Journal articles on the topic 'Intensive care units – Organization and administration'
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Vincent, Heather, Deborah J. Jones, and Joan Engebretson. "Moral distress perspectives among interprofessional intensive care unit team members." Nursing Ethics 27, no. 6 (May 14, 2020): 1450–60. http://dx.doi.org/10.1177/0969733020916747.
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Aim: To examine interprofessional healthcare professionals’ perceptions of triggers and root causes of moral distress. Design: Qualitative description of open-text comments written on the Moral Distress Scale–Revised survey. Methods: A subset of interprofessional providers from a parent study provided open-text comments that originated from four areas of the Moral Distress Scale–Revised, including the margins of the 21-item questionnaire, the designated open-text section, shared perceptions of team communication and dynamics affecting moral distress, and the section addressing an intent to leave a clinical position because of moral distress. Open-text comments were captured, coded, and divided into meaning units and themes using systematic text condensation. Participants: Twenty-eight of the 223 parent study participants completing the Moral Distress Scale–Revised shared comments on situations contributing to moral distress. Results: All 28 participants working in the four medical center intensive care units reported feelings of moral distress. Feelings of moral distress were associated with professional anguish over patient care decisions, team, and system-level factors. Professional-level contributors reflected clinician concerns of continuing life support measures perceived not in the patient’s best interest. Team and unit-level factors were related to poor communication, bullying, and a lack of collegial collaboration. System-level factors included clinicians feeling unsupported by senior administration and institutional culpability as a result of healthcare processes and system constraints impeding reliable patient care delivery. Ethical considerations: Approval was obtained from the Institutional Review Board (IRB) of the University of Texas Health IRB and the organization in which the study was conducted. Conclusion: Moral distress was associated with feelings of anguish, professional intimidation, and organizational factors that impacted the delivery of ethically based patient care. Participants expressed a sense of awareness that they may experience ethical dilemmas as a consequence of the changing reality of providing healthcare within complex healthcare systems. Strategies to combat moral distress should target team and system interventions designed to improve interprofessional collaboration and support professional ethical values and moral commitments of all healthcare providers.
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Kendall-Gallagher, Deborah, and Mary A. Blegen. "Competence and Certification of Registered Nurses and Safety of Patients in Intensive Care Units." American Journal of Critical Care 18, no. 2 (March 1, 2009): 106–13. http://dx.doi.org/10.4037/ajcc2009487.
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Background Adverse events that place patients at risk for harm are common in intensive care units. Clinicians’ level of knowledge and judgment appear to play a role in the prevention, mitigation, and creation of adverse advents. Research suggests a possible association between nurses’ specialty certification and clinical expertise. The relationship between specialty certification and clinical competence of registered nurses and safety of patients is a relatively new area of inquiry in nursing. Objective To explore the relationship between the proportion of certified staff nurses in a unit and risk of harm to patients. Methods Hierarchical linear modeling was used in a secondary data analysis of 48 intensive care units from a random sample of 29 hospitals to examine the relationships between unit certification rates, organizational nursing characteristics (magnet status, staffing, education, and experience), and rates of medication administration errors, falls, skin breakdown, and 3 types of nosocomial infections. Medicare case mix index was used to adjust for patient risk. Results Unit proportion of certified staff registered nurses was inversely related to rate of falls, and total hours of nursing care was positively related to medication administration errors. The mean number of years of experience of registered nurses in the unit was inversely related to frequency of urinary tract infections; however, the small sample size requires that caution be exercised when interpreting results. Conclusions Specialty certification and competence of registered nurses are related to patients’ safety. Further research on this relationship is needed.
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Abou Ramdan, Amal H., and Walaa M. Eid. "Toxic Leadership: Conflict Management Style and Organizational Commitment among Intensive Care Nursing Staff." Evidence-Based Nursing Research 2, no. 4 (October 8, 2020): 12. http://dx.doi.org/10.47104/ebnrojs3.v2i4.160.
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Context: Toxic leadership becomes a real problem in nursing administration. Its toxicity harms the nursing staff's progress and creates a challenging work environment full of struggles that, in turn, produce adverse outcomes on the nursing staff's commitment toward the organization.
Aim: This study envisioned to compare toxic leadership among intensive care nursing staff at Tanta University Hospital and El Menshawy hospital and assess its relation to their conflict management style used and organizational commitment at the two hospitals.
Methods: A descriptive, comparative, via cross-sectional research design was applied. All intensive care units at Tanta University Hospitals and El-Menshawy General Hospital were included. All available nurses (n=544) at Tanta University hospitals' ICUs (n=301) and El-Menshawy hospital's ICUs (n=243) was incorporated. Toxic leadership, conflict management styles assessment, and organizational commitment scales were utilized to achieve this study's aim.
Results: The nursing staff perceived that their leaders had high 10.6%, 11.5%, and moderate 12%, 11.9% overall toxic leadership levels at Tanta University Hospitals, and Elmenshawy Hospital, respectively. 43.9% of the nursing staff had a high level of using compromising style to manage conflict with their supervisors at Tanta University hospitals contrasted to 36.6% using competing style at El Menshawy hospital. 78.4% of the nursing staff had a low level of overall organizational commitment at Tanta University hospital's ICUs compared to 63% at El-Menshawy General hospital's ICUs.
Conclusion: Toxic leadership affected the nursing staff's choice of conflict management style used when handling conflict with toxic leaders at two hospitals and had a negative effect on affective and normative dimensions of organizational commitment in both hospitals. Therefore, improving leadership experiences is necessary by conducting a leadership development program to meet the nursing staff's expectations and improve their commitment. Also, adjusting the hospital's policies is vital to permit nursing staffs' involvement in leadership evaluation as a mean for early detection of leaders' toxic behaviors.
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Simons, Sherri Lee. "Keeping the Wisdom at Work." Neonatal Network 26, no. 4 (July 2007): 267–69. http://dx.doi.org/10.1891/0730-0832.26.4.267.
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THE CURRENT SHORTAGE OF nurses is no secret to those who work in or manage neonatal intensive care units. The Health Resources and Service Administration projected that the vacancy rate among nursing positions will increase to 20 percent by 2015.1 Specialty care nurses are even harder to find.2,3 In one survey, 57 percent of hospitals reported that specialty unit positions are the hardest to fill and tend to have the highest vacancy rate.3 A dangerous worker shortage, more severe than many expect, is compounded by deep systems problems in the way most health care organizations operate today.4
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Zambonin, Fernanda, Karen Ludimylla Bezerra Lima, Amanda Ramos de Brito, Ticiane Batista de Brito, Raphael Florindo Amorim, and Raquel Voges Caldart. "Classificação dos pacientes na emergência segundo a dependência da enfermagem." Revista de Enfermagem UFPE on line 13, no. 4 (April 19, 2019): 1133. http://dx.doi.org/10.5205/1981-8963-v13i4a236792p1133-1141-2019.
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RESUMO Objetivo: caracterizar o grau de dependência dos cuidados de enfermagem de usuários internados no setor de emergência. Método: trata-se de estudo quantitativo, transversal, de base secundária e a amostra se constituiu dos usuários internados na área de estabilização no mês de março de 2017. Utilizou-se um instrumento para os dados sociodemográficos e clínicos e o Sistema de Classificação de Pacientes (SCP) de Fugulin, Gaidzinski e Kurcgant. Realizou-se a análise estatística no programa Epi Info. Resultados: verificou-se que 62,16% (n=46) da amostra era do sexo masculino, idade média de 55,29 ± 20,76 anos, principal diagnóstico de internação as doenças do aparelho circulatório (39,19%) e média de permanência de 4,29 ± 6,59. O SPC foi aplicado 166 vezes e predominou o cuidado de intensivo (69,28%), seguido por semi-intensivo (13,86%) e de alta dependência (11,45%). Conclusão: constatou-se um elevado número de cuidados intensivos e semi-intensivos, atrelados à longa permanência no setor, o que descaracteriza as unidades de emergência como local de estabilização. Fornece-se com essa caracterização bases científicas e fidedignas para o gerenciamento hospitalar e de pessoal de enfermagem. Descritores: Administração Hospitalar; Assistência ao Paciente; Emergências; Enfermagem em Emergência; Enfermagem; Organização e Administração.ABSTRACT Objective: to characterize the degree of dependency of users hospitalized in the emergency unit with respect to nursing care. Method: this is a quantitative, cross-sectional and secondary-based study. The sample consisted of patients hospitalized in the stabilization unit in March 2017. An instrument was used to obtain sociodemographic and clinical data, and also the Patient Classification System (PCS) proposed by Fugulin, Gaidzinski and Kurcgant. Statistical analysis was performed using the Epi InfoTM software. Results: 62.16% (n=46) of the sample were male, with mean age of 55.29 ± 20.76 years. The main diagnosis of hospitalization was diseases of the circulatory system (39.19%), and the mean permanence was 4.29 ± 6.59. The PCS was applied 166 times and intensive care was prevalent (69.28%), followed by semi-intensive (13.86%) and high dependency (11.45%). Conclusion: There was a high number of intensive care and semi-intensive care provided and linked to prolonged length of stay in the sector, which mischaracterizes emergency units as patient stabilization sectors. This characterization provides scientific and trustworthy bases for hospital management and nursing personnel. Descriptors: Hospital Administration; Patient Care; Emergencies; Emergency Nursing; Nursing; Organization and Administration.RESUMEN Objetivo: caracterizar el grado de dependencia de los usuarios internados en el sector de emergencia en relación a los cuidados de enfermería. Método: se trata de un estudio cuantitativo, transversal y de base secundaria. La muestra se compuso de los usuarios internados en la unidad de estabilización durante el mes de marzo de 2017. Se utilizó un instrumento para obtener los datos sociodemográficos y clínicos y el Sistema de Clasificación de Pacientes (SCP) de Fugulin, Gaidzinski y Kurcgant. Se realizó el análisis estadístico en el programa Epi InfoTM. Resultados: se verificó que el 62,16% (n=46) de la muestra era del sexo masculino, con edad media de 55,29 ± 20,76 años. El principal diagnóstico de internación fue las enfermedades del aparato circulatorio (39,19%) y el promedio de permanencia fue de 4,29 ± 6,59. El SCP fue aplicado 166 veces y predominó el cuidado intensivo (69,28%), seguido por el semi-intensivo (13,86%) y el de alta dependencia (11,45%). Conclusión: Se constató un elevado número de cuidados intensivos y semi-intensivos relacionados con la larga permanencia en el sector, lo que descaracteriza las unidades de emergencia como locales de estabilización. Esta caracterización proporciona bases científicas y fidedignas para la gestión hospitalaria y de personal de enfermería. Descriptores: Administración Hospitalaria; Asistencia al Paciente; Emergencias; Enfermería de Emergencia; Enfermería; Organización y Administración.
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Atia, Gehan A. F. "Effect of Central Venous Catheter Care Bundle Implementation on Outcomes of Critically Ill Patients." Evidence-Based Nursing Research 2, no. 1 (January 15, 2020): 12. http://dx.doi.org/10.47104/ebnrojs3.v2i1.93.
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Context: Central venous access device (CVAD) bundles for insertion and maintenance demonstrate a reduction in the frequency of complications and bloodstream infection when implemented with compliance monitoring, with the reported success of CVAD bundles. Aim: This study aimed to examine the effect of central venous catheter care bundle implementation on outcomes of critically ill patients. Methods: Quasi-experimental research (pre/post-test design) used to achieve the aim of this study. The study conducted at general and surgical intensive care units affiliated to Menoufia University and teaching hospital. Two study samples recruited in this study. All nurses working at the ICUs, as mentioned above, were recruited in this study. They were 6o critical care nurses. A convenient sample of all available critically ill patients at the time of the study was subjected to treatment via a central venous catheter. Four study tools used to collect the data of this study. These are a structured interview questionnaire, CVC nurses’ knowledge assessment questionnaire, nurses’ compliance assessment checklists, and patient complications assessment records.
Results: The study result showed a highly statistically significant difference between pre and post-test knowledge scores of studied nurses regarding assisting line insertion, removal, maintenance, care, and infection control practices. Besides, a highly statistically significant difference between pre and post-test scores of nurses’ compliance to central venous catheter care practices of assisting in CVC insertion, blood sample withdrawal, medication and fluid administration, CVP measurements, CVC removal, and the management of central venous line complications. The study also revealed a highly statistically significant difference between the study and control group patients regarding the central venous catheter complications. However, signs of infection were the most frequent complications in both groups.
Conclusion. The study concluded that a statistically significant difference between pre and post nurses’ knowledge and compliance with the CVC care bundle. The patients’ outcomes were also improved significantly after the implementation of the CVC care bundle compared to the controls. The study recommended the adoption of the current care bundle that should be disseminated and updated following the international organizations’ recommendation for implementing evidence-based practices for successful central line-associated bloodstream infection (CLABSI) prevention.
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Eryilmaz, Mehmet, Yusuf Alper Kilic, and Murat Durusu. "Organization in Intensive Care Units During Extraordinary Situations." Dahili ve Cerrahi Bilimler Yoğun Bakım Dergisi/ Turkish Journal of Medical and Surgical Intensive Care 2, no. 2 (August 1, 2011): 49–52. http://dx.doi.org/10.5152/dcbybd.2011.11.
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Livianu, J., JMC Orlando, A. Giannini, RGG Terzi, M. Moock, C. Marcos, and N. David. "Organization and staffing of intensive care units in Brazil." Critical Care 4, Suppl 1 (2000): P219. http://dx.doi.org/10.1186/cc938.
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Belyaeva, Irina A., Leyla S. Namazova-Baranova, Nikolai N. Volodin, and Elena E. Petryaykina. "Organization of breastfeeding in neonatal intensive care units: discussion issues." Pediatric pharmacology 16, no. 3 (September 7, 2019): 152–58. http://dx.doi.org/10.15690/pf.v16i3.2027.
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Claeys, MJ, F. Roubille, G. Casella, R. Zukermann, N. Nikolaou, L. De Luca, M. Gierlotka, et al. "Organization of intensive cardiac care units in Europe: Results of a multinational survey." European Heart Journal: Acute Cardiovascular Care 9, no. 8 (January 24, 2020): 993–1001. http://dx.doi.org/10.1177/2048872619883997.
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Background: The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe. Methods: A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries ( n=13) from middle-income countries ( n=14). Results: A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries. Conclusion: More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Chavali, Siddharth, Obaid A. Sidiqqi, and Girija P. Rath. "Organization of a Neurointensive Care Unit." Journal of Neuroanaesthesiology and Critical Care 06, no. 03 (September 2019): 182–86. http://dx.doi.org/10.1055/s-0039-3399475.
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AbstractAlthough in its infancy as a specialty, neurocritical care is rapidly developing its own niche, with a wide profile of patients—both neurosurgical and those with neurological pathologies. Rapid advances in monitoring technology as well as surgical techniques have led to an increasing number of patients, often presenting with myriad concurrent illnesses, who could be best served if managed by specialist neurointensivists. Neurocritical care units are being developed as free-standing intensive care units in several tertiary care hospitals, and literature regarding their establishment and organization is scant, leading to questions regarding how best to utilize resources to gain maximum benefit. This review aims to outline the challenges that are likely to be faced during establishment of such a unit, and to identify certain issues that are specific to this specialty.
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Hasin, Yonathan, Nicolas Danchin, Gerasimos S. Filippatos, Magda Heras, Uwe Janssens, Jonathan Leor, Menachem Nahir, et al. "Recommendations for the structure, organization, and operation of intensive cardiac care units." European Heart Journal 26, no. 16 (March 21, 2005): 1676–82. http://dx.doi.org/10.1093/eurheartj/ehi202.
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Vincent, J. L., P. Suter, D. Bihari, and H. Braining. "Organization of intensive care units in Europe: lessons from the EPIC study." Intensive Care Medicine 23, no. 11 (November 1997): 1181–84. http://dx.doi.org/10.1007/s001340050479.
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Akram, Gazala, Anton Slavin, and Paul Davies. "The administration of psychotropic PRN medication in Scottish psychiatric intensive care units." Journal of Psychiatric Intensive Care 10, no. 02 (February 25, 2014): 64–74. http://dx.doi.org/10.1017/s1742646414000028.
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TRUJILLO, MAXIMO H., KADUO ARAI, and EZEQUIEL BELLORIN-FONT. "Practical guide for drug administration by intravenous infusion in intensive care units." Critical Care Medicine 22, no. 6 (June 1994): 1049–63. http://dx.doi.org/10.1097/00003246-199406000-00028.
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Guinemer, Camille, Martin Boeker, Bjoern Weiss, Daniel Fuerstenau, Felix Balzer, and Akira-Sebastian Poncette. "Telemedicine in Intensive Care Units: Protocol for a Scoping Review." JMIR Research Protocols 9, no. 12 (December 31, 2020): e19695. http://dx.doi.org/10.2196/19695.
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Background Telemedicine has been deployed to address issues in intensive care delivery, as well as to improve outcome and quality of care. Implementation of this technology has been characterized by high variability. Tele-intensive care unit (ICU) interventions involve the combination of multiple technological and organizational components, as well as interconnections of key stakeholders inside the hospital organization. The extensive literature on the benefits of tele-ICUs has been characterized as heterogeneous. On one hand, positive clinical and economical outcomes have been shown in multiple studies. On the other hand, no tangible benefits could be detected in several cases. This could be due to the diverse forms of organizations and the fact that tele-ICU interventions are complex to evaluate. The implementation context of tele-ICUs has been shown to play an important role in the success of the technology. The benefits derived from tele-ICUs depend on the organization where it is deployed and how the telemedicine systems are applied. There is therefore value in analyzing the benefits of tele-ICUs in relation to the characteristics of the organization where it is deployed. To date, research on the topic has not provided a comprehensive overview of literature taking both the technology setup and implementation context into account. Objective We present a protocol for a scoping review of the literature on telemedicine in the ICU and its benefits in intensive care. The purpose of this review is to map out evidence about telemedicine in critical care in light of the implementation context. This review could represent a valuable contribution to support the development of tele-ICU technologies and offer perspectives on possible configurations, based on the implementation context and use case. Methods We have followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and the recommendations of the Joanna Briggs Institute methodology for scoping reviews. The scoping review and subsequent systematic review will be completed by spring 2021. Results The preliminary search has been conducted. After removing all duplicates, we found 2530 results. The review can now be advanced to the next steps of the methodology, including literature database queries with appropriate keywords, retrieval of the results in a reference management tool, and screening of titles and abstracts. Conclusions The results of the search indicate that there is sufficient literature to complete the scoping review. Upon completion, the scoping review will provide a map of existing evidence on tele-ICU systems given the implementation context. Findings of this research could be used by researchers, clinicians, and implementation teams as they determine the appropriate setup of new or existing tele-ICU systems. The need for future research contributions and systematic reviews will be identified. International Registered Report Identifier (IRRID) DERR1-10.2196/19695
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Rosselli, Diego, Juan David Rueda, María Daniela Silva, and Jorge Salcedo. "Economic Evaluation of Four Drug Administration Systems in Intensive Care Units in Colombia." Value in Health Regional Issues 5 (December 2014): 20–24. http://dx.doi.org/10.1016/j.vhri.2014.05.001.
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Lopes, Martina Celi Bandeira Rufino, Guilherme Duprat Ceniccola, Wilma Maria Coelho Araújo, and Rita Akutsu. "Nutrition support team activities can improve enteral nutrition administration in intensive care units." Nutrition 57 (January 2019): 275–81. http://dx.doi.org/10.1016/j.nut.2018.04.017.
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Valentin, A., M. Capuzzo, B. Guidet, R. Moreno, B. Metnitz, P. Bauer, and P. Metnitz. "Errors in administration of parenteral drugs in intensive care units: multinational prospective study." BMJ 338, mar12 1 (March 12, 2009): b814. http://dx.doi.org/10.1136/bmj.b814.
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Render, M. L., R. W. Freyberg, R. Hasselbeck, T. P. Hofer, A. E. Sales, J. Deddens, O. Levesque, and P. L. Almenoff. "Infrastructure for quality transformation: measurement and reporting in veterans administration intensive care units." BMJ Quality & Safety 20, no. 6 (February 23, 2011): 498–507. http://dx.doi.org/10.1136/bmjqs.2009.037218.
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Wendlandt, Blair, Thomas Bice, Shannon Carson, and Lydia Chang. "Intermediate Care Units: A Survey of Organization Practices Across the United States." Journal of Intensive Care Medicine 35, no. 5 (February 11, 2018): 468–71. http://dx.doi.org/10.1177/0885066618758627.
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Purpose: Intermediate care units (IMCUs) represent an alternative care setting with nurse staffing levels between those of the general ward and the intensive care unit (ICU). Despite rising prevalence, little is known about IMCU practices across US hospitals. The purpose of this study is to characterize utilization patterns and assess for variation. Materials and Methods: A 14-item survey was distributed to a random nationwide sample of pulmonary and critical care physicians between January and April 2017. Results: A total of 51 physicians from 24 different states completed the survey. Each response represented a unique institution, the majority of which were public (59%), academic (73%), and contained at least 1 IMCU (65%). Of the IMCUs surveyed, 58% operated as 1 mixed unit that admitted medical, cardiac, and surgical patients as opposed to having separate subspecialty units. Ninety-one percent of units admitted step-down patients from the ICU, but 39% of units accepted a mix of step-up patients, step-down patients, postoperative patients, and patients from the emergency department. Intensivists managed care in 21% of units whereas 36% had no intensivist involvement. Conclusion: Organization practices vary considerably between IMCUs across institutions. The impact of different organization practices on patient outcomes should be assessed.
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Mesek, Inge, Georgi Nellis, Jana Lass, and Irja Lutsar. "MEDICATION USE IN NEONATAL INTENSIVE CARE UNITS ACROSS EUROPE." Archives of Disease in Childhood 101, no. 1 (December 14, 2015): e1.3-e1. http://dx.doi.org/10.1136/archdischild-2015-310148.11.
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ObjectivesThis is the first Europe-wide study aiming to describe the medication use in Neonatal Intensive Care Units and to analyse the factors that might influence the prescription pattern.MethodsA pan-European one day point-prevalence study was conducted in 2012 where all of the prescriptions for hospitalised neonates were recorded. A trade name, manufacturer, active pharmaceutical ingredients (API), strength, galenic form and route of administration were registered.ResultsAltogether 2173 prescriptions were administered to 726 neonates from 21 countries, of whom 66% (477/726) were preterm, 12% (84/726) extremely preterm. There was inverse correlation between gestational age (GA) and median number of prescriptions per neonate (group median 2/IQR 1–4, extremely preterm 4/3–6, very preterm 3/2–5, late preterm 2/1–3, full-term 2/1–3). Median number of prescriptions per neonate was highest in the eastern region, among extremely preterm neonates (median=6.5/IQR 6–8.5). Highest prescription rate was for alimentary medicines (93/per 100 admissions), systemic antiinfectives (79/100) and medicines for blood (71/100). Antiinfectives were most frequently prescribed in the southern region (103/100). Multivitamins were most frequently used medications in most regions (western 74, southern 31, northern 31/100), except in eastern region (5/100). Most commonly prescribed API-s were multivitamins (32/100), caffeine (19/100), gentamicin (18/100), amino acids (18/100) and colecalciferol (15/100). Most frequently prescribed medications among extremely preterm neonates were caffeine (60/100), among very preterms multivitamins and caffeine (45 and 43/100), among late preterms multivitamins (44/100) and among full-terms phytomenadione (26/100) and gentamicin (24/100).ConclusionsOur study revealed the most commonly used medications in neonates. Higher prescription rate among preterm neonates calls for further analysis of the suitability and safety of medications for infants with lower GA.
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Multz, Alan S. "Intensive care unit organization and management for the question of open versus closed units." Current Opinion in Critical Care 4, no. 6 (December 1998): 454–56. http://dx.doi.org/10.1097/00075198-199812000-00022.
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Merkouris, Anastasios, Elizabeth D. E. Papathanassoglou, Dimitrios Pistolas, Vasileia Papagiannaki, John Floros, and Chryssoula Lemonidou. "Staffing and Organisation of Nursing Care in Cardiac Intensive Care Units in Greece." European Journal of Cardiovascular Nursing 2, no. 2 (July 2003): 123–29. http://dx.doi.org/10.1016/s1474-5151(03)00029-x.
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Purpose: To explore staffing and organisational characteristics of nursing care in cardiac intensive care units (CICUs) in Greece. Methodology: An exploratory descriptive survey design with additional cross-sectional comparisons was employed. A specifically developed survey-type questionnaire, addressed to nurse managers, was distributed to all CICUs in Greece. Results: The response rate was 76.2% ( N=32 units). Nursing staff per bed ratios over 24 h (whole-time equivalent) were very low and exhibited a mean of 1.25 (±0.53). The total registered nurse to assistance nurse (RN/AN) ratio was 2.74, but a lot of variability was observed and in many units ANs operated in RNs positions. Only 42% of the nurses had participated at in-service continuing education programs and a systematic training program in cardio pulmonary resuscitation (CPR) was provided in only 12 (37.5%) units. The reported frequencies at which specific technical tasks were performed autonomously by nurses varied substantially and reflected a medium to low level of practice autonomy; the most frequently reported tasks were: peripheral IV line insertion, CPR chest compression, titration of vasoactive drugs and administration of analgesics. Higher percentages of nurses had received in-service training associated with the likelihood of performance of several technical tasks ( P<0.03). Conclusions: Future studies need to explore the effect of these organisational characteristics on patient outcomes. The endorsement of nation-wide standards for nursing staffing and training in CICUs is imperative.
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Bastani, Peivand, Mostafa Sheykhotayefeh, Ali Tahernezhad, Seyyed Mostafa Hakimzadeh, and Samaneh Rikhtegaran. "Reflections on COVID-19 and the ethical issues for healthcare providers." International Journal of Health Governance 25, no. 3 (June 23, 2020): 185–90. http://dx.doi.org/10.1108/ijhg-05-2020-0050.
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PurposeHealthcare governance places medical ethics at the forefront of defining and maintaining the quality of care. Examples of serious ethical issues include sexual abuse of patients (Dubois, Walsh, Chibnall et al., 2017), criminal prescription of opioids (Johnson, 2019) and unnecessary surgical procedures (Tayade and Dalvi, 2016) or shortages in service delivery because of little knowledge or experience especially during pandemic outbreaks (Hay-David et al., 2020). In many cases involving medical ethics, patients are identified as the first victims; however, this study aimed to consider clinicians and other healthcare practitioners as other probable victims (Ozeke et al., 2019).Design/methodology/approachThe World Health Organization (WHO) estimates that tens of millions of patients worldwide suffer disabling injuries or death every year due to unsafe medical practices and services. Nearly, one in ten patients is harmed due to preventable causes while receiving health care in well-funded and technologically advanced hospital settings (WHO, 2016). Much less is known about the burden of unsafe care in non-hospital settings, where most healthcare services are delivered (Jha et al., 2013). Furthermore, there is little evidence concerning the burden of unsafe care in developing countries, where the risk of harm to patients is likely to be greater, due to limitations in infrastructure, technologies and human resources (Elmontsri et al., 2018).FindingsWhile these problems are endemic in health care, they are exacerbated in times of health and social crises such as the coronavirus disease of 2019 (COVID-19) pandemic. This pandemic has few precedents, being most closely paralleled with the global influenza pandemic of 1918 (Terry, 2020). Initially compared to the severe acute respiratory syndrome (SARS) outbreak of 2002–2003 (Parrym, 2003), COVID-19 is already proving much more deadly. The WHO’s estimates of the number of SARS cases from the start of the outbreak in 2002, until it was brought under control in July 2003, was 8,437 cumulative cases, with 813 deaths (WHO, 2003). The European Center for disease prevention and Control estimated that as of May 15, 2020, that 4,405,680 cases of COVID-19 have been reported with 302,115 deaths (ECDC, 2020)Research limitations/implicationsThe outbreak of COVID-19 was declared in February 2020 in the Islamic Republic of Iran, and up to March 2020, the cases of morbidity reached 12,729, with 611 deaths (Bedasht, 2020). The current figure at the time of editing (May 16, 2020) is 118,392 cases, with 6,937 deaths (Worldometer, 2020). Acting in cognizance of its ethical responsibility to the citizens of Iran, the Iranian government has taken the following action to attempt to mitigate the deleterious effects of the virus: in each province, one or more hospitals have been evacuated and allocated to patients with pulmonary problems with suspected to COVID-19. Access to intensive care units and specialist equipment is a primary ethical issue that concerns the Iranian healthcare system. The issue is exacerbated by the knowledge that these facilities are not distributed equitably in the country. Therefore, equity is the first ethical concern in this situation.Practical implicationsAll nurses, clinicians, practitioners and specialists have been asked to volunteer their services in hospitals in the most infected areas. This raises ethical concerns about access to personal protective equipment (PPE) such as appropriate masks, gowns, gloves and other equipment to protect healthcare workers from infection. Access to PPE was restricted because of government failure to stockpile the necessary amount of disposable medical equipment. This was related to lack of domestic capacity to produce the equipment and problems accessing it internationally due to political-economic sanctions that were imposed on Iran by the USA and some European countries. Such shortages can quickly lead to a catastrophic situation; current evidence demonstrates that about 40% of healthcare workers are vulnerable to the COVID-19 infection (Behdasht, 2020). However, it should be noted that this is not a problem limited to Iran. As of March 2020, the WHO was already warning about PPE shortages and the dangers this posed for healthcare workers around the world (WHO, 2020).Social implicationsA Disaster Committee was created by the Iranian Ministry of Health to take responsibility for decision-making and daily information sharing to the community. The ethical dilemma that arises in terms of reporting the situation is the conflict between transparently presenting accurate and timely information and the creation of public panic and fear that this may cause in the community.Originality/valueAs a steward for public health, the Ministry of Health was afforded direct responsibility to maintain intra-sector relationships and leadership with other organizations such as political executive organizations, municipalities, military agencies, schools, universities and other public organizations to reach consensus on the best methods of controlling the COVID-19 outbreak. An important ethical issue is found in potential areas of conflict between the therapeutic and preventive roles of the Ministry of Health and those related to public health and the civil administrations.
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Zimmerman, JE, DM Rousseau, J. Duffy, K. Devers, RR Gillies, DP Wagner, EA Draper, SM Shortell, and WA Knaus. "Intensive care at two teaching hospitals: an organizational case study." American Journal of Critical Care 3, no. 2 (March 1, 1994): 129–38. http://dx.doi.org/10.4037/ajcc1994.3.2.129.
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OBJECTIVE: To examine structural and organizational characteristics at two ICUs with marked differences in risk-adjusted survival. METHODS: We performed on-site organizational analysis in two ICUs at two major teaching hospitals. Our main outcome measures were interviews and direct observations by a team of clinical and organizational researchers; demographic, clinical, and survival data for 888 ICU admissions; and questionnaire responses from 70 nurses and 42 physicians on ICU structure and organization. ICU performance was measured using risk-adjusted survival and the ratios of actual to predicted ICU length of stay and resource use. RESULTS: Structural and organizational questionnaires, self-evaluation by staff members, and the research team's implicit judgments following detailed on-site analysis failed to distinguish units with higher and lower risk-adjusted survival. Both units exhibited practices to emulate and practices to avoid. CONCLUSIONS: The methods used in this study can identify organizational problems and potential means for improvement. The best practices and suggestions for improvement at these units provide examples of methods for improving ICU management.
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Beckmann, U., L. F. West, G. J. Groombridge, I. Baldwin, G. K. Hart, D. G. Clayton, R. K. Webb, and W. B. Runciman. "The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. the Development and Evaluation of an Incident Reporting System in Intensive Care." Anaesthesia and Intensive Care 24, no. 3 (June 1996): 314–19. http://dx.doi.org/10.1177/0310057x9602400303.
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Intensive care units are complex, dynamic patient management environments. Incidents and accidents can be caused by human error, by problems inherent in complex systems, or by a combination of these. Study objectives were to develop and evaluate an incident reporting system. A report form was designed eliciting a description of the incident, contextual information and contributing factors. Staff group sessions using open-ended questions, observations in the workplace and a review of earlier narratives were used to develop the report form. Three intensive care units participated in a two-month evaluation study. Feedback questionnaires were used to assess staff attitudes and understanding, project design and organization. These demonstrated a positive attitude and good understanding by more than 90% participants. Errors in communication, technique, problem recognition and charting were the predisposing factors most commonly chosen in the 128 incidents reported. It was concluded that incident monitoring may be a suitable technique for improving patient safety in intensive care.
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Usenko, L. V., and A. V. Tsarev. "Vladimir Negovsky: a dream incarnation." EMERGENCY MEDICINE 16, no. 7-8 (April 5, 2021): 136–45. http://dx.doi.org/10.22141/2224-0586.16.7-8.2020.223718.
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The article deals with the life path and research activities of the founder of resuscitation science (intensive care) Vladimir A. Negovsky. He was born in 1909 in the city of Kozelets, Ukraine. After graduating from university in 1933, Negovsky worked as a researcher in the pathophysiological laboratory of the Central Institute of Hematology and Blood Transfusion in Moscow, where he worked for about a year with Professor S.S. Bryuchonenko, the creator of one of the world’s first heart-lung apparatus and where, apparently, his scientific interests were finally formed. In 1936, Negovsky wrote a letter to the Prime Minister of the USSR V.M. Molotov, in which he substantiated the prospects and importance of research in the field of cardiopulmonary resuscitation and asked for help in creating a research laboratory on this problem. Surprisingly, his request was granted — in the same year an order was issued on the organization of a special-purpose laboratory on the problem: ‘Restoration of life processes in phenomena similar to death”. Such a scientific research laboratory was created for the first time in the world. V.A. Negovsky and his collaborators modified the resuscitation method proposed by F.A. Andreev (1879–1952) and included the injection of Ringer-Locke’s solution with adrenaline into the carotid artery towards the heart (centripetally, i.e. against the blood flow). This method was improved by Negovsky and the Laboratory staff by using the radial and brachial arteries as an access for centripetal blood injection, which made it possible to simplify the technique for use in clinical practice and was supplemented by artificial lung ventilation by forced air injection into the lungs with bellows, as they have shown that intra-arterial pumping alone without mechanical ventilation is often ineffective. In the years before the attack of Nazi Germany on the USSR (1938–1941), V.A. Negovsky and his colleagues carried out a series of experimental studies devoted to the resuscitation of animals with lethal blood loss, as well as to the problem of extinction and restoration of brain functions, the results of which were published in several articles. In 1942, V.A. Negovsky defended his PhD on the topic “The relationship of respiration and blood circulation in the process of dying of animals from blood loss and in the subsequent period of restoration of vital functions”. During World War II, Negovsky organized a front-line medical teams, with which he went to the front line and where, in 1943, the developed complex of resuscitation measures was first used for wounded soldiers. In his dissertation on medicine “Restoration of vital functions of an organism in a state of agony or a period of clinical death” defended in 1943, he outlined the main provisions of the pathophysiology of terminal states and the principles of a complex method of resuscitation; the dissertation was published in a book in the same year. In 1945–1946, V.A. Negovsky publishes reports in the journals “JAMA” and “Nature” about the clinical experience of using the developed method of cardiopulmonary resuscitation and the importance of developing this problem of medicine, thus providing a priority in creating a new scientific direction. In 1946, using the experience gained in the war, the Laboratory staff continued their clinical work, starting to provide medical care to dying patients at the Institute of Thoracic Surgery of the USSR of the Academy of Medical Sciences, thus creating their own clinical resuscitation unit. In 1947, V.A. Negovsky was awarded the title of professor. Despite the successes achieved, Negovsky and his colleagues had to overcome stubborn misunderstanding and expressed resistance from many representatives of the medical community. An interesting fact in the biography of V.A. Negovsky was his participation in 1953 in the CPR (chest compression and administration of pharmacological drugs) of Joseph Stalin. In 1952, the Laboratory team created the first instruction, which was published by the USSR Ministry of Health for use in clinical practice “On the introduction into medical practice of methods for restoring the vital functions of an organism in a state of agony or clinical death”, which was republished in 1955, 1959 and 1963 with the introduction of changes to the CPR algorithm. In 1959, on the initiative of V. \A. Negovsky, the first prototype of the intensive care unit in the USSR was organized, which was named “Center for the Treatment of Shock and Terminal States”. In 1961, he reported about creating a new medical science — resuscitation science, the subject of which is nonspecific general pathological reactions of the body, pathogenesis, therapy, and prevention of terminal states, life support in critical states. In 1972, in the first issue of the newly created journal “Resuscitation”, V.A. Negovsky published an article “The second step in resuscitation — the treatment of the ‘post-resuscitation’ disease”, in which he outlines the pathophysiological mechanisms of the development of post-resuscitation changes in the body. A special topic is overcoming the “iron curtain” and acquaintance of V.A. Negovsky with the American founder of the first Intensive Care Units (ICU) P. Safar, who laid the foundation for many years of scientific interaction and personal friendship. In 1985, on the basis of the Laboratory, Negovsky organized the Research Institute of General Reanimatology of the USSR of the Academy of Medical Sciences, which now bears his name. Vladimir Negovsky loved classical music, especially I.S. Bach, painting — Sandro Botticelli, Francisco Goya, always found time and energy for skiing. He died on August 2, 2003, and is buried in Moscow.
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Gurses, Ayse P., and Pascale Carayon. "Identifying Performance Obstacles among Intensive Care Nurses." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 49, no. 11 (September 2005): 1019–23. http://dx.doi.org/10.1177/154193120504901104.
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In this paper, we compare findings of two studies aimed at identifying performance obstacles among intensive care nurses. The first study is a qualitative study where data was collected from 15 intensive care nurses using individual, semi-structured interviews. The second study is a cross-sectional study conducted among 298 nurses from 17 intensive care units (ICUs) of seven hospitals using a questionnaire survey. Based on the results of these two studies, the most commonly experienced performance obstacles among ICU nurses include inadequate help from others, tools and equipment, ineffective inter-provider communication, materials and supplies, poor physical work environment, and family issues. The results of these two studies have implications regarding efforts aimed at redesigning ICU work organization in order to reduce nursing workload and improve quality of working life and quality and safety of care.
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Raman, Sainath, Samiran Ray, and Mark J. Peters. "Survey of Oxygen Delivery Practices in UK Paediatric Intensive Care Units." Critical Care Research and Practice 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/6312970.
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Purpose.Administration of supplemental oxygen is common in paediatric intensive care. We explored the current practice of oxygen administration using a case vignette in paediatric intensive care units (PICU) in the united kingdom.Methods.We conducted an online survey of Paediatric Intensive Care Society members in the UK. The survey outlined a clinical scenario followed by questions on oxygenation targets for 5 common diagnoses seen in critically ill children.Results.Fifty-three paediatric intensive care unit members from 10 institutions completed the survey. In a child with moderate ventilatory requirements, 21 respondents (42%) did not follow arterial partial pressure of oxygen (PaO2) targets. In acute respiratory distress syndrome, cardiac arrest, and sepsis, there was a trend to aim for lower PaO2as the fraction of inspired oxygen (FiO2) increased. Conversely, in traumatic brain injury and pulmonary hypertension, respondents aimed for normal PaO2even as the FiO2increased.Conclusions.In this sample of clinicians PaO2targets were not commonly used. Clinicians target lower PaO2as FiO2increases in acute respiratory distress syndrome, cardiac arrest, and sepsis whilst targeting normal range irrespective of FiO2in traumatic brain injury and pulmonary hypertension.
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Briggs-Steinberg, Courtney, and Shetal Shah. "Rationale for In-Neonatal Intensive Care Unit Administration of Live, Attenuated Rotavirus Vaccination." American Journal of Perinatology 35, no. 14 (June 8, 2018): 1443–48. http://dx.doi.org/10.1055/s-0038-1660463.
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AbstractRotavirus is the most common nonseasonal vaccine preventable illness. Despite increased severity of rotaviral illness in early infancy, most neonatal intensive care units (NICU) do not administer rotavirus vaccination either during the NICU stay at age of eligibility or at discharge as the Advisory Committee on Immunization Practices recommends. In this commentary, we review the rationale for the administration of rotavirus vaccination to premature infants. Further, we outline data supporting vaccine administration at chronologic age while still admitted to the NICU.
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Thakar, Charuhas V., Annette Christianson, Ron Freyberg, Peter Almenoff, and Marta L. Render. "Incidence and outcomes of acute kidney injury in intensive care units: A Veterans Administration study*." Critical Care Medicine 37, no. 9 (September 2009): 2552–58. http://dx.doi.org/10.1097/ccm.0b013e3181a5906f.
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Martín-González, Félix, Javier González-Robledo, Fernando Sánchez-Hernández, and María Moreno-García. "Success/Failure Prediction of Noninvasive Mechanical Ventilation in Intensive Care Units." Methods of Information in Medicine 55, no. 03 (2016): 234–41. http://dx.doi.org/10.3414/me14-01-0015.
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SummaryObjectives: This paper addresses the problem of decision-making in relation to the administration of noninvasive mechanical ventila tion (NIMV) in intensive care units.Methods: Data mining methods were employed to find out the factors influencing the success/failure of NIMV and to predict its results in future patients. These artificial intelligence-based methods have not been applied in this field in spite of the good results obtained in other medical areas.Results: Feature selection methods provided the most influential variables in the success/ failure of NIMV, such as NIMV hours, PaCO2 at the start, PaO2 / FiO2 ratio at the start, hematocrit at the start or PaO2 / FiO2 ratio after two hours. These methods were also used in the preprocessing step with the aim of improving the results of the classifiers. The algorithms provided the best results when the dataset used as input was the one containing the attributes selected with the CFS method. Conclusions: Data mining methods can be successfully applied to determine the most influential factors in the success/failure of NIMV and also to predict NIMV results in future patients. The results provided by classifiers can be improved by preprocessing the data with feature selection techniques.
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Celi, L. A., F. Cismondi, S. M. Vieira, S. R. Reti, J. M. C. Sousa, S. N. Finkelstein, and A. S. Fialho. "Disease-based Modeling to Predict Fluid Response in Intensive Care Units." Methods of Information in Medicine 52, no. 06 (2013): 494–502. http://dx.doi.org/10.3414/me12-01-0093.
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SummaryObjective: To compare general and disease-based modeling for fluid resuscitation and vasopressor use in intensive care units.Methods: Retrospective cohort study in -volving 2944 adult medical and surgical intensive care unit (ICU) patients receiving fluid resuscitation. Within this cohort there were two disease-based groups, 802 patients with a diagnosis of pneumonia, and 143 patients with a diagnosis of pancreatitis. Fluid resuscitation either progressing to subsequent vasopressor administration or not was used as the primary outcome variable to compare general and disease-based modeling.Results: Patients with pancreatitis, pneumonia and the general group all shared three common predictive features as core variables, arterial base excess, lactic acid and platelets. Patients with pneumonia also had non-invasive systolic blood pressure and white blood cells added to the core model, and pancreatitis patients additionally had temperature. Disease-based models had significantly higher values of AUC (p < 0.05) than the general group (0.82 f± 0.02 for pneumonia and 0.83 ± 0.03 for pancreatitis vs. 0.79 ± 0.02 for general patients).Conclusions: Disease-based predictive mod -eling reveals a different set of predictive variables compared to general modeling and improved performance. Our findings add support to the growing body of evidence advantaging disease specific predictive modeling.
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Mesiano, Eni Rosa Aires Borba, and Edgar Merchán-Hamann. "Bloodstream infections among patients using central venous catheters in intensive care units." Revista Latino-Americana de Enfermagem 15, no. 3 (June 2007): 453–59. http://dx.doi.org/10.1590/s0104-11692007000300014.
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Central Venous Catheters (CVC), widely used in Intensive Care Units (ICU) are important sources of bloodstream infections (BSI). This prospective cohort epidemiological analytical study, aimed to infer the incidence of BSI, the risk factors associated and evaluate the care actions related to the use of these catheters in seven ICU in the Federal District - Brasília, Brazil. From the 630 patients using CVC, 6.4% developed BSI (1.5% directly related to the catheter and 4.9% clinic BSI). The hospitalization term was 3.5 times greater among these patients. Different modalities of catheter insertion and antiseptic substances use were observed. Time of CVC permanence was significantly associated to infection incidence (p<1x10-8) as well as the right subclavian access and double-lumen catheters. Patients with neurological disorders and those submitted to tracheotomy were the most affected. We suggest the organization of a "catheter group" aiming to standardize procedures related to the use of catheters in order to reduce the hospitalization term and hospital costs.
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Belotserkovskiy, B. Z., E. B. Gelfand, A. O. Bykov, O. A. Mamontova, and D. N. Protsenko. "Criteria for the administration of systemic antimicotic therapy in surgical intensive care units (literature review)." Pelvic Surgery and Oncology 9, no. 4 (November 13, 2019): 11–20. http://dx.doi.org/10.17650/2686-9594-2019-9-4-11-20.
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This review focuses on the practical aspects of prevention and treatment of fungal infections in surgical patients. It covers epidemiology and risk factors for invasive candidiasis, updates on the etiological structure of fungal infections in patients in critical conditions, and provides the information on drug sensitivity of Candida species. The authors discuss the limitations of cultural and non-cultural diagnostic methods used in invasive candidiasis, emphasizing the importance of analyzing the existing risk factors in combination with a comprehensive assessment of clinical and laboratory data for timely initiation of adequate antifungal therapy. The review provides a brief description of currently available antimicotics, including polyenes, triazoles, and echinocandins. It also describes the benefits of anidulafungin, which does not interact with other drugs and has no negative effect on the liver and kidney. The article also covers indications for antifungal agents in surgical intensive care units in accordance with international and Russian guidelines. A cohort of patients with abdominal diseases requiring preventive and empirical treatment with antimicotics is described. In additions to that, the manuscript contains a rationale for the use of echinocandins in targeted therapy of invasive candidiasis.
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Manias, Elizabeth. "Errors in administration of parenteral medications are a serious safety problem in intensive care units." Australian Critical Care 22, no. 3 (August 2009): 141–43. http://dx.doi.org/10.1016/j.aucc.2009.06.002.
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Smithburger, Pamela L., Randall B. Smith, Sandra L. Kane-Gill, and Philip E. Empey. "Patient Predictors of Dexmedetomidine Effectiveness for Sedation in Intensive Care Units." American Journal of Critical Care 23, no. 2 (March 1, 2014): 160–65. http://dx.doi.org/10.4037/ajcc2014678.
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Background Dexmedetomidine, a selective α2-adrenergic receptor agonist, is increasingly used as a sedative in intensive care despite variations in patients’ responses. Objectives To determine the effectiveness of dexmedetomidine as a sedative and specific patient characteristics that play a role in adequate sedation with dexmedetomidine. Methods A 6-month, pilot, prospective observational study was performed in a medical intensive care unit at an academic medical center. Patients receiving dexmedetomidine were followed up until use of the drug was stopped and they were classified as nonresponders or responders. Effective sedation was defined as a score of 3 to 4 on the Sedation Agitation Scale after the administration of dexmedetomidine. Patient characteristics, laboratory values, home and inpatient medications, and dexmedetomidine dosing information were collected to identify predictors of clinical response. Results During the 6-month study period, 38 patients received dexmedetomidine. The drug was ineffective as a sedative in 19 patients (50%) and effective in 11 (29%). Effectiveness could not be assessed in 8 patients because of clinical confounders. According to standard multiple logistic regression analysis, successful sedation was more likely in patients with a lower score on the Acute Physiology and Chronic Health Evaluation II (Odds Ratio [OR] 0.81; 95% CI, −0.39 to −0.03) and patients who took antidepressants at home (OR 10.27; 95% CI, 0.23 to 4.43) than in patients who had a higher score or did not take antidepressants at home. Conclusions Effective sedation with dexmedetomidine is variable.
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Heczková, Jana, and Alan Bulava. "Nurses’ knowledge of the medication management at intensive care units." Pielegniarstwo XXI wieku / Nursing in the 21st Century 17, no. 1 (March 1, 2018): 18–23. http://dx.doi.org/10.2478/pielxxiw-2018-0003.
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Abstract Introduction. The medicine management is considered an important area of health care, which is ensured by various healthcare professionals including nurses. Nurses gain the competence of medicines administration immediately after graduation. This competence can be applied to any area of healthcare. Even in specialized settings such as intensive care units, any additional qualification e.g. specialized education is not required. On the contrary, appropriate education is considered an important factor that could help to reduce the risk of adverse events related to medication management. Aim. The aim of this study was to analyse the students’ knowledge in this field at the end of nursing studies at bachelor level (n = 67) and specialized intensive care nursing studies at master level (n = 42). Methodology. Knowledge was assessed using a written test, which was related to the management of medicinal products administered commonly at intensive care units by qualified nurses as well as nurse specialists without distinction. From the point of view of the formal competencies of healthcare professionals, the questions were divided into three categories. Results. The mean success rate on the test was 53.4%. The highest range of knowledge was demonstrated by already qualified students at the end of specialised studies with prior work experience in ICU, the lowest by students just before graduation. The highest rating was achieved by all students in the activity-oriented category for which the responsibility lies primarily with the medical doctor, but nurses were expected to have this knowledge and participate at related activities on the basis of a physician’s order. This knowledge included also the area of clinical pharmacology. On the other hand, the lowest score was achieved by all groups of students in the category of activities that are not treated by the physician’s order, and the use of diverse knowledge from different areas was usually necessary. Conclusions. Clinical practice has an irreplaceable role for nurses in the process of qualifying education as well as lifelong learning. The extent of nursing education in medicine management, the manner of nursing training, as well as the proportion of nursing specialists in the nursing team at specialised workplaces, deserves much greater attention in terms of ensuring safe care in this area. Shifting some competencies and duties in medicine management, especially related to intravenous (IV) therapy, to less qualified healthcare professionals appears to be highly controversial and risky.
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Kirchhoff, Karin T., and Jennifer A. Kowalkowski. "Current Practices for Withdrawal of Life Support in Intensive Care Units." American Journal of Critical Care 19, no. 6 (November 1, 2010): 532–41. http://dx.doi.org/10.4037/ajcc2009796.
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BackgroundNurses are present at the bedside of patients undergoing withdrawal of life support more often than any other member of the health care team, yet most publications on this topic are directed at physicians.ObjectivesTo describe the training, guidance, and support related to withdrawal of life support received by nurses in intensive care units in the United States, how the nurses participated, and how the withdrawal of life support occurred.MethodsA questionnaire about withdrawal of life support was sent to 1000 randomly selected members of the American Association of Critical-Care Nurses, with 2 follow-up mailings.ResultsResponses were received from 48.4% of the nurses surveyed. Content on withdrawal of life support was required in only 15.5% of respondents’ basic nursing education and was absent from work site orientations for 63.1% of respondents. Nurses’ actions during withdrawal were most often guided by individual physician’s orders (63.8%), followed by standardized care plans (20%) and standing orders (11.8%). Nurses rated the importance of emotional support during and after the withdrawal of life support very highly, but they did not believe they were receiving that level of support. Most respondents (87.5%) participated in family conferences where withdrawal of life support was discussed. After physicians, nurses were most influential concerning administration of palliative medications. Patients’ families were present during withdrawal procedures between 32.3% and 58.4% of the time.ConclusionsTo improve their practice, intensive care nurses should receive formal training on withdrawal of life support, and institutions should develop best practices that support nurses in providing the highest quality care for patients undergoing this procedure.
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Chang, Hui-Lan, Chih-Hsin Tang, Yuan-Man Hsu, Lei Wan, Ya-Fen Chang, Chiung-Tsung Lin, Yao-Ru Tseng, et al. "Nosocomial Outbreak of Infection With Multidrug-ResistantAcinetobacter baumanniiin a Medical Center in Taiwan." Infection Control & Hospital Epidemiology 30, no. 1 (January 2009): 34–38. http://dx.doi.org/10.1086/592704.
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Objective.To investigate a nosocomial outbreak of infection with multidrug-resistant (MDR)Acinetobacter baumanniiin the intensive care units at China Medical University Hospital in Taiwan.Design.Prospective outbreak investigation.Setting.Three intensive care units in a 2,000-bed university hospital in Taichung, Taiwan.Methods.Thirty-eight stable patients in 3 intensive care units, all of whom had undergone an invasive procedure, were enrolled in our study. Ninety-fourA. baumanniistrains were isolated from the patients or the environment in the 3 intensive care units, during the period from January 1 through December 31, 2006. We characterizedA. baumanniiisolates by use of repetitive extragenic palindromic–polymerase chain reaction (REP-PCR) and random amplified polymorphic DNA (RAPD) fingerprinting. The clinical characteristics of the source patients and the environment were noted.Results.All of the clinical isolates were determined to belong to the same epidemic strain of MDRA. baumanniiby the use of antimicrobial susceptibility tests, REP-PCR, and RAPD fingerprinting. All patients involved in the infection outbreak had undergone an invasive procedure. The outbreak strain was also isolated from the environment and the equipment in the intensive care units. Moreover, an environmental survey of one of the intensive care units found that both the patients and the environment harbored the same outbreak strain.Conclusion.The outbreak strain ofA. baumanniimight have been transmitted among medical staff and administration equipment. Routine and aggressive environmental and equipment disinfection is essential for preventing recurrent outbreaks of nosocomial infection with MDRA. baumannii.
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González-García, María, Alberto Lana, Paula Zurrón-Madera, Yolanda Valcárcel-Álvarez, and Ana Fernández-Feito. "Nursing Students’ Experiences of Clinical Practices in Emergency and Intensive Care Units." International Journal of Environmental Research and Public Health 17, no. 16 (August 6, 2020): 5686. http://dx.doi.org/10.3390/ijerph17165686.
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Clinical practices are key environments for skill acquisition during the education of nursing students, where it is important to encourage reflective learning. This study sought to explore the experience of final year nursing students during their clinical placement in emergency and intensive care units and to identify whether differences exist between female and male students. Using qualitative methodology, a documentary analysis of 28 reflective learning journals was carried out at a public university in Northern Spain. Four themes were identified: “an intense emotional experience”, “the importance of attitudes over and above techniques”, “identifying with nurses who dominate their environment and are close to the patient in complex and dehumanized units” and “how to improve care in critically ill patients and how to support their families”. The female students displayed a more emotional and reflective experience, with a strong focus on patient care, whereas male students identified more with individual aspects of learning and the organization and quality of the units. Both male and female students experienced intense emotions, improved their learning in complex environments and acquired attitudes linked to the humanization of care. However, the experience of these clinical rotations was different between female and male students.
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Gill, Tamoor, Gideon Victor, Raisa Kousar, and Noman Iqbal. "Sources of stress in high performance healthcare organization: A study comparing intensive care and general ward nurses." Journal of Shifa Tameer-e-Millat University 3, no. 1 (August 9, 2020): 3–9. http://dx.doi.org/10.32593/jstmu/vol3.iss1.64.
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Objective: To compare stressors of nurses working in intensive care units and general wards of a high-performance health care organization.
Methodology: A comparative cross-sectional survey was conducted. Using stratified random sampling, 121 intensive care and 121 general ward nurses, cumulatively 242 were offered to participate in the study. IRB and EC approvals were obtained. A self-administered questionnaire with structured responses was used for data collection. The data were analyzed for descriptive and inferential statistics in SPSS 23.
Results: The study participants were predominantly 152(62.8%) female; 182(75.2%) having diploma in nursing and 169(69.8%) RN-I; 38(31.4%) intensive care and 35(28.9%) general ward nurse who were performing 12-hours shift duty; 50(41.3%) intensive care and 65(51.2%) general ward nurses were dissatisfied with their salary. The average patients assigned to intensive care nurse were two and six to a general ward nurse. Independent t-test and ANOVA revealed significant difference of stressors in intensive versus general ward nurses, gender, working hours, satisfaction with salary, professional qualification, experience and shift work (P-Value <0.05). Common stressors were unclear demands, pressured to work long hours, not having control at workplace and being not able to talk to line managers about something that has upset or annoyed them at workplace.
Conclusion: The general ward nurses face more stressors than intensive care units’ nurses. Workplace stressors could compromise healthy working environment and patient safety whereas favorable environment could increase job satisfaction, staff productivity, and quality of care. Workplace-oriented stress management strategies must be adopted.
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Barra, Daniela Couto Carvalho, Grace Teresinha Marcon Dal Sasso, and Sônia Regina Wagner de Almeida. "Usability of computerized nursing process from the ICNP® in intensive care units." Revista da Escola de Enfermagem da USP 49, no. 2 (April 2015): 0326–34. http://dx.doi.org/10.1590/s0080-623420150000200019.
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OBJECTIVE To analyze the usability of Computerized Nursing Process (CNP) from the ICNP® 1.0 in Intensive Care Units in accordance with the criteria established by the standards of the International Organization for Standardization and the Brazilian Association of Technical Standards of systems. METHOD This is a before-and-after semi-experimental quantitative study, with a sample of 34 participants (nurses, professors and systems programmers), carried out in three Intensive Care Units. RESULTS The evaluated criteria (use, content and interface) showed that CNP has usability criteria, as it integrates a logical data structure, clinical assessment, diagnostics and nursing interventions. CONCLUSION The CNP is a source of information and knowledge that provide nurses with new ways of learning in intensive care, for it is a place that provides complete, comprehensive, and detailed content, supported by current and relevant data and scientific research information for Nursing practices.
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Al Mustafa, Safa Azaat, Mehmood Khan, and Matloub Hussain. "Implementing Barcode Medication Administration Systems in Public Sector Medical Units." International Journal of Decision Support System Technology 10, no. 2 (April 2018): 23–39. http://dx.doi.org/10.4018/ijdsst.2018040102.
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Medication errors in healthcare have a high cost since it is one of the main causes of harming a patient; it leads to inefficient utilization of healthcare organization resources. The barcode medication administration system helps in improving the patients' safety. The purpose of this article is to determine preparatory needs for introducing a Barcoding Medication Administration System (BCMA) in the medical units in one of the largest tertiary hospital in Abu Dhabi City, United Arab Emirates. Analytical Hierarchical Process (AHP) has been employed to describe systematic decision-making by prioritizing different factors that affect the implementation of BCMA and how technology plays a role in helping to reduce or prevent human errors by promoting safety in the health care sectors. Five major domains are identified: leadership, technology, process, education, quality and safety. Leadership was found to be the most important factor oppositely of technology was the least important.
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Partanen, Juha. "The merchant, the priest, and the humble engineer. Observations on the Rotterdam drug scene." Nordic Studies on Alcohol and Drugs 14, no. 3 (June 1997): 167–83. http://dx.doi.org/10.1177/145507259701400307.
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The Dutch policy on drugs has often been criticized in other countries. It has been claimed that the Netherlands has given up the fight against drugs and does not fulfill its international responsibilities. The purpose of this article is to show that the drug problem is taken seriously in the Netherlands, and plenty of resources are used to deal with it. The Dutch view on the nature of the problem and appropriate ways to treat drug users, however, is different from what is common elsewhere. The object of the study is the drug scene and the administration of drug-related services in Rotterdam. The focus in this article is on the relationship between drug users and the drug control system. The study draws upon observations and documents, and numerous interviews with civil servants, treatment staff, and drug users during a three-week visit in Rotterdam. In Rotterdam there are separate markets for cannabis and hard drugs. About 150 cafes are permitted to sell cannabis products provided they follow the rules: no sales to minors under 18 years of age, no alcohol, no hard drugs, no advertising. Hard drugs are sold illegally in 300-400 apartments located in the older parts of the city. The number of hard drug users is estimated to be 2500 - 4000, and the majority of them are registered in the Rotterdam Drug Information System (RODIS), which makes them eligible to use the services provided by the city for addicted drug users, gamblers, and alcoholics. No legal sanctions relate to smoking of cannabis or to possession of small amounts, whereas large-scale trade, smuggling, and commercial cultivation are criminal activities. Neither is the use of hard drugs or possession for personal use criminalized. The core of the drug problem is seen to be on the one hand the nuisance caused by those addicted hard-drug users who resort to petty crime and threaten the safety of other people, leading to the deterioration of the urban environment, and on the other hand the threat to the economy and politics of the country created by criminal drug organizations. In dealing with drug-related nuisance the aim is harm reduction. The central idea is the normalization of the drug problem. This means that efforts are made to keep drug users in contact with society, instead of pushing them outside by pursuing repressive policies. The threshold to health and social services and to treatment is kept as low as possible. At the same time addicts are held responsible for their behavior, and they are required to follow the regulations of the institutions providing support and treatment. Decisions concerning drug policies in Rotterdam are made at the top level, by the mayor, the public prosecutor, and the chief of police. They are assisted by the aldermen responsible for health, social affairs, and public order, and by commissions set up by the city council. Two remarkable aspects of the administration of drug-related affairs are a close cooperation between health authorities and the police, and an emphasis on Japanese-style neighborhood policing. The support and treatment services for drug users are run by private foundations that are fully financed by the government and the city. The extent and the variety of available services is impressive, ranging from consultation bureaus and daycare centers to intensive care units and a methadone dispensing program for 1 200 daily customers. The extensive system of municipal services is supplemented by voluntary aid mainly provided by churches and religious organizations. The Dutch way of dealing with the drug problem thus combines tolerance for drug use with a comprehensive network of services for drug users and a strict and carefully designed administration. Such an approach derives from the traditions of governance and political culture in Dutch society. These are crystallized in three character masks: those of the pragmatic and prudent merchant who is more concerned with practical problems than lofty ideals, the charitable and paternalistic priest, and the humble engineer who in his age-long fight against floods has learned that nature can be controlled but never fully tamed.
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Thompson, Elizabeth, Krystle Perez, P. Smith, Reese Clark, Matthew Laughon, and Christoph Hornik. "Sildenafil Exposure in the Neonatal Intensive Care Unit." American Journal of Perinatology 36, no. 03 (August 6, 2018): 262–67. http://dx.doi.org/10.1055/s-0038-1667378.
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Objective Pulmonary hypertension causes substantial morbidity and mortality in infants. Although Food and Drug Administration approved to treat pulmonary arterial hypertension in adults, sildenafil is not approved for infants. We sought to describe sildenafil exposure and associated diagnoses and outcomes in infants. Study Design Retrospective cohort of neonates discharged from more than 300 neonatal intensive care units from 2001 to 2016. Results Sildenafil was administered to 1,336/1,161,808 infants (0.11%; 1.1 per 1,000 infants); 0/35,977 received sildenafil in 2001 versus 151/90,544 (0.17%; 1.7 per 1,000 infants) in 2016. Among infants <32 weeks' gestational age (GA) with enough data to determine respiratory outcome, 666/704 (95%) had bronchopulmonary dysplasia (BPD). Among infants ≥32 weeks GA, 248/455 (55%) had BPD and 76/552 (14%) were diagnosed with meconium aspiration. Overall, 209/921 (23%) died prior to discharge. Conclusion The use of sildenafil has increased since 2001. Exposed infants were commonly diagnosed with BPD. Further studies evaluating dosing, safety, and efficacy of sildenafil are needed.
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Rodrigues, Vinícius Picanço, Igor Czermainski de Oliveira, Gisele de Lorena Diniz Chaves, Ellen Larissa de Carvalho Aquino, and Cláudia Viviane Viegas. "Respostas à pandemia em comunidades vulneráveis: uma abordagem de simulação." Revista de Administração Pública 54, no. 4 (August 2020): 1111–22. http://dx.doi.org/10.1590/0034-761220200250.
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Abstract Populations living in favelas are facing even more vulnerabilities with the sudden escalation of the COVID-19 pandemic, as social distancing is challenging in such settings. Furthermore, these populations typically lack proper sanitation and hygiene conditions, which are requirements to adequately control the outbreak. This paper proposes the use of System Dynamics modeling to support the public policy-making process in order to avert negative effects of the pandemic in the Brazilian favelas based on measures elicited from the social movement named “Favelas Contra o Corona.” The simulation model assessed the effectiveness of strategies and policy bundles encompassing temporary transfer of the favela population, supply of hygiene products, emergency sanitation structures, and expansion of Intensive Care Units. Results indicate that a suitable combination of strategies can bring significant effects to the number of avoidable deaths and the availability of Intensive Care Units for the population.
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Rodrigues, Vinícius Picanço, Igor Czermainski de Oliveira, Gisele de Lorena Diniz Chaves, Ellen Larissa de Carvalho Aquino, and Cláudia Viviane Viegas. "Pandemic responses in vulnerable communities: a simulation-oriented approach." Revista de Administração Pública 54, no. 4 (August 2020): 1111–22. http://dx.doi.org/10.1590/0034-761220200250x.
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Abstract Populations living in favelas are facing even more vulnerabilities with the sudden escalation of the COVID-19 pandemic, as social distancing is challenging in such settings. Furthermore, these populations typically lack proper sanitation and hygiene conditions, which are requirements to adequately control the outbreak. This paper proposes the use of System Dynamics modeling to support the public policy-making process in order to avert negative effects of the pandemic in the Brazilian favelas based on measures elicited from the social movement named “Favelas Contra o Corona.” The simulation model assessed the effectiveness of strategies and policy bundles encompassing temporary transfer of the favela population, supply of hygiene products, emergency sanitation structures, and expansion of Intensive Care Units. Results indicate that a suitable combination of strategies can bring significant effects to the number of avoidable deaths and the availability of Intensive Care Units for the population.
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Pauwels, Jochen, Isabel Spriet, Xuebin Fu, Sandrina von Winckelmann, Ludo Willems, Jos Hoogmartens, and Ann Van Schepdael. "CHEMICAL STABILITY AND COMPATIBILITY STUDY OF VANCOMYCIN FOR ADMINISTRATION BY CONTINUOUS INFUSION IN INTENSIVE CARE UNITS." Journal of Liquid Chromatography & Related Technologies 34, no. 17 (October 12, 2011): 1965–75. http://dx.doi.org/10.1080/10826076.2011.582909.
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