. Os principais resultados observados foram:a macrohemodinâmica não diferiu nos 2 momentos do exame, o BIS (bispectral índex of sedation) se manteve na faixa recomendada nos 2 momentos do exame, tendo aumentado quando o paciente acordava, conforme esperado, e a proporção de vasos pequenos perfundidos e o índice de fluxo da microcirculação foram significativamente menores, enquanto o índice de heterogeneidade foi significativamente maior quando os pacientes estavam recebendo infusão de propofol quando comparados com a infusão de midazolam. Concluímos que, em pacientes com choque séptico, a administração de midazolam resulta em uma melhora dos parâmetros microcirculatórios quando comparada com a administração de propofol. Essa diferença não pode ser atribuída a alterações de variáveis hemodinâmicas sistêmicas. / Over the past few years, despite all research and development, mortality from sepsis remains high. In microcirculatory studies using experimental models of sepsis, and invasive techniques, significant reduction in functional capillary density were observed. The recently developed technique called sidestream dark field (SDF) imaging, allows transcutaneously evaluation of the microcirculation. This technique has demonstrated reduction on functional capillary density in patients with severe sepsis, when compared to healthy individuals. Subsequently, it was shown that even in septic patients with stabilized vital signs, persistent alterations in the microcirculation are associated with worse prognosis. Obviously, patients with severe sepsis or septic shock suffer a lot of therapeutic interventions, many of them affecting the microvasculature. Studies analyzing the microcirculation in patients using nitroglycerin, corticosteroids, receiving blood transfusion or infusion of norepinephrine were recently published. However, to date, no publications have described the influence of sedatives in the microcirculation of these patients. The most commonly drugs used for sedation of mechanically ventilated patients are midazolam and propofol. The main objectives of this study were to observe the effects of two sedative agents used in clinical practice in the microcirculation of patients with septic shock. The sidestream dark field imaging technique was used to compare the effects on microcirculation of midazolam with propofol in patients with septic shock and verify a relationship between microcirculatory changes caused by sedatives and different variations of hemodynamic parameters such as blood pressure, heart rate, lactate and central venous oxygen saturation.We have prospectively studied 16 patients admitted to the Intensive Care Unit of Casa de Saúde São José. Patients admitted with a diagnosis of septic shock and in need of mechanical ventilation were submitted to microcirculation analysis in the sublingual mucosa using sidestream dark field imaging technique. These patients were sedated according to the sedation protocol, initially with propofol, and later on with midazolam. The main results were: the macrohemodynamics did not differ during the two moments of examination; BIS (bispectral index of sedation) remained in the range recommended during both exams and increased when patients woke up, as expected, and finally, the proportion of small vessels perfused and microcirculatory flow index were significantly lower, while the heterogeneity index was higher, when patients were receiving propofol infusion in comparison with the midazolam one. We concluded that in patients with septic shock, midazolam administration results in an improvement of the microcirculation when compared with the administration of propofol and this difference could not be attributed to changes in systemic hemodynamic.

O Objetivo deste estudo controlado e duplo-cego foi avaliar os efeitos cardiovasculares induzidos pelo bloqueio pterigomandibular com o anestésico local cloridrato de lidocaína 2%, associado à epinefrina, seguido da administração de ansiolítico (midazolam 15mg) ou placebo, para realização de cirurgia de colocação de implantes dentários inferiores bilaterais, em 22 pacientes (13 mulheres 9 homens). Os parâmetros cardiovasculares Pressão Arterial Sistólica (PAS), Diastólica (PAD), Média (PAM) e Freqüência Cardíaca (FC) foram monitorados pelos métodos oscilométrico e fotopletismográfico. Os valores médios foram registrados a cada minuto e de forma contínua durante as etapas do experimento da seguinte forma: Fase 0 Período basal; Fase 1 Anestesia local; Fase 2 incisão; Fase 3 perfuração; Fase 4 colocação dos implantes; Fase 5 sutura; Fase 6 período final. Os indivíduos que receberam midazolam não apresentaram alterações de PAS, PAD, PAM e FC significativas (p>0,01) comparada ao placebo. Ocorreram alterações significantes dos valores para o grupo que recebeu placebo e dos valores médios do grupo que receberam midazolam na freqüência cardíaca / The purpose of this controlled and double-blind trial was to evaluate cardiovascular effects induced by pterigomandibular block of local anesthetic (LA) 2 % lidocaína hydrochloride with epinephrine, followed administration of benzodiazepine (midazolam 15mg on hour prior) or placebo during the surgical phase of placement of the lower bilateral dental implant in 22 normotensive outpatients (13 female and 9 male). The cardiovascular parameters systolic (SP), diastolic (DP) and mean (MP) pressures and heart rate (HR) were monitored by oscillometric and photopletismographic methods in 06 clinical phases during the procedure. The mean values were recorded every minute and in a continuous way during the phases of the experiment following the sequence: phase 0 basal period; phase 1 - anesthesia local; phase 2 mucoperiostal flap; phase 3 perforation; phase 4 placement of dental implants; phase 5 suture; phase 6 the end period. The group with received midazolam didnt induce significant SP, DP, MP and HR changes (p>0.01) compared to placebo. Significantly higher values in placebo group and mean values in midazolam group in heart-frequency were observed.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-26T09:52:02Z No. of bitstreams: 2 Dissertação - Larissa da Silva Moura - 2015.pdf: 2134342 bytes, checksum: 01ed98fe80185227f4ae4ac62f8c3caa (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-26T09:52:35Z (GMT) No. of bitstreams: 2 Dissertação - Larissa da Silva Moura - 2015.pdf: 2134342 bytes, checksum: 01ed98fe80185227f4ae4ac62f8c3caa (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-01-26T09:52:35Z (GMT). No. of bitstreams: 2 Dissertação - Larissa da Silva Moura - 2015.pdf: 2134342 bytes, checksum: 01ed98fe80185227f4ae4ac62f8c3caa (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2015-09-29 / The effectiveness of a sedative for pediatric dental treatment is commonly assessed through observational scales that assess the children behaviour. There is little information about the ability of a variety of scales in properly evaluate this behavior. The aim of this study was to analyze the characteristics of three scales,e,g,. Houpt Scale, Ohio State University Behavioral Rating Scale (OSUBRS) and Venham Behavior Rating Scale, to measure the behavior of preschool children during dental procedures under sedation. This study was an observational study nested to a randomized clinical trial (NCT02284204), which included 27 children between 4 and 6 years of age with early childhood caries and negative behavior in previous consultation. Participants underwent dental treatment under moderate sedation with midazolam and ketamine with or without addition of sevoflurane. The sessions were videotaped and five trained and calibrated observers watched the movies to record the behavior of children according to each scale. The data showed non-normal distribution (Shapiro-Wilk, P> 0.05); descriptive and correlation analyses were made (Spearman test). A total of 1,209 minutes of videos were observed and analyzed. Global scales (Houpt overall behavior and Venham) had closer scores of good behavior. The most frequent scores for Houpt were “no crying” and “no movement”, and for OSUBRS, “quiet”. Statistically significant correlations (P <0.05) occurred between Houpt overall behavior and Venham; Houpt overall behavior with Houpt categories movement (scores 2 and 4) and cry (scores 1, 2 and 4); Venham with Houpt movement (score 4) and cry (scores 2 and 4). OSUBRS scores 1 and 4 had high correlation coefficients with Houpt overall behavior and Venham. The Houpt overall behavior and the Venham Behavior Scale were highly correlated to measure behavior of children in dental treatment under sedation. OSUBRS showed better correlation with global scales compared to the categories of crying and movement of Houpt scale. / Para a avaliação da eficácia de um agente sedativo para tratamento odontológico de crianças, uma das medidas utilizadas é o comportamento, e isso é feito através de escalas observacionais. No entanto, há poucas informações sobre a capacidade de avaliar corretamente esse comportamento. O objetivo deste estudo foi analisar as características de três escalas - Escala comportamental de Houpt, Ohio State University Behavioral Rating Scale (OSUBRS) e Escala comportamental de Venham - em mensurar o comportamento de crianças pré-escolares durante procedimento odontológico sob sedação. Esse trabalho foi um estudo observacional aninhado a um ensaio clínico randomizado (NCT02284204) que incluiu 27 crianças entre 4 e 6 anos de idade com cárie dentária e comportamento resistente ao tratamento odontológico. Os participantes foram submetidos a tratamento odontológico sob sedação moderada com uso de midazolam e cetamina com adição ou não de sevoflurano. Os atendimentos foram gravados em vídeo e cinco observadores treinados e calibrados assistiram para registrar o comportamento das crianças segundo cada escala. Os dados apresentaram distribuição não-normal (Shapiro-Wilk, P>0,05); foram feitas análises descritivas e de correlação (teste de Spearman). Um total de 1.209 minutos de vídeos foram observados e analisados. Escalas globais (Houpt comportamento geral e Venham) apresentaram escores mais próximos de bom comportamento. Os escores mais frequentes para Houpt foram de pouco choro e movimento e, para OSUBRS, comportamento quieto. Correlações estatisticamente significantes (P<0,05) ocorreram entre Houpt comportamento geral e Venham (rho= -,87); Houpt comportamento geral com Houpt categorias movimento (escore 2 e 4) e choro (escores 1, 2 e 4); Venham com Houpt movimento (escore 4) e choro (escores 2 e 4). OSUBRS escores 1 e 4 tiveram altos coeficientes de correlação com Houpt comportamento geral e Venham. Concluiu-se que a escala de Comportamento Geral de Houpt e a Escala Comportamental de Venham foram altamente correlacionadas para aferir comportamento de crianças em tratamento odontológico sob sedação. OSUBRS apresentou melhor correlação com as escalas globais, se comparado com as categorias de choro e movimento de Houpt.

Made available in DSpace on 2016-04-28T20:18:33Z (GMT). No. of bitstreams: 1 2009 - Maurilia Rosa.pdf: 1267730 bytes, checksum: 83f63cab4df91abac0ab57c414b16bd6 (MD5) Previous issue date: 2009-07-24 / Ocular eye and adnexa examination is a routine in Veterinary practice. Diagnostic and treat diseases that affect domestic animals site is the main goal of these procedures. The importance of this research was the electrophysiology study of equine retina thru an FullField ERG examination in standing horses intravenouslly sedated, with auriculopalpebral nerve block and corneal topical anesthesia. Protocols and procedures used in clinical ERG were according International Society of Clinical Electrophysiology of Vision (ISCEV) standards. In this study, forty healthy horses were evaluated by FullField ERG. In the present study, 15 males and 25 mares, aging between 2 months to 18 years (m?dian age 4,6 years). Horses were randomly allocated into eight groups according sedative drugs as Xylazine, Romifidine, Detomidine, Medetomidine and corneal electrode ERG-Jet Electrode (ERG-jet), Dowson Trick Litzkow (DTL-plus) types. Group 1 was GXDTL, Group 2 GDDTL, Group 3 GRDTL, Group 4 GMDTL, Group 5 GXERG, Group 6 GDERG, Group7 GRERG, and Group 8 GMERG. In all groups a-b complex amplitude and implicit times were investigated and compared for both eyes. Quality and costs of sedation drugs were estimated. This research leads to the conclusion that was differences between corneal electrodes and ERG-jet showed safer and more practical during ERG examination. There were no difference between drugs sedation effect but Detomidine and Medetomidine showed better results to promote sedation during examination than Romifidine and Xylazine. The sedation protocol using Romifidine showed the lowest cost. / O exame oft?lmico ? uma pr?tica rotineira na Medicina Veterin?ria que objetiva identificar e tratar as afec??es do globo ocular e anexos dos animais dom?sticos. Neste trabalho estudamos a eletrofisiologia da vis?o do eq?ino, atrav?s do exame de eletrorretinografia de campo total, com o uso de seda??o e bloqueio anest?sico, com o animal na posi??o quadr?pede. Para execu??o dos exames, estabeleceu-se um protocolo b?sico de acordo com as normas e recomenda??es do International Society for Clinical Eletrophysiology of Vision (ISCEV), Foram avaliados 40 equinos considerados normais ap?s exame oft?lmico, sendo 15 machos e 25 f?meas, com idade variando entre dois meses a 18 anos (m?dia de 4,6 anos) pelo de exame de Eletrorreninografia de Campo Total e na posi??o qudr?pede. Os animais foram divididos em oito grupos em fun??o do f?rmaco sedativo (Xilazina, Romifidina, Detomidina e Medetomidina), e do tipo de eletrodo utilizados ERG - Jet Electrode (ERG-Jet) e Dowson Trick Litzkow (DTL). Foram ent?o assim denominados; o Grupo 1: GXDTL, Grupo 2: GDDTL, Grupo3: GRDTL, Grupo4: GMDTL, Grupo5: GXERG, Grupo 6: GDERG, Grupo 7: GRERG e o Grupo 8: GMERG. Em todos os grupos mensuraram-se os valores das amplitudes de pico das ondas a e b , seus implicit time , para os olhos direito e esquerdo. Tamb?m foram avaliados o tempo, a qualidade e o custo da seda??o. Conclu?mos que houve diferen?a entre os eletrodos avaliados, e que o eletrodo ERG-jet mostrou-se mais adequado em raz?o da sua seguran?a e praticidade de utiliza??o. As drogas estudadas n?o diferiram entre si quanto aos resultados do eletrorretinograma, por?m a Detomidina e Medetomidina apresentaram um desempenho superior em rela??o ? Romifidina e ? Xilazina na efici?ncia de conten??o e facilita??o do exame. A seda??o com Romifidina foi a que representou menor custo de execu??o.

ABSTRACTThe Belgian Euthanasia Act of 2002 (The Act), amended in 2014 to include the Minor Act (The Minor Act), has drawn international criticisms for its liberal laws and practices regarding Euthanasia. This paper is a response to allegations that the liberal laws on Euthanasia has encouraged doctors to adopt a paternalistic 2 approach towards their patients by terminating their lives without their explicit consent, i.e. engaging in Involuntary Euthanasia.3, 4, 5Although in theory, only Voluntary Euthanasia (explicit patient request and therefore consent) is permitted in Belgium 6 the allegations implied that in practice, Involuntary Euthanasia (no explicit patient request and therefore consent is given) is practiced, especially in the Intensive Care Units (ICU) in Belgium.This paper attempted to make distinctions between Terminal Sedation and Euthanasia based on current dominant discourse in Bioethics and argued that it is not Involuntary Euthanasia that is practiced in the ICU but Non-Voluntary Euthanasia or Terminal Sedation (explicit patient request and therefore consent is unavailable) is practiced based on the intent of the doctor. In presenting its arguments, this paper focused specifically on the reports it procured from its qualitative research. Finally, in order to understand if doctors in the ICU are Gods or Monsters, the paper attempted to answer four questions namely:1. Are doctors in Belgium Gods, who help end lives?2. Or are they Monsters, who help end lives?3. Or are they pre-hippocratic doctors, historically called Witch-Doctors, who are“for hire” to either “cure or to kill” with no loyalty to the Hippocratic Oath?4. Or are they mutated witch-doctors pressured to practice Euthanasia in a countrywhere the laws are perhaps fatally flawed? / Doctorat en Philosophie / info:eu-repo/semantics/nonPublished

Koloskopi är en undersökning av tjocktarmen som förväntas öka i antal eftersom studiervisar att screening minskar dödligheten i kolorektalcancer. Patienten kan i vissa falluppleva undersökningen som smärtsam och obehaglig. Sjuksköterskan har enbetydelsefull roll i omvårdnaden. Syftet med studien var att belysa faktorer sompåverkar upplevelsen av smärta och obehag vid en koloskopiundersökning utansedering. Metoden var en litteraturstudie baserad på 19 vetenskapliga artiklar som harkvalitetsbedömts enligt protokoll. Vid analysen skapades tre övergripande kategorier.Fysiska faktorer som påverkar smärtupplevelsen, personlig upplevelse av smärta ochobehag samt patientens erfarenhet. I resultatet framkom följande huvudfynd. Skillnadenmellan hur kvinnor och män upplevde smärta, svårigheter med att mäta och bedömasmärta och obehag samt patientens erfarenhet och dess betydelse för smärtupplevelsen.Det är viktigt med en individanpassad smärthantering. Sjuksköterskan bör ha en adekvatsmärtutbildning och en bred erfarenhet för att kunna ge en god omvårdnad vidkoloskopiundersökningen. / Colonoscopy is an examination of the colon, which is expected to increase in numbersince studies show that screening reduces mortality from colorectal cancer. The patientmay sometimes feel that the examination is painful and unpleasant. The nurse has animportant role in the care of the patient. The aim of this study was to elucidate factorsaffecting the experience of pain and discomfort during a colonoscopy without sedation.The method was a literature review based on 19 scientific articles that have beenassessed according to quality protocols. The analysis generated three broad categories.Physical factors affecting the experience of pain, personal experience of pain anddiscomfort, and the patient's experience. The results revealed the following keyfindings: The difference between how men and women experienced pain, difficulty inmeasuring and assessing pain and discomfort and the patient's experience and itsrelevance to pain. It is important to have an individualized pain management plan. Thenurse should have an adequate pain education and wide experience in order to providegood care during colonoscopy.

No description available.

Objectives: The objective of this thesis is to identify and understand communication and information exchange events and their influencing factors that are precursors to medical errors. Methods: Palliative Sedation Therapy is used as a case study to understand how communication and information sharing occur on an in-patient palliative care unit. Data sources were non-participant observation and interviews. Directed content analysis was used to analyze the data, with previously published conceptual models of communication acting as the guides for this analysis. Results/Discussion: Results identified several communication issues that have the potential to act as precursors to medical error at different points in the communication act. A model identifying the points where these precursors can impact communication was created. Conclusion: These results can be used to identify how improvements to communication and information exchange can increase the effectiveness of communication and reduce the likelihood of medical errors occurring.