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Ismail, Ahmad. "The Influence of Context on Utilizing Research Evidence for Pain Management in Jordanian Pediatric Intensive Care Units." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/38503.
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Background: Little is known about the use of pain management evidence in Jordanian Pediatric Intensive Care Units (PICUs). Purpose: To assess the existence, content, and the factors influencing the use of pain management evidence in Jordanian PICUs. Methods: Three studies were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework. 1. A scoping review of the literature to identify pain management interventions in the PICU; 2. A cross-sectional and multisite survey to determine the current pain management practices, and the availability and content of practice guidelines in Jordanian PICUs; 3. A correlational and multisite survey to examine the relationship between the contextual factors and nurses’ use of pain management research evidence in Jordanian PICUs. Results: 1. Twenty-seven studies were included in the scoping review. The majority of the studies focused mainly on pharmacological interventions (n= 21, 78%). Morphine and fentanyl were the most commonly used pharmacological agents for pain management in the PICUs. The use of non-pharmacological interventions was limited. 2. Four of six eligible PICUs participated in the cross-sectional study. All four units had written pain management guidelines. Fentanyl was the most commonly used pharmacological agent in two units. Intravenous infusions of opioids were not administered for patients on mechanical ventilation in two units. The use of non-pharmacological interventions was reported in one unit. 3. From the four participating units, 73 nurses completed the correlation study survey. Social capital predicted both the instrumental and conceptual research use for pain management by Jordanian PICU nurses. Structural and electronic resources predicted the instrumental research use for pain management by Jordanian PICU nurses. Conclusions: Pain management practices and supporting guidelines varied in Jordanian PICUs. Context influences Jordanian PICU nurses’ use of research for pain management. Not all of the pain management practices in Jordan are evidence informed. There is an opportunity for improvement in pain management in Jordanian PICUs.
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Maxton, Fiona, University of Western Sydney, College of Social and Health Sciences, and of Nursing Family and Community Health School. "Sharing and surviving the resuscitation : parental presence during resuscitation of a child in PICU : the experiences of parents and nurses." THESIS_CSHS_NFC_Maxto_F.xml, 2005. http://handle.uws.edu.au:8081/1959.7/593.
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Parents’ presence and participation in their child’s care in the paediatric intensive care unit (PICU) is now commonplace. Despite parents expressing a deep need to be with their child particularly during periods of crisis, it is precisely at these times that they are often prevented from staying. The growing debate regarding family presence during a cardiopulmonary (CPR) resuscitation attempt continues to be controversial and conflicting. Current knowledge is mostly derived from quantitative studies conducted in the adult intensive care or emergency environments. The experiences of parents of children in the PICU, and the nurses caring for them are unknown. Using van Manen’s hermeneutic phenomenological approach, this study describes the phenomenon of parental presence during resuscitation of a child in PICU for eight Australian parent couples and six nurses. Experiential descriptions, obtained in tape-recorded unstructured interviews were subjected to two layers of analysis. Thematic analysis provided the phenomenological description in seven themes. Four themes refer to the parents’ experience in Being only for a child; Making sense of a living nightmare; Maintaining hope: facing reality and Living in a relationship with staff. Three themes describe the nurses’ experience: Under the parents’ gaze; Walking in their shoes and Holding parents in mind. A second layer of hermeneutic analysis revealed parents’ and nurses’ collective experience to have their being in four elements of the phenomenon. These elements are Being in chaos; Struggling to connect; Being for another and Being complete. The final description of the parents’ and nurses’ experience of parental presence during resuscitation in PICU as Sharing and surviving the resuscitation is drawn from the findings from each of these layers of meaning. The findings from this study conclude that the parents’ inherent need to be with their child overrode their anxieties of the resuscitation scene, curbing their feelings of chaos. Parental presence however, was a complex and dynamic concept that required a new relationship between parents and nurses. Implications of this study include recommendations for improving staff knowledge and education, as well as practical interventions for enhanced support for both parents and nursesDoctor of Philosophy (PhD)
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O'Hara, Sullivan Susan. "Macrocognition in the Health Care Built Environment (m-HCBE): A Focused Ethnographic Study of 'Neighborhoods' in a Pediatric Intensive Care Unit: A Dissertation." eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsn_diss/46.
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Objectives: The objectives of this research were to describe the interactions (formal and informal) in which macrocognitive functions occur and their location on a pediatric intensive care unit (PICU); describe challenges and facilitators of macrocognition using three constructs of space syntax (openness, connectivity, and visibility); and analyze the health care built environment (HCBE) using those constructs to explicate influences on macrocognition.
Background: In high reliability, complex industries, macrocognition is an approach to develop new knowledge among interprofessional team members. Although macrocognitive functions have been analyzed in multiple health care settings, the effect of the HCBE on those functions has not been directly studied. The theoretical framework, “Macrocognition in the Health Care Built Environment” (m-HCBE) addresses this relationship.
Methods: A focused ethnographic study was conducted, including observation and focus groups. Architectural drawing files used to create distance matrices and isovist field view analyses were compared to panoramic photographs and ethnographic data.
Results: Neighborhoods comprised of corner configurations with maximized visibility enhanced team interactions as well as observation of patients, offering the greatest opportunity for informal situated macrocognitive interactions (SMIs).
Conclusions: Results from this study support the intricate link between macrocognitive interactions and space syntax constructs within the HCBE. These findings help to advance the m-HCBE theory for improving physical space by designing new spaces or refining existing spaces, or for adapting IPT practices to maximize formal and informal SMI opportunities; this lays the groundwork for future research to improve safety and quality for patient and family care.
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Gill, Fenella. "Paediatric intensive care nursing behaviours to reduce parental stress." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2001. https://ro.ecu.edu.au/theses/1028.
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A child's admission to a paediatric intensive care unit (PICU) is stressful for the family. Parental presence and involvement with their child in hospital have been recognised as important in reducing their stress. Several studies have identified parental needs in the PICU. Nurses have reported that they felt inadequately prepared to meet those needs. Although principles to guide nursing strategies have been identified, contextual behaviours of PICU nurses to reduce parental stress have not A qualitative study, using an ethnographic approach, was designed to describe contextual behaviours of experienced PICU nurses. Participants self identified their level of clinical practice to be at The Competency Standards for Specialist Critical Care Nurses (CACCN Inc., 1996). Fifteen nurses from six Australian PJCUs (two each in Brisbane and Sydney, one each in Melbourne and Adelaide) were interviewed. Recalled critical incidents identifying nursing behaviours to reduce parental stress were audiotaped, transcribed, analysed and interpreted. NUD•IST (version 4.0) was used to facilitate the initial data analysis. King's conceptual framework for nursing (1981), was used to illustrate the interactions of the interpersonal relationships between staff and parents and the effect of the culture within the PlCU. King's conceptual framework consists of three interacting, open systems; individuals as personal systems, two or more individuals forming interpersonal systems, and larger groups with common interests forming social systems or cultures. The nurses described parental stressors and behaviours. Nursing behaviours were anticipatory or in response to parental cues. Demonstrating empathy, sensitivity, caring and encouraging the parental role enabled rapport to be developed. Keeping parents fully informed, listening and talking through problems were also important stress reducing behaviours. PICU cultural behaviours, such as restricting parents' presence with their child, resulted in increased stress. The nurses found their role more difficult when parents were non English speaking, were of a different culture, religion or social background, or had long stays in the PICU. The nurses' personal challenges included the death of a patient, the need to remain impartial, and the pressure to always perform. The PICU nurses' ability to quickly establish rapport during a stressful time in the parents' lives was crucial to be able to reduce their stress. Many contextual nursing behaviours to reduce parental stress were described. However, consideration must be given to modifying those behaviours that increased parental stress. From both the perspective of positive and negative nursing behaviour, this study will enable nurses to be aware of behaviours that reduce and exacerbate parental stress in order to improve their practice in supporting parents.
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Kallio, M. (Merja). "Neurally adjusted ventilatory assist in pediatric intensive care." Doctoral thesis, Oulun yliopisto, 2014. http://urn.fi/urn:isbn:9789526206349.
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Abstract Guidelines and instructions derived from adult randomized controlled trials are generally followed in pediatric ventilation, as there have been no large trials of this kind in children. Current treatment strategies aim at preventing ventilator-induced lung injury by avoiding too large tidal volumes, supporting patient's spontaneous breathing and preventing lung collapse with positive end-expiratory airway pressure. Neurally adjusted ventilatory assist (NAVA) is a novel ventilation mode that provides respiratory support proportional to the electrical activity of the diaphragm (Edi). The aims of this thesis were to assess daily practices in pediatric ventilation in Finland and to compare NAVA with conventional ventilation in terms of safety and quality of care. Current treatment practices were studied with a preliminary enquiry and a 3-month prospective survey that was offered to all hospital units providing ventilatory care for children <16 years of age. NAVA was compared with current standard ventilation in a crossover trial involving 18 pediatric patients and in a larger controlled trial in which 170 patients were randomized to receive either NAVA or conventional ventilation. Respiratory distress was the most common indication for invasive ventilation in neonates, and postoperative care in older children. The principles of lung-protective ventilation were generally accepted and the goals were achieved in the majority of treatment episodes. The low incidence of pediatric invasive ventilation favours centralization. NAVA proved to be a safe and feasible primary ventilation mode in pediatric intensive care. It improved patient-ventilator synchrony and led to lower peak inspiratory pressures and oxygen requirements. It also reduced the need for sedation during longer treatment periods. Information derived from the Edi-signal could be used to optimize the level of sedation and to identify patients with a potential risk of extubation failureTiivistelmä Nykyisin käytössä olevat menetelmät lasten hengityskonehoidossa perustuvat suurelta osin aikuisilla tehtyihin tutkimuksiin ja totuttuihin tapoihin, sillä lasten hengityskonehoidosta on olemassa vain vähän tutkittua tietoa. Hengityskonehoidon aiheuttamaa keuhkovauriota pyritään ehkäisemään välttämällä suuria kertahengitystilavuuksia, tukemalla potilaan omia hengityksiä ja säilyttämällä ilmateissä positiivinen paine uloshengityksen aikanakin. Neuraalisesti ohjattu ventilaatio (NAVA) on uusi hengityskonehoitomuoto, joka tukee potilaan omia hengityksiä ohjaamalla koneen antamaa tukea pallealihaksen sähköisen signaalin avulla. Tämän tutkimuksen tavoitteena oli selvittää lasten hengityskonehoidon nykytilaa Suomessa sekä tutkia, voidaanko NAVAa käyttämällä parantaa hoidon laatua ja turvallisuutta. Nykyisiä hoitokäytäntöjä selvitettiin vuonna 2010 kysely- ja seurantatutkimuksella, johon kutsuttiin mukaan kaikki Suomessa lapsia ja vastasyntyneitä hoitavat tehohoito-osastot. NAVAa verrattiin nykyiseen hengityskonehoitoon 18 potilaan vaihtovuoroisessa tutkimuksessa sekä suuremmassa 170 lapsipotilaan satunnaistetussa kontrolloidussa tutkimuksessa. Eri syistä johtuvat hengitysvaikeudet ovat yleisin syy hengityskonehoitoon vastasyntyneillä ja suurten leikkausten jälkeinen hoito isommilla lapsilla. Keuhkoja säästävän hoidon periaatteet ovat Suomessa yleisesti hyväksyttyjä ja toteutuvat valtaosassa hoitojaksoja. Hengityskonehoitojaksojen määrän vähäisyys puoltaa hoidon keskittämistä suuriin sairaaloihin. NAVAa käyttämällä hengityskoneen antama tuki ajoittuu paremmin potilaan omien hengitysten mukaan ja sen avulla saavutetaan matalammat ilmatiepaineet sekä vähäisempi lisähapen tarve. Pitkissä hoitojaksoissa NAVA vähentää rauhoittavan lääkityksen tarvetta, ja pallealihaksen signaalia seuraamalla on mahdollista optimoida sedaatioaste aikaisempaa tarkemmin. Palleasignaalia voidaan myös hyödyntää arvioitaessa potilaan valmiutta hengitystuesta vieroittamiseen
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Rashotte, Judith Mary. "Pediatric intensive care nurses and their grief experiences." Thesis, University of Ottawa (Canada), 1996. http://hdl.handle.net/10393/10425.
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While the phenomenon of grief has received considerable attention and has been researched at length, there is a paucity of literature that has focused on health care professionals' experience of grief. The purpose of this study was to investigate the grief experience of pediatric intensive care nurses when their patients die. A phenomenological method was used in this study in order to obtain rich descriptions of nurses' experience of grief within their workplace. The purposive sample consisted of six registered nurses employed in an intensive care unit in a university-teaching pediatric hospital. In-depth, semi-structured interviews were conducted with the study participants in order to generate the data base. The audio-taped interviews were transcribed and analyzed for recurring themes emerging from the data according to the procedure outlined by Colaizzi. These nurses acknowledged they suffered multiple exposures to children's deaths and experienced grief. The interviews revealed eight themes that included one about their grief responses--hurting; two that described the influencing contextual factors--nurse-family unit relationship and dissonance, and five that related to coping strategies employed to manage their feelings of grief--self-expression, self-nurturance, termination of relationship activities, engaging in control taking activities and self-reflection. Further analysis revealed that managing grief effectively was an experiential learning process for the participants. The resultant themes were compared with the broader literature on grieving the loss of a significant other, grief and the health care professional, and the literature that addressed issues of occupational stress in the care of the critically ill, the dying, and the bereaved. The findings of this study could encourage further research that examines interventions designed to enhance the type of education and support needed in relation to the grief experience of nurses.
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Koontz, Victoria S. "Parental satisfaction in a pediatric intensive care unit." Huntington, WV : [Marshall University Libraries], 2003. http://www.marshall.edu/etd/descript.asp?ref=346.
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Simas, Ana Luísa Oliveira de. "Training report : clinical studies coordination in oncology." Master's thesis, Universidade de Aveiro, 2014. http://hdl.handle.net/10773/12966.
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Mestrado em Biomedicina FarmacêuticaThis report describes a curricular training experience in Study Coordination, developed at Unidade de Investigação Clínica (Clinical Research Unit) of Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E. (Portuguese Oncology Institute-Porto), in the ambit of the Master in Pharmaceutical Medicine at University of Aveiro. This report describes the State of the Art in Pharmaceutical R&D Process in Europe, especially in Oncology, emphasising its current trends and stressing specificities of special and vulnerable populations, in the scope of the traineeship. The study coordination activities were essentially performed in the Pathology Clinics of Lung, Urology, Gynaecology, Paediatrics, and the Intensive Care Service. The activities developed had the main goal of acquiring experience in oncology clinical trials, while reinforcing the knowledge from my academic background. These activities included screening and randomisation of patients, preparation and processing of study visits, data entry and query resolution, and documents management, among other activities transversal to the 15 clinical trials, accompanied in the traineeship. Globally, the traineeship allowed a good overview of the activities involved in the conduction of clinical trials in a hospital, and a worthy introduction to the marketplace. I strengthened the knowledge acquired from my academic background. I developed competences and skills at the professional and personal level, such as dealing with unforeseen situations, and developed strategies to overcome challenges. I sharpened my vision of careers in clinical research, and hope to continue addressing new challenges in this area.
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Palmer, Lydia Helmick. "Prevention of Skin Breakdown in the Pediatric Intensive Care Unit." Thesis, University of South Carolina, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3561837.
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Skin breakdown occurs when one or more layers of the skin have been disrupted (McLane et al., 2004; National Pressure Ulcer Advisory Panel, 2007). While some literature uses the terms skin breakdown and pressure ulcer interchangeably, these are actually two distinct conditions and pressure ulcers are encompassed in the definition of skin breakdown (Kuller, 2001; Lund, 1999; Suddaby et al., 2006). The consequences of skin breakdown in the pediatric population can include increased cost of treatment, infection, increased morbidity and mortality as well as psychological consequences from resulting alopecia or scarring (Schindler, 2010; Willock & Maylor, 2004). Development of skin breakdown has also been associated with increased morbidity, increased length of stay, and higher costs of care (McCord et al., 2004).
Prevention of skin breakdown can be accomplished by the use of barriers and specialty surfaces. Barrier protection is achieved by the use of preparations, such as zinc oxide, petrolatum-containing compounds, and alcohol-free barrier films, and also by the application of transparent film and hydrogel dressings (Atherton, 2004; Atherton, 2005; Baharestani, 2007; Campbell et al., 2000; Lund et al., 2001). Surfaces can be useful in the prevention of skin breakdown by aiding in the distribution of pressure and decreasing moisture, and can also be used to aid in temperature control for some patients (Norton, Coutts, & Sibbald, 2011). The PICO format question used to guide this project is: For patients in Pediatric Intensive Care Units, is barrier protection or use of specialty surfaces more effective at preventing skin breakdown?
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Watson, J'ai. "Impact of Noise on Nurses in Pediatric Intensive Care Units." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1378393887.
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Alamu, Josiah Olusegun Herwaldt Loreen A. "Evaluation of antimicrobial use in a pediatric intensive care unit." Iowa City : University of Iowa, 2009. http://ir.uiowa.edu/etd/277.
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Alamu, Josiah Olusegun. "Evaluation of antimicrobial use in a pediatric intensive care unit." Diss., University of Iowa, 2009. https://ir.uiowa.edu/etd/277.
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A pediatric intensivist in the University of Iowa Hospitals and Clinic's (UIHC) Pediatric Intensive Care Unit (PICU) was concerned about antimicrobial use in the unit. However, no one had quantified antimicrobial use in the UIHC's PICU or described the patterns of antimicrobial use in this unit. To address the intensivist's concern, the principal investigator (PI) conducted a retrospective study to determine the percentage of patients who received antimicrobial treatments, to determine the indications for antimicrobial use, and to identify antimicrobial agents used most frequently in the unit. On basis of our data, we hypothesized that empiric antimicrobial use, particularly the duration of therapy, could be decreased.
We implemented a six-month intervention during which we asked the pediatric intensivists to complete an antimicrobial assessment form (AA) to document their rationale for starting antimicrobial treatments. We postulated that this documentation process might remind physicians to review antimicrobial therapies, especially empiric therapies, when the microbiologic data became available. In addition, we utilized the AA form to identify factors pediatric intensivists considered when deciding to prescribe empiric antimicrobial treatments.
Data from the AA forms suggested that pediatric intensivists in the UIHC's PICU often considered elevated C-reactive protein, elevated white blood cell counts, and elevated temperatures when deciding to start empiric antimicrobial therapy. Data from the three nested periods showed that the median duration of empiric and targeted treatments decreased during the intervention and remained stable during the post-intervention period. The PI estimated that 193 days of empiric antimicrobial therapy and 59 days of targeted antimicrobial therapy, respectively, may have been saved by the decreased durations of therapy. Time series analysis assessing the trend in use of piperacillin-tazobactam, cefepime, and ceftriaxone (measured in mg/wk) did not reveal a significant change over time.
On the basis of our results, an intervention strategy using an AA form alone may not be an effective strategy for antimicrobial stewardship in PICUs. Additional measures such as automatic stop orders and computer decision support may be useful for reducing the duration of empiric therapy in PICUs.
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Mosavian, Pour Mir Kaber. "Learning and quality improvement : nursing in the pediatric intensive care unit." Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/63141.
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Maintaining a high quality of care in a Pediatric Intensive Care Unit (PICU) is a constant challenge. Continual 24/7 staffing, ongoing staff turnover, and the constant introduction of new equipment and procedures in a highly technologically-dependent unit requires continuous learning to deliver and improve the quality of children’s care. While all staff consider continuous learning important to maintaining and improving care, learning as quality improvement is made most explicit when new nursing staff are hired and incorporated into the PICU.
In this dissertation, I investigated the process of learning by individuals in the interactive social environment of the PICU to answer the following questions: How does learning occur among the newly hired nurses in the PICU? And, how does learning contribute to quality improvement? In this mixed method inquiry, I employed ethnography, Social Network Analysis and simple descriptive and inferential statistical methods to explore process of learning among the newly hired nurses in Western Canada Hospital.
I found that learning among newly hired nurses happened through face to face interactions in the context of two main activities: Orientation sessions and their Preceptorship. The most significant learning for the newly hired nurses, however, happened during their Preceptorship. Learning in the Preceptorship was social and experiential as they moved from legitimate peripheral participation in the multi-disciplinary and complementary social environment of the PICU into full participation as members of the PICU Community of Practice (CoP). This learning required the transformation and development of their individual and collective identity, as their preceptors, fellow nurses, and other staff employed scaffolding to mentor them through their constantly evolving Zone of Proximal Development (ZPD). Social and experiential learning activities became the basis for continuous quality improvement (CQI).
I conclude that, in the PICU, quality improvement is the tangible manifestation and product of social and experiential learning. Rather than a sequence of corrective actions, in its most effective form, quality of care is improved through scaffolded ongoing learning activities in the authentic setting of a CoP. I recommend the unit to adopt a “learning together” sociocultural approach with scaffolding as key component for successful learning and CQI.Medicine, Faculty of
Experimental Medicine, Division of
Medicine, Department of
Graduate
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Tingling, Louis Gilbert. "Root Cause of Medication Errors In a Pediatric Intensive Care Unit." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7201.
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Five to 27% of all pediatric medication orders lead to errors and play a significant role in the morbidity and mortality of the pediatric patients admitted to hospitals. The practice problem explored the high rate of medication errors in the pediatric intensive care unit (PICU) of the project site, where the population is particularly vulnerable due to their acute illnesses. The purpose of this project was to analyze the root causes of all cases of medication error in this hospital's PICU during the last 2 years. The literature review was used to categorize secondary data extracted from the hospital's quality assurance database. An analysis of the 41 total medication errors showed that 49% of the medication errors made in the PICU were due to the nurse administering the incorrect dose of medication. Most (60%) occurred on the day shift when the unit was busy and the patient's medication orders were constantly being changed. Missed doses' mostly due to oversight and ineffective follow-up by clinical staff, pharmacy, and providers accounted for 27% of the medication errors. There were instances in which the physician and the pharmacy did not properly order and verify a medication. The summary of the root cause analysis and recommendations from the literature for improved clinical practice will be presented through the hospital's quality assurance structure. Recommendations include implementing computerized physician order entry, regular education of staff, involvement of the pharmacist in new medication orders, updated nursing protocols, and support systems for decision making. The implications of this project for positive social change include the impact of improved practices on decreasing medication errors and improving health outcomes in the PICU population.
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Slaymaker, Lora. "A CHILD'S-EYE VIEW OF THE PEDIATRIC INTENSIVE CARE UNIT (ETHNOGRAPHY, ACUTE ILLNESS)." Thesis, The University of Arizona, 1985. http://hdl.handle.net/10150/291273.
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Mack, Elizabeth H. "Propofol as a bridge to extubation in the pediatric intensive care unit." University of Cincinnati / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1243354898.
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Halbrooks, Emma. "Post-operative use of dexmedetomidine in a pediatric cardiovascular intensive care unit." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12410.
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Thesis (M.A.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Introduction: Dexmedetomidine (DEX) was first approved by the Food and Drug Administration in 1999 for use as a sedative in adults who are initially intubated and require mechanical ventilation in an intensive care unit. DEX is not currently approved for use in children but its use to sedate children during radiologic procedures began to appear in the literature in 2005. The use of DEX in the pediatric population has expanded significantly since but appropriate dosage and clinical safety still needs further study. Children who have undergone heart surgery are a population that has benefited from DEX. A study of the pharmacokinetic properties of DEX in children indicated that children may benefit from higher dosages than the current dosage of 0.2-0. 7 mcg/kg/hr that is currently approved for adults (Suet al., 2011). Populations such as infants, neonates, and children with trisomy 21, in particular, have not been well described. At Children's Hospitals and Clinics of Minnesota, DEX is a frequently used sedative, often at higher dosages than 0.7 mcg/kg/hr and often in infants. Our retrospective study addresses DEX's effect on pediatric patients that are post-operative from cardiac surgery. Methods: Cardiac surgical cases that took place from April 2010 through April 2011 were reviewed. There were 107 patients who had heart surgery and received DEX post-operatively that were included in our study. Data regarding a patient's dosage, length of infusion, vital signs (heart rate, blood pressure, and respiratory rate) were collected every day that the patient received DEX. Evidence of withdrawal, adverse events, or any other adverse responses associated with the DEX infusion was also retrieved. Data regarding the patient vital signs were analyzed by age group: infant (less than one year), one to three years, and greater than three years, to compare against age-appropriate standards. All statistical analysis was conducted with SPSS 15.0 (Chicago, IL). Results: The average age of patients included was 6.2 months, with a range of 0.1 to 209.4 months. Seventy patients (approximately 65%) were infants. Nine patients (about 8%) were neonates (less than one month of age). The average weight was 6.5 kg. Patients were on DEX for a median of 1.6 days, to a maximum of 23.9 days. Their overall average dose was 0.83 mcg/kg/hr. Children age one to three years required the highest average dose of approximately 1 mcg/kg/hr. There was a statistically significant decrease in heart rate from baseline during the first 12 hours of infusion. The decrease in heart rate was most pronounced in infants and neonates. Systolic blood pressure decreased during the first 12 hours but was not statistically significant. The respiratory rate of extubated patients remained stable. A slight decrease could be seen in children greater than 3 years old but was not clinically significant. Children with trisomy 21 required the same dose of DEX as children without trisomy 21. There was no significant difference between the vital signs of children with trisomy 21 and children without. Incidence of withdrawal amongst patients was 5.7%. Agitation following the DEX infusion was higher in 17% of patients. An adverse event caused 6.5% of patients to be discontinued from DEX. Conclusions: Despite the statistically significant decreases in heart rate, the average values of patients' vital signs remained within the age-appropriate clinical standards. Patients were hemodynamically stable. Incidence of withdrawal and adverse events were low. Agitation after discontinuation was higher, particularly in infants. DEX is a safe sedative in this pediatric subpopulation.
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Davies, Kylie. "Determining standard criteria for endotracheal suctioning in the paediatric intensive care patient an exploratory study /." Connect to thesis, 2009. http://adt.ecu.edu.au/adt-public/adt-ECU2009.0001.html.
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Prentiss, Andrea S. "Hearing the Child's Voice: Their Lived Experience in the Pediatric Intensive Care Unit." FIU Digital Commons, 2014. http://digitalcommons.fiu.edu/etd/1633.
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Background: More than 200,000 children are admitted annually to Pediatric Intensive Care Units (PICUs) in the US. Research has shown young children can provide insight into their hospitalization experiences; child reports rather than parental reports are critical to understanding the child’s experience. Information relating to children’s perceptions while still in the PICU is scarce.
Aims: The purpose of this qualitative study was to investigate school age children’s and adolescents’ perceptions of PICU while in the PICU; changes in perceptions after transfer to the General Care Unit (GCU); differences in perceptions of school age children/adolescents and those with more invasive procedures.
Methods: Interviews were conducted in PICU within 24-48 hours of admission and 24-48 hours after transfer to GCU. Data on demographics, clinical care and number/types of procedures were obtained.
Results: Participants were 7 school age children, 13 adolescents; 10 Hispanic; 13 males. Five overarching themes: Coping Strategies, Environmental Factors, Stressors, Procedures/Medications, and Information. Children emphasized the importance of peer support and visitation; adolescents relied strongly on social media and texting. Parent visits sometimes were more stressful than peer visits. Video games, TV, visitors, and eating were diversional activities. In the PICU, they wanted windows to see outside and interesting things to see on the ceiling above them. Children expressed anticipatory fear of shots and procedures, frustration with lab work, and overwhelming PICU equipment. Number of child responses was higher in PICU (927) than GCU (593); the largest difference was in Environmental Factors. Variations between school age children and adolescents were primarily in Coping Strategies, especially in social support. Number of GCU procedures were the same (8 children) or greater (2 children) than PICU procedures.
Discussion: Admission to PICU is a very stressful event. Perceptions from children while still in PICU found information not previously found in the literature. Longitudinal studies to identify children’s perceptions regarding PICU hospitalization and post-discharge outcomes are needed.
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Legro, Amanda B. R. "Nutrition support and clinical outcomes of children in a pediatric intensive care unit." Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1527973.
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The purpose of this thesis was to investigate the impact of enteral nutrition (EN) support factors on days of mechanical ventilation (MV) and length of stay (LOS) in a pediatric intensive care unit (PICU) among subjects age 3 7 weeks to 21 years. Specifically, nutrition support factors included a) days to reach prescribed calories, b) days to reach prescribed protein, c) percentage of prescribed calories received, and d) percentage of prescribed protein received through the use of EN.
Purposive sampling was used to select subjects that received nutrition support in the PICU. Data was collected via chart review within the time frame January 1, 2011 to August 1, 2013.
The results demonstrated MV days and LOS were significantly different for patients who reached prescribed calories and protein within 72 hours of admission. LOS was also significantly different for patients who received at least 80% prescribed calories.
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Silva-Cruz, Aracely Lizet, Karina Velarde-Jacay, Nilton Yhuri Carreazo, and Raffo Escalante-Kanashiro. "Risk factors for extubation failure in the intensive care unit." Associacao de Medicina Intensiva Brasileira - AMIB, 2018. http://hdl.handle.net/10757/624625.
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Objective: To determine the risk factors for extubation failure in the intensive care unit. Methods: The present case-control study was conducted in an intensive care unit. Failed extubations were used as cases, while successful extubations were used as controls. Extubation failure was defined as reintubation being required within the first 48 hours of extubation. Results: Out of a total of 956 patients who were admitted to the intensive care unit, 826 were subjected to mechanical ventilation (86%). There were 30 failed extubations and 120 successful extubations. The proportion of failed extubations was 5.32%. The risk factors found for failed extubations were a prolonged length of mechanical ventilation of greater than 7 days (OR = 3.84, 95%CI = 1.01 - 14.56, p = 0.04), time in the intensive care unit (OR = 1.04, 95%CI = 1.00 - 1.09, p = 0.03) and the use of sedatives for longer than 5 days (OR = 4.81, 95%CI = 1.28 - 18.02; p = 0.02). Conclusion: Pediatric patients on mechanical ventilation were at greater risk of failed extubation if they spent more time in the intensive care unit and if they were subjected to prolonged mechanical ventilation (longer than 7 days) or greater amounts of sedative use.Revisión por pares
Revisión por pares
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Avery, Stephanie. "Attending to Values at Stake When a Child is Dying: A Study of Pediatric Intensive Care Unit Nursing from the Perspectives of Bereaved Parents." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39206.
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Existing literature has identified that health care providers significantly shape the experiences of parents at the end-of-life in the pediatric intensive care unit. However, there is a gap in the literature of the specific nursing influence on parental experiences of a child’s death in this context. Employing the interpretive descriptive methodology, this qualitative study was designed to explore parents’ moral experiences of nursing care at the end-of-life in the pediatric intensive care unit, and was analyzed through a lens of nursing ethics. Face-to-face, semi-structured interviews were conducted with eleven parents (six mothers and five fathers) of six children who died in a pediatric intensive care unit at a university-affiliated tertiary hospital in Eastern Canada.
Study results revealed close connections between parents’ abilities to meaningfully parent a child through their death and the nursing care that they received at the end-of-life, and highlighted the varying helpful guiding roles that nurses adopted at different moments in parental experiences. Results also indicated that parents attributed immense value to feeling that nurses cared-for-and-about their child and the parents themselves, since this made parents feel that their child’s death mattered to the nurses whom they had formed relationships with. This study enhances our understanding of the individualized nature of parents’ moral experiences of nursing care at the end-of-life in the pediatric intensive care unit, and study results suggest implications for nursing practice, education, and research.
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Hall, Julianne. "Building trust to work with a grounded theory study of paediatric acute care nurses work : a thesis submitted to Auckland University of Technology in partial fulfilment of the degree of Master of Health Science (Nursing), 2004." Full thesis. Abstract, 2004.
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Sackey, Peter V. "Inhaled sedation with isoflurane in the intensive care unit /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-962-9/.
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Oliveira, NeulÃnio Francisco de. "Terminalidade em UTI PediÃtrica e Neonatal: prÃticas mÃdicas que antecedem o Ãbito em um hospital de referÃncia do Nordeste Brasileiro." Universidade Federal do CearÃ, 2011. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12419.
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nÃo hÃMudanÃas que aconteceram no sÃculo XX, permitiram que avanÃos tecnolÃgicos aumentassem a sobrevida diante de doenÃas anteriormente incurÃveis e processos patolÃgicos irreversÃveis. No entanto, a busca incessante pela cura, alÃm de levar ao aumento da sobrevida, tambÃm gerou a obstinaÃÃo terapÃutica, ou seja, medidas terapÃuticas fÃteis diante de evoluÃÃo inexorÃvel para a morte, impactando em indicadores como Ãndice de satisfaÃÃo do cliente e cuidadores, tempo mÃdio de permanÃncia, elevaÃÃo de custos, bem como em prejuÃzo na distribuiÃÃo equitativa de recursos. No inÃcio dos anos 90, a limitaÃÃo do suporte de vida (LSV) comeÃou a ser estudada e considerada, em paÃses da Europa, Estados Unidos, Canadà e Austrlia, como forma de assistir os pacientes nesses casos, uma vez que as medidas terapÃuticas nÃo mais trariam benefÃcios, mas gerariam prolongamento do sofrimento e do processo de morrer. No Brasil, contudo, os estudos sÃo limitados e os dados referentes ao Nordeste do paÃs sÃo ainda muito escassos. O objetivo do estudo foi caracterizar as condutas mÃdicas que antecederam o Ãbito de pacientes em UTI pediÃtrica e neonatal em um hospital de referÃncia do Nordeste Brasileiro. Foram estudados 86 prontuÃrios de pacientes que morreram nas referidas UTIs no perÃodo de dezembro/09 a novembro/10. Apenas 3,5% dos Ãbitos ocorreram apÃs LSV registrada em prontuÃrio, destes 33,7% tinham doenÃa crÃnica associada, sendo as neoplasias as mais comuns. As causas de Ãbito mais comuns foram sepse (23,5%), falÃncia de mÃltiplos ÃrgÃos (18,8%), insuficiÃncia respiratÃria (12,9%), cardiopatias congÃnitas (8,2%) e as outras causas somaram 36,6%. A maior parte dos pacientes morreu apÃs aumento das medidas de suporte avanÃado de vida, considerando as ultimas 24h antes do Ãbito: drogas vasoativas (59,3% 24h antes e 70,9% no momento do Ãbito); VentilaÃÃo mecÃnica (89,5% 24h antes e 95,2% no momento do Ãbito). Enquanto as medidas de cuidados e conforto nÃo tiveram a mesma expressÃo, tendo um aumento irrelevante: sedaÃÃo (39,5% 24h antes e 43% no momento do Ãbito); analgesia (60% 24h antes e 60,5% no momento do Ãbito). As manobras de ressuscitaÃÃo cardiopulmonar foram registradas em 4,7% 48h antes do Ãbito, 29,1% 24h antes e 69,4% no momento do Ãbito. O uso de adrenalina foi registrado em 55,4% antes do Ãbito. Conclui-se que a LSV ainda nÃo à frequentemente considerada como uma alternativa de assistÃncia de final de vida a pacientes pediÃtricos e neonatais no Estado do CearÃ, onde as condutas mais prevalentes incluem o incremento do suporte avanÃado de vida em detrimento das medidas de conforto e cuidados paliativos. Comparando-se com estudos do Sul e Sudeste do paÃs, evidencia-se uma grande diferenÃa, onde se observam uma maior prevalÃncia de LSV e cuidados paliativos para pacientes em fase terminal, o que denota prÃticas mais humanas e de maior qualidade na assistÃncia.
Changes around the world at the XX century allowed new technologies to improve the possibilities of surviving in so many cases of sickness that were incurable before. Besides the benefits it brought, other consequences have come together specially futility, in other words futile therapeutic measures when the cure is impossible and the death is inevitable. These facts have influence in client satisfaction, lengh of stay and costs elevation. Since 1990 life support limitation (LSL) started to be considered in Europe, United States, Canada and Austrlia to assist patients in terminal conditions to whom curative practices wouldnât bring any benefit. In Brazil there is a limited number of studies and the data from the Northeastern are even less. The aim of this study was to describe the medical practices before death in patients in PICU and NICU at a reference pediatric hospital in Brazilian Northeastern. Data were collected from 86 medical charts. Only 3.5% of LSL was registered. 33.7% of patients had some chronic disease and neoplasic ones were more comons. The main causes of death were: sepsis (23.5%), MDOS (18.8%), respiratory failure (12.9%), congenital heart disease (8.2%) and the other causes 36.6% together. Most of patients died after increment in vasoatives administration, considering the final 24 hours before death (59.3% 24h before, 70.9% at the momento of death). Mechanical ventilation (89.5% 24h before, 95.2% at the moment). In the other hand palliative care and pain control were not so frequent as could be expected: sedative (39.5 24h before, 43% at the moment) analgesic (60% 24h before, 60.5% at the moment). CPR was offered in 4.7% of patients 48h before death, 29.1% 24h before and 69.4% at the moment of death. Adrenaline was used in 55.4% at the moment of death. These data show that LSL is not a frequente alternative to assist terminal patients at PICU and NICU in Brazilian Northeastern, where more prevalent practices are to maintain life support instead of offer palliative care and pain control. At Southern and Southeastern practice include LSL and palliative care more frequently, what suggests better practices of the end-of-life care.
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DIUANA, MARINA CASTINHEIRAS. "FRATERNAL BONDS: A STUDY BASED ON THE EXPERIENCE ACQUIRED IN PEDIATRIC INTENSIVE CARE UNITS." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2010. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=35596@1.
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PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIROAs relações fraternas, assim como a fraternidade tem sido objeto de estudo de diversos autores psicanalistas contemporâneos. O presente estudo tem como objetivo estudar a importância do laço fraterno na constituição do sujeito e quais são suas repercussões no ambiente intensivista pediátrico, tendo em vista que alguns hospitais realizam visitas dos irmãos às crianças internadas. É contemplada a importância da fratria na construção da subjetividade, além do valor da fraternidade e dos laços de amizade e solidariedade constatados a partir da experiência clínica e corroborado pelas discussões clínicas recentes.
Fraternal relationships among siblings as well as fraternity itself have been an object of study by many contemporary psychoanalysts. The objective of this study is to analyze the importance of fraternal bonds and its repercussion in the pediatric intensive-care environment, considering that some hospitals support children s visits to hospitalized siblings. This paper also addresses the importance of the fraternal relationships in the construction of subjectivity in addition to the value of fraternity, friendship and solidarity bonds which were observed from clinical experience and confirmed by recent clinical discussions.
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Scaggs, Huang Felicia. "Potential Pathogens Are Predominant in the Oral Microbiome of Pediatric Intensive Care Unit Patients." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1563272800210079.
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Guan, Ling. "The effect of massage on autonomic nervous system in patients in pediatric intensive care units." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/43634.
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Background: Patients in Pediatric Intensive Care Units (PICU) face high stressors. The autonomic nervous system (ANS) plays an important role in modulating stress and inflammatory responses. Excess stress reaction includes SNS over-stimulation and PNS suppression. If prolonged, this situation may be source of severe acute and chronic inflammation. Massage therapy is a noninvasive intervention that may regulate stress-induced ANS dysfunction by stimulating PNS and decreasing SNS responses; therefore, acting toward homeostasis.
Objectives: Primary objective was to assess the massage effect on rebalancing the ANS function (measured by Heart Rate Variability, HRV). Secondary objective was to investigate the correlation between HRV and clinical severity (measured with Pediatric Logistic Organ Dysfunction (PELOD) Scores). Pilot study objective was to determine study feasibility.
Methods: All PICU patients were eligible for the study. 22 patients were randomly allocated into one or six massage sessions per day (30-min per session). HRV was extracted from PICU central station. Clinical information was collected from medical records. Descriptive statistics and graphs were used. Study feasibility (problems and solutions) was also assessed.
Results: 18 subjects were included in the analyses. logHF and logLF increased significantly during the first massage session compared to baseline values (p<0.05). HF increased by a mean of 75.06% (95% CI: 19.9~130.23%, p=0.01) and LF increased by a mean of 56.3% (95% CI: 20.31~92.29 %, p=0.004) during the first massage session; although HF and LF decreased in four subjects. After massage the increases in both HF and LF were not significant. LF/HF ratio, when out of the normal range, converged toward normal values during massage. In the six massage sessions (n=7), HF and LF increased in the initial three sessions and plateaued in the remaining sessions. There was a positive relationship between HRV and clinical severity. Study feasibility analysis led us identifying problems and finding solutions.
Conclusion: ANS dysfunction was correlated with clinical severity. Massage therapy had an effect in improving ANS function with increasing PNS and decreasing SNS activities in PICU patients. The optimal number of massage sessions seemed to be three. However, massage could also be a stress for some patients in certain conditions.
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Kyösti, E. (Elina). "Long-term outcome, quality of life, and socio-economic consequences of surviving pediatric intensive care." Doctoral thesis, Oulun yliopisto, 2019. http://urn.fi/urn:isbn:9789526223865.
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Abstract Critical illness or staying in intensive care unit (ICU) may have a negative impact on a child’s quality of life or the family’s life. The aim of this study is to clarify the long-term mortality and causes of death in Finnish pediatric intensive care population, as well as the health-related quality of life (HRQL), psychological outcome, schooling difficulties, and family socioeconomical situation in those alive six years after intensive care. The study population consisted of all ICU treated pediatric patients in Finland in 2009 and 2010. The long-term mortality and causes of death were retrospectively compared with the population of all other Finnish children who had not been on an ICU. Survivors were sent questionnaire material regarding their HRQL and psychological and social situation. 68 out of 2729 (2.5%) patients died before the end of 5 years follow-up. The standardized mortality rate for the ICU patients was 53.4. The most common causes of death were cancer (35.3%), neurologic (17.6%), and metabolic diseases (11.7%), whereas trauma was the most common cause of death in the control group (45.3%). Questionnaires were answered by 1109 (30.1%) children. 90 children (8.4%) had poor HRQL. They had a higher rate of chronic diagnoses, medication on a daily basis and a greater need for healthcare services than those with normal HRQL-scores. Asthma, neurological diseases, chromosomal alterations, cancer and long-term pain were associated with poor HRQL. Psychological outcome was abnormal for 84 children (7.6%), and was also associated with chronic diseases. Children with difficulties in school more often had a severe disease and frequently need for healthcare services. In conclusion, mortality after intensive care is low, but the risk of death is increased even at 3 years after discharge. The burden of chronic diseases hamper the quality of life, psychological wellbeing and school performanceTiivistelmä Vaikea sairaus tai tehohoito voi vaikuttaa haitallisesti lapsen kehitykseen sekä perheen hyvinvointiin. Tämän tutkimuksen tarkoituksena oli selvittää suomalaisten tehohoidettujen lasten pitkäaikaiskuolleisuus ja kuolinsyyt sekä lasten elämänlaatu, psyykkinen hyvinvointi, erityisen tuen tarve koulussa ja perheen sosioekonominen asema kuusi vuotta tehohoidon jälkeen. Tutkittava joukko koostui kaikista Suomessa v. 2009 ja 2010 tehohoidetuista lapsista. Kuolleisuutta ja kuolinsyitä verrattiin niiden suomalaislasten kuolinsyihin, jotka eivät olleet saaneet tehohoitoa vuonna 2009 tai 2010. Eloonjääneiden lasten elämänlaatu, psyykkinen vointi ja sosioekonominen tilanne selvitettiin kyselyiden avulla. Tutkittavista 2 729 potilaasta 68 (2,5 %) kuoli ennen seuranta-ajan päättymistä. Vakioitu kuolleisuussuhde oli tehohoidettujen lasten osalta 53,4. Yleisimmät kuolinsyyt tehohoidetuilla olivat kasvaimet (35,3 %), neurologiset sairaudet (17,6 %) ja aineenvaihduntasairaudet (11,7 %), verrokkiryhmässä onnettomuudet olivat merkittävin kuolinsyy (45,3 %). Kyselyihin vastasi 1109 (30,1 %) lasta. Heistä 90 (8,4 %) koki elämänlaatunsa huonoksi. Useat pitkäaikaissairaudet, lääkityksen ja terveyspalveluiden tarve oli yleisempää elämänlaatunsa huonoksi kokevien joukossa. Astma, neurologiset sairaudet, kromosomimuutokset, kasvaimet ja pitkäaikainen kiputila liittyivät huonoon elämänlaatuun. Psyykkinen vointi oli heikentynyt 84 lapsella (7,6 %). Myös huono psyykkinen vointi liittyi pitkäaikaissairauksiin, samoin erityisen tuen tarve koulussa. Yhteenvetona todettakoon, että lasten kuolleisuus tehohoidon jälkeen on Suomessa matala, mutta kuoleman riski on koholla usean vuoden ajan tehohoidon päättymisestä. Vaikeat pitkäaikaissairaudet lisäävät kuolleisuutta tehohoidon jälkeen sekä heikentävät eloonjääneiden elämänlaatua, psyykkistä vointia vaikeuttavat koulunkäyntiä, ja aiheuttavat taakkaa lapsen perheelle
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Evans, J. H., R. J. Valleley, and Jodi Polaha. "Integrating Pediatric Behavioral Health Into Rural Primary Care: Research Findings." Digital Commons @ East Tennessee State University, 2006. https://dc.etsu.edu/etsu-works/6617.
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Menon, Prema Ramachandran. "Telemedicine Enhances Communication in the Intensive Care Unit." ScholarWorks @ UVM, 2016. http://scholarworks.uvm.edu/graddis/574.
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Patients admitted to the Intensive Care Unit (ICU) are critically ill and often at extremely high risk of death. These patients receive aggressive interventions to prolong their lives. Despite these measures, many patients still succumb to their illness. Although ICU physicians are good at predicting which patients have a high risk of mortality, they are still offering interventions that do not prolong life, but potentially cause more suffering at the end of life. This is because there is a lack of high quality and early communication to discuss prognosis and establish patients' goals of care. This gap in communication is even more profound when patients are transferring from rural hospitals to busy tertiary care centers.
This dissertation discusses the utilization of tele-video conferencing to enhance early communication with family members/loved ones of critically ill patients prior to their transfer from a rural hospital to a tertiary care center. It begins with a description of telemedicine and its uses in the ICU to date. Chapter 2 discusses the poor prognoses of patients receiving high intensity interventions such as cardiopulmonary resuscitation (CPR). The extremely dismal outcomes underscore the importance of early, thorough discussions regarding prognosis and goals of care in these patients. The next chapter describes a pilot study utilizing telemedicine to conduct formal unstructured telemedicine conferences with family members prior to transfer. This study demonstrated that palliative care consultations can be provided via telemedicine for critically ill patients and that adequate preparation and technical expertise are essential. Although this study is limited by the nature of the retrospective review, it is evident that more research is needed to further assess its applicability, utility and acceptability. Chapter 4 describes an investigation into the barriers and facilitators of conducting conferences via telemedicine and the perceptions of clinicians regarding the use of telemedicine for this purpose. This chapter identified unique barriers and facilitators to the use of telemedicine that will need to be addressed when designing a telemedicine intervention for conducting family conferences.
This thesis describes the importance and process of implementation of telemedicine for the novel purpose of enhancing early communication among physicians and family members of critically ill loved ones. Further studies are needed to refine and investigate patient and family centered clinical outcomes utilizing this intervention.
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Polaha, Jodi, Karen Schetzina, and Katie Baker. "A Collaborative Practice Training Model for Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/ijhse/vol3/iss2/6.
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Meyer, Rosan Waltraut. "The impact of ongoing audit on nutritional support in paediatric intensive care." Thesis, Stellenbosch : Stellenbosch University, 2004. http://hdl.handle.net/10019.1/50156.
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Thesis (Mnutr)--Stellenbosch University, 2004.ENGLISH ABSTRACT: Objective: To assess the impact of a continuous auditing process on nutritional support in a tertiary paediatric intensive care unit. Design: Prospective, longitudinal audit initiated in 1994. Re-auditing took place almost every 2 years: 1994-1995, 1997-1998 and 2001, leading to completion of the audit cycle. Setting: An 8 bed Paediatric Intensive Care Unit (PICU) in StMary's Hospital London. Subjects: All ventilated patients admitted for more than a complete 24-hour period were included in the audit. The units' standard daily fluid charts were used for data collection. Data was collected until discharge from PICU or a maximum of 10 days. Incomplete and imprecise data was disregarded during the data analysis process. Outcome measures and interventions: The outcome measures include time taken to initiate nutritional support, the route of feeding and delivery of calories by day 3, judged by the Estimated Average Requirements (EAR) for energy. Feeding algorithms and protocols introduced after each audit: nasogastric feeding algorithm following the 1994-1995 audit, blind nasojejunal tube insertion technique and related feeding algorithms after the audit in 1997-1998. Results: Time taken to initiate enteral feeding was reduced from 15 hours (1994- 1995) to 5.5 hours (2001). The proportion of parenterally fed patients fell from 11% (1994-1995) to 1% (200 1 ). The proportion of enterally fed patients via the nasojejunal route rose from 1% (1994-1995) to 20% (2001). An increase was noticed in patients reaching 50% and 70% of energy requirement by day 3 following admission was documented: 7% in1994-1995 to 35% in 2001 for 70% of EAR (p = 0.0008) and 18% in 1994-1995 to 58% in 2001 for 50% of EAR. (p< 0.0001) Conclusion: This audit process demonstrates the effectiveness of continuous auditing in an intensive care unit in improving the quality of nutritional support. This is possible only with a multi-disciplinary team approach.
AFRIKAANSE OPSOMMING: Doel: Om die impak van 'n deurlopende ouditerings proses op die voedingsondersteuning in 'n tersi~re pediatriese intensiewesorg-eenheid te evalueer. · Studie Ontwerp: 'n Prospektiewe, longetudinale oudit is in 1994 geYnisieer. Herouditee·ring het ongeveer elke 2 jaar plaasgevind: 1994-1995, 1997-1998 en 2001. Dit het tot die voltooiing van 'n ouditering siklus gelei. Plek: 'n Agt-bed Pediatriese lntensiewesorgeenheid (PISE) in StMary's Hospitaal London, Engeland. Pasiente: Alle geventilleerde pasiente wat opgeneem was vir !anger as 'n volledige 24 uur-periode is by die oudit ingesluit. Die eenheid se standard daaglikse vogkaarte dokumentasie is gebruik vir data-insameling. Data-insameling het plaasgevind tot en met ontslag vanuit die PISE vir 'n maksimum van 10 dae. Onvolledige en onakkurate data is uitgesluit tydens die data analise proses. Uitkomste en Intervensie: Die uitkomste is gemeet deur die impak van die ouditerings proses te evalueer ten opsigte van tydsduur voordat daar voedings geYnisieer is, die voedingsroete en die hoeveelheid energie gelewer teen dag 3, vergelyk met die geskatte gemiddelde energie behoefte. Voedings-algoritmes en protokolle is geYmplementeer na elke oudit: nasogastriese voedings-algoritmes is na die 1994-1995 oudit geYmplimenteer, 'n blinde nasojejunale buisinplasingstegniek en I relevante voedings algoritmes het na die 1997-1998 oudit gevolg. Resultate: Die tydsduur om voedingondersteuning te inisieer het van 15 ure (1994- 1995) tot 5.5 ure (2001) verminder. Die persentasie pasiente wat parenterale voeding ontvang het, het gedaal van 11% (1994-1995) tot 1% (2001), met 'n toename in enterale voeding via die nasojejunale roete van 1 %(1994) tot 20% (2001). 'n Toename in pasiente wat meer as 50% en 70% van hul energie behoefte bereik het teen dag 3 is opgemerk: 7% in 1994-1995 en 35% in 2001 het meer as 70% van die geskatte gemiddelde behoefte vir energie ontvang. (p=0.0008) Agtien persent het in 1994-1995 en 58% in 2001 meer as 50% van hul gemiddelde energie behoeftes bereik (p < 0.0001). Gevolgtrekking: Hierdie ouditerings proses demonstreer die effektiewiteit van deurlopende ouditering in 'n intensiewesorg-eenheid deur die verbetering van die kwalitiet van voedingondersteuning. Dit is slegs moontlik met 'n multidissiplinere span benadering.
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Wu, Yanlan, and 吴艳兰. "Risk factors for death in pediatric intensive care unit of a tertiary children's hospital in Guangzhou city." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206970.
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Background:
Most of the previous studies about risk factors associated with death in pediatric intensive care unit (PICU) were done in western countries and focused on physiological and laboratorial indexes. Some of them had inconsistent results. There were few studies about the epidemiologic profile of mortality and risk factors associated with death in the PICU in China. Compared with other countries, China has different health care policy, insurance system, population, culture, and socioeconomic situation that may affect disease outcomes differently. Some data showed that Chinese PICUs had higher mortality. It is important to know more about the possible factors associated with excess death in PICU in a Chinese setting.
Objectives:
The objectives of this study were to estimate mortality (incidence proportion of death) in pediatric intensive care unit (PICU) in a tertiary hospital and identify the main risk factors associated with death in PICU.
Methods:
This was a case-control study. We retrospectively investigated the clinical data of patients who were admitted to the PICU during January 2010 to December 2013 in a tertiary hospital in Guangzhou, China. All the dead cases in PICU during the studied period were chosen as cases, and the controls were randomly selected from the patients who were alive when they were discharged from the PICU during the same period. The incidence proportion of death was estimated, and then logistic regression model was carried out to explore the risk factors for death.
Results:
The overall mortality in this PICU was 6.5% (95% CI 5.6 % - 7.4%) during January 2010 to December 2013. The following factors were found to have significant association with higher risk for death: middle level socioeconomic status (OR 2.51, 95% 1.07 - 5.87) and low level socioeconomic status (OR 5.86, 95% CI 2.32 - 14.77) compared with the high level socioeconomic status; admission from pediatric emergency observation unit (OR 2.08, 95% CI 1.10 - 3.91) compared with admission from transfer system (i.e. other hospital); critical severity of disease (OR 2.62 , 95% CI 1.48 - 4.64), and seriously critical severity of disease (OR 8.41, 95% CI 3.26 - 21.67) compared with non-critical severity of disease ; existence of multiple organ dysfunction syndrome (OR 3.64, 95% CI 1.91- 6.91) compared with absence of multiple organ dysfunction syndrome; existence of comorbidity (OR 3.14, 95% CI 1.68 - 5.86) compared with absence of comorbidity; infectious disease (OR 2.42, 95% CI 1.07- 5.49), neoplasm (OR 4.53, 95% CI 1.63 - 12.62), neurological disease ( OR 4.21, 95% CI 1.85 - 9.59) and endocrine, immune and nutritional disease (OR 7.56,
95% CI 2.10 - 27.20 ) compared with respiratory disease .
Conclusion:
Our study was the first one to comprehensively investigate the risk factors for death in PICU of a tertiary hospital in China. We described profile of dead cases, estimated the mortality and investigated the risk factors associated with death in PICU. During January 2010 to December 2013 the mortality in the PICU was found to be 6.5%, and risk factors for higher mortality in PICU included lower level socioeconomic status, admission from the pediatric emergency observation unit, more severe conditions of disease, presence of comorbidity and multiple organ dysfunction syndrome, and disease categories of infectious diseases, neoplasm, neurological disease, and endocrine, immune and nutritional disease. Our study provided information for developing preventive strategy to reduce the mortality in PICU.published_or_final_version
Public Health
Master
Master of Public Health
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Axelsson, Johannes, and Linn Elam. "Ett steg närmare hem : Föräldrars upplevelser av överflytt från BIVA till vårdavdelning." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-10081.
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När det är dags för ett barn att överflyttas från en barnintensivvårdsavdelning (BIVA) till en vanlig vårdavdelning lämnas en känd miljö med känd personal och noggrann monitorering för att påbörja en ny fas på ett okänt ställe. Denna nya fas kan för föräldrarna representera förbättring av barnets hälsa och ett steg närmare hem, men är också initialt en period av oro, stress och rädsla. Studiens syfte var att beskriva föräldrars upplevelser av överflyttning av sitt barn från BIVA till vårdavdelning. En kvalitativ metod användes med intervjuer som datainsamlingsmetod där fem föräldrar intervjuades. Kvalitativ innehållsanalys valdes som analysmetod. Resultatet visar att information om vårdavdelningen, möjligheter för smärtlindring till barnet och innehåll i det som överrapporteras var viktigast för att känna kontroll och trygghet. Det sågs stora skillnader mellan BIVA och avdelningen men överflyttningen upplevdes även som ett positivt steg för förbättring och hemgång. Föräldrarna hade överlag en positiv upplevelse av överflyttningen. Kontroll och trygghet är viktigt vårdtiden igenom och så också under överflyttningen. Den minskade vårdnivån innebar att föräldrar fick ta ett större egenansvar.
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Chaiwanon, Wongsakorn. "Capacity planning and admission control policies for intensive care units." Thesis, Massachusetts Institute of Technology, 2010. http://hdl.handle.net/1721.1/62406.
Full textAbstract:
Thesis (S.M.)--Massachusetts Institute of Technology, Sloan School of Management, Operations Research Center, 2010.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 135-143).
Poor management of the patient flow in intensive care units (ICUs) causes service rejections and presents significant challenges from the standpoint of capacity planning and management in ICUs. This thesis reports on the development of a simulation framework to study admission control polices that aim to decrease the rejection rate in the ICU at Children's Hospital Boston (CHB), and to provide predictions for the future state of the ICU system. To understand the patient flow process, we extensively analyze the arrival and length of stay (LOS) data from the ICU census. The simulation model for the ICU is developed based on the results from this statistical analysis as well as the currently-practiced scheduling and admission policies of the ICU at CHB. The model is validated to provide accurate estimates for important performance metrics such as rejection rates in the ICU. The simulation model is used to study the performance of many admission control policies. The policies of our interest exploit "caps" to control the number of scheduled patients who are allowed to enter the ICU on a single day. In particular, we consider two cap-based policies: the uniform cap policy (UCP), which is the existing policy in CHB, and the service-specific cap policy (SSCP), which is originally proposed in this thesis. While the UCP implements caps on the total census of surgical patients, the SSCP utilizes the service-oriented heterogeneity of surgical patients' LOS and enforces caps on separate groups of surgical patients based on their average LOS. We show that the UCP can reduce the rejection rate in the ICU at the expense of extra waiting time of scheduled patients. The SSCP is shown to further decrease the rejection rate while increasing the waiting time compared to the UCP. We also demonstrate that the performance of both policies depends on the level of system utilization. In order to validate our results theoretically, a discrete-time queueing model for the ICU is developed and verified to provide estimates for performance measures that are consistent with the results from simulation. Finally, we introduce the notion of state-dependent prediction, which aims to identify the likelihood of the future state of the ICU conditional on the information of a current state. Several experiments are conducted by simulation to study the impact of a current state on a state in the future. According to our results, current state information can be useful in predicting the state of the ICU in the near future, but its impact gradually diminishes as the time difference between the present and future grows. Our major finding is that the probability of unit saturation at a certain future time can be determined almost entirely by the number of current patients who will leave the ICU after that time, regardless of the total number of patients who are currently staying in the unit. These results imply the potential development of adaptive cap-based policies that dynamically adjust caps according to the outcomes of state-dependent predictions.
by Wongsakorn Chaiwanon.
S.M.
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Fasciani, Linda. "A study of the relationship between stress levels and coping among pediatric and neonatal intensive care nurses /." Staten Island, N.Y. : [s.n.], 1990. http://library.wagner.edu/theses/nursing/1990/thesis_nur_1990_fasci_study.pdf.
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Coyer, Fiona Maree. "The Development of Family-Focused Intensive Care Nursing Through Action Research." Thesis, Queensland University of Technology, 2004. https://eprints.qut.edu.au/15932/1/Fiona_Coyer_Thesis.pdf.
Full textAbstract:
Introduction:
The purpose of this study was to facilitate an improved understanding by intensive care nurses about their care of family members of critically ill patients. The study aimed to challenge intensive care nurses to reconceptulaise family nursing within the context of the intensive care unit (ICU).
Background to the study:
Critical illness is not an event that occurs in isolation for the patient and staff. It affects the patient's family in a unique way. A plethora of literature exists identifying the needs of family members in the ICU. However, there are considerably fewer studies which have examined interventions to meet family members' needs and no identified research that discreetly examined the concept of family-focused nursing in the intensive care environment.
Design of the study:
This study utilised a collaborative action research methodology. It was developed in four phases through the cyclical, dynamic steps of action research.
Setting:
This study was undertaken in the general intensive care facility of a metropolitan tertiary referral hospital.
Phase One:
Phase One of the study was the establishment of a collaborative action research group (CARG) with interested registered nurses working in a general intensive care unit. The CARG explored the first two research questions of this study: 1) What are intensive care nurses' perceptions of family-focused nursing? and 2) Is familyfocused nursing appropriate in the intensive care environment? Data were collected through audio taping meetings, flip chart notes and the researcher's reflective diary. Data analysis was undertaken utilising open coding. For the first research question, open coding of the data revealed two categories relating to perceptions of family focused intensive care nursing: partnership in care and maintaining a balance. For the second research question, CARG members agreed unanimously that family focused nursing was appropriate in the intensive care environment. The CARG determined future direction of the action research phases, commencing with a family needs analysis in Phase Two.
Phase Two:
Phase Two of the study was the utilization of a descriptive survey to determine family member needs in the ICU to determine focuses for interventions during Phase Three. Both family members and staff in the ICU were surveyed utilising the Critical Care Family Needs Index (CCFNI) (Molter & Leske, 1983). Data were analysed by the CCFNI subcategories of assurance, proximity, information, comfort and support, comparing means, rank ordering of means and t-test for statistically significant differences in means between the family members and staff participants. Results indicated that statistically significant differences in means scores between family members and staff participants were in the CCFNI categories of assurance, proximity, information and support. On the basis of these results, a platform for Phase Three of this study arose. The areas for intervention for Phase Three were identified by the CARG as: the provision of staff education seminars to raise staff awareness of family needs and the development of a structured family assessment tool to identify family needs in the ICU.
Phase Three:
Phase Three of the study addressed research question three: "How can intensive care nurses provide care that is focused toward the family of the critically ill patient?" Phase Three examined practice interventions in two areas. Phase Three Part A was the implementation of nursing staff education seminars. Forty-two nursing staff participated in the family needs education seminars. Data were collected by detailed researcher field notes and completion of a descriptive survey, the CCFNI, post seminar attendance. Thirty-five participants completed the CCFNI. This CCFNI data from nursing participants in the education seminars was compared to family members CCFNI data from Phase Two. Open coding of data from the education seminars revealed codes of family needs, visiting, family presence, encouragement, simple things and boundaries under the theme of "establishing the context" and attitudes, confidence, empathy and culture under the theme of "building a partnership". CCFNI results highlighted statistically significant differences in means scores between family members and staff participants were in the subcategories of proximity and support. Results demonstrated that through understanding family members needs that intensive care nurses can provide care that is focused toward the family of the critically ill patient. This is a building process to be achieved over time. Phase Three Part B was the content validity development of a family assessment tool for the Computer Information System (CIS) in the ICU. A family assessment tool (See Figure 6.1) was developed through the literature and in consultation with the CARG. A series of focus groups were organised. All nursing staff in the general ICU were invited to participate. Twenty-nine registered nurses (43.9%, n=66) participated in the family assessment tool focus groups. The five domains of the family assessment tool, family roles, family spokesperson, family perception and coping, family issues and family health needs, were each discussed to determine readability, clarity and applicability. The focus groups agreed on content validity of the family assessment tool. (See Figure 6.2).
Phase Four:
Finally, Phase Four of the study has addressed research question four: "Is action research an appropriate methodology to transform intensive care nursing practice?" Somekh's (1995) framework was utilised to guide this critical evaluation. It is suggested that action research is an appropriate methodology to transform intensive care nursing practice as it enables the development of professional, it is sensitive to the specific nature of intensive care nursing, it acknowledges of attributes of the researcher in the process. It is also an appropriate methodological choice as it provides opportunity for a critical evaluation and a platform for the ongoing nature of the action research journey.
Conclusions:
Overall the findings achieved the objectives of the study in that organisational, cultural and clinical practice changes were identified to facilitate family-focused intensive care nursing. Collaboration occurred with intensive care nurses to effect change. The action research process involved in the change process was articulated throughout the four phases of the study. An improved understanding by intensive care nurses about their family nursing practice was demonstrated in Phase Three and the efficacy of action research methodology for clinical practice change was demonstrated in Phase Four.
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Coyer, Fiona Maree. "The Development of Family-Focused Intensive Care Nursing Through Action Research." Queensland University of Technology, 2004. http://eprints.qut.edu.au/15932/.
Full textAbstract:
Introduction: The purpose of this study was to facilitate an improved understanding by intensive care nurses about their care of family members of critically ill patients. The study aimed to challenge intensive care nurses to reconceptulaise family nursing within the context of the intensive care unit (ICU). Background to the study: Critical illness is not an event that occurs in isolation for the patient and staff. It affects the patient's family in a unique way. A plethora of literature exists identifying the needs of family members in the ICU. However, there are considerably fewer studies which have examined interventions to meet family members' needs and no identified research that discreetly examined the concept of family-focused nursing in the intensive care environment. Design of the study: This study utilised a collaborative action research methodology. It was developed in four phases through the cyclical, dynamic steps of action research. Setting: This study was undertaken in the general intensive care facility of a metropolitan tertiary referral hospital. Phase One: Phase One of the study was the establishment of a collaborative action research group (CARG) with interested registered nurses working in a general intensive care unit. The CARG explored the first two research questions of this study: 1) What are intensive care nurses' perceptions of family-focused nursing? and 2) Is familyfocused nursing appropriate in the intensive care environment? Data were collected through audio taping meetings, flip chart notes and the researcher's reflective diary. Data analysis was undertaken utilising open coding. For the first research question, open coding of the data revealed two categories relating to perceptions of family focused intensive care nursing: partnership in care and maintaining a balance. For the second research question, CARG members agreed unanimously that family focused nursing was appropriate in the intensive care environment. The CARG determined future direction of the action research phases, commencing with a family needs analysis in Phase Two. Phase Two: Phase Two of the study was the utilization of a descriptive survey to determine family member needs in the ICU to determine focuses for interventions during Phase Three. Both family members and staff in the ICU were surveyed utilising the Critical Care Family Needs Index (CCFNI) (Molter & Leske, 1983). Data were analysed by the CCFNI subcategories of assurance, proximity, information, comfort and support, comparing means, rank ordering of means and t-test for statistically significant differences in means between the family members and staff participants. Results indicated that statistically significant differences in means scores between family members and staff participants were in the CCFNI categories of assurance, proximity, information and support. On the basis of these results, a platform for Phase Three of this study arose. The areas for intervention for Phase Three were identified by the CARG as: the provision of staff education seminars to raise staff awareness of family needs and the development of a structured family assessment tool to identify family needs in the ICU. Phase Three: Phase Three of the study addressed research question three: "How can intensive care nurses provide care that is focused toward the family of the critically ill patient?" Phase Three examined practice interventions in two areas. Phase Three Part A was the implementation of nursing staff education seminars. Forty-two nursing staff participated in the family needs education seminars. Data were collected by detailed researcher field notes and completion of a descriptive survey, the CCFNI, post seminar attendance. Thirty-five participants completed the CCFNI. This CCFNI data from nursing participants in the education seminars was compared to family members CCFNI data from Phase Two. Open coding of data from the education seminars revealed codes of family needs, visiting, family presence, encouragement, simple things and boundaries under the theme of "establishing the context" and attitudes, confidence, empathy and culture under the theme of "building a partnership". CCFNI results highlighted statistically significant differences in means scores between family members and staff participants were in the subcategories of proximity and support. Results demonstrated that through understanding family members needs that intensive care nurses can provide care that is focused toward the family of the critically ill patient. This is a building process to be achieved over time. Phase Three Part B was the content validity development of a family assessment tool for the Computer Information System (CIS) in the ICU. A family assessment tool (See Figure 6.1) was developed through the literature and in consultation with the CARG. A series of focus groups were organised. All nursing staff in the general ICU were invited to participate. Twenty-nine registered nurses (43.9%, n=66) participated in the family assessment tool focus groups. The five domains of the family assessment tool, family roles, family spokesperson, family perception and coping, family issues and family health needs, were each discussed to determine readability, clarity and applicability. The focus groups agreed on content validity of the family assessment tool. (See Figure 6.2). Phase Four: Finally, Phase Four of the study has addressed research question four: "Is action research an appropriate methodology to transform intensive care nursing practice?" Somekh's (1995) framework was utilised to guide this critical evaluation. It is suggested that action research is an appropriate methodology to transform intensive care nursing practice as it enables the development of professional, it is sensitive to the specific nature of intensive care nursing, it acknowledges of attributes of the researcher in the process. It is also an appropriate methodological choice as it provides opportunity for a critical evaluation and a platform for the ongoing nature of the action research journey. Conclusions: Overall the findings achieved the objectives of the study in that organisational, cultural and clinical practice changes were identified to facilitate family-focused intensive care nursing. Collaboration occurred with intensive care nurses to effect change. The action research process involved in the change process was articulated throughout the four phases of the study. An improved understanding by intensive care nurses about their family nursing practice was demonstrated in Phase Three and the efficacy of action research methodology for clinical practice change was demonstrated in Phase Four.
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Ng, W. Y. Phoebe. "The factors affecting the perceived sense of maternal competence on their babies in the special care baby unit in Hong Kong /." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B3639628X.
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Johnson, Randall. "Evaluation of an Education Intervention for the Staff on the Head of the Bed Elevation in the Pediatric Intensive Care Unit." Doctoral diss., University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/3036.
Full textAbstract:
Elevating the head of bed (HOB) reduces risks for aspiration and ventilator associated pneumonia (VAP) in the adult population. Educational interventions have resulted in improvements in achieving a target HOB elevation of 30[degrees] in adults. Limited research has addressed this intervention in the pediatric intensive care unit (PICU). The aim of this study was to determine if an educational intervention for the PICU staff would result in improvement in the HOB elevation in the PICU. Four research questions were studied: 1) What is the common practice related to the elevation of the HOB in the PICU? 2) Is there a difference in the mean HOB elevation before and after an education intervention? 3) Is there a difference in the percent of time the HOB is at or above 30[degrees] after the intervention? and 4) What factors influence HOB elevation in the PICU? A quasi-experimental, pre, and post measurement, with nonequivalent comparison group design was used. The angle of the HOB elevation was measured with the "Pitch and Angle Locator" (PAL) (Johnson, Mequon, WI). Baseline measurements (n = 99) were obtained for patients admitted to a PICU at various days and times over a 2-week period. An educational intervention was done for the staff members in the PICU, with a focus on the importance of keeping the HOB up and strategies for measuring the HOB elevation. Posters to reinforce the information were placed on the unit. Post-intervention, measurements (n = 98) were obtained for another 2-week period. At the time of data collection, staff members caring for the PICU patients were asked to provide responses for what influenced them to place the patient at the documented HOB elevation. Children were older in the post-intervention group than in the pre-intervention (8.8 yrs, vs. 3.7, yrs, respectively, t = -6.67, df = 195, p= .000). The children also weighed more in the post-intervention group than in the pre-intervention (32.0 kg vs. 19.7 kg, respectively, t = -4.19, df= 195, p = .000). The mean HOB elevation was 23.5[degrees] before the intervention. After the intervention, the mean HOB increased to 26.5[degrees] (t = -1.19, df 195, p = .033). For ventilated patients, the mean HOB elevation went from 23.6[degrees] to 29.1[degrees] (t = -3.25, df 95, p= .001), and for patients mechanically ventilated and in an adult bed, the mean increased from 26[degrees] [plus or minus] 7.89[degrees], pre- intervention to 30[degrees] [plus or minus] 8.59[degrees] post-intervention (t = -1.80, df 63, p = .038). The percent of the time the measures were greater than 30[degrees] increased from 26% to 44% pre- and post-intervention respectively (X2 6.71, df 1, p= .005). Responses (n = 230) related to the factors that influenced positioning were categorized as follows: physician order (3%), safety (7%), found this way (11%), therapeutic intervention (16%), comfort (24%), and patient condition (39%). An educational intervention can impact the practice of elevation of the HOB in a PICU, thus decreasing the risks of developing aspiration and VAP. Although the mean HOB increased statistically, the HOB was less than 30[degrees] in more than half of the post intervention measurements, indicating the need for ongoing reinforcement of the education. The PAL device was a new, reliable method for recording HOB elevation in both adult beds and cribs. Follow-up research is needed to determine if these gains in HOB elevation have been sustained over time and their impact on VAP.Ph.D.
School of Nursing
Health and Public Affairs
Nursing PhD
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Dubuc, Alexandra. "Assessing the Nutritional Status and Adequacy of Energy and Protein Intakes of Children Admitted to the Pediatric Intensive Care Unit." Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/40404.
Full textAbstract:
Children admitted to the pediatric intensive care unit (PICU) are at high risk of malnutrition due to the stress of critical illness, and challenges with meeting nutrient needs. The objectives of this study were to describe the prevalence of malnutrition (undernutrition) at admission and discharge from the PICU and the adequacy of dietary intakes during PICU stay according to current practice guidelines. Sixty patients (median age 1.8y) were enrolled. Malnutrition (moderate-severe) was identified in 12% of patients at admission and 15% at discharge using weight-for-length and BMI-for-age z scores. Mid-upper arm circumference z score declined significantly (p=0.002) during PICU stay. Median (IQR) delivery of enteral energy and protein during the first 10 days was 64 (50-73)% and 62 (40-82)%, respectively, of prescribed goal. A total of 174 feeding interruptions were noted in 36 enterally fed patients. Malnutrition was present in the PICU and areas for improvement in nutrient delivery were identified.
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Ozcan, Hilal. "Healing design: a phenomenological approach to the relation of the physical setting to positive social interaction in pediatric intensive care units in the United States and Turkey." Texas A&M University, 2004. http://hdl.handle.net/1969.1/3072.
Full textAbstract:
This study examines the impact of the physical setting in the care and healing process of hospitalized children, their families, and the caregivers in two selected pediatric intensive care units (PICUs) in the U.S. and Turkey. A holistic, cross-cultural, comparative, and naturalistic approach emphasized the importance of the total (i.e., physical, social, cultural, spiritual, organizational, political) environment and quality of life to health and healing. Information was gathered through qualitative methods such as participant observations, behavioral maps, in-depth interviews, and floor plan analysis. Despite some universal features of the PICU atmosphere, the value and place ascribed to pediatric critical care in Turkey and the U.S. present different worldviews. Field studies revealed social interaction as a universal healing function despite its cultural specificity stemming from socio-cultural, ethnic, economic, and religious differences between different groups.
Crowding, parental absence, and over-stimulation, which stem from the lack of individual patient rooms, and organizational problems related with human resources and staffing shortage play against the critically ill childÂs deep need to heal in the Turkish PICU. Despite spatial limitations, informal social interactions and cooperative relationships among caregivers, their devotion, and their ability to adapt to the existing physical and social environment enable care delivery. While staffing shortage continues to be a crucial problem in the U.S. model, specialization of labor and the systemic organization in general support care delivery, reducing the importance of informal social interactions and cooperation among caregivers. However, emphasizing the role of the family in the childÂs care, social interaction is also identified as a healing function in this setting. Therefore, despite the significant role the physical setting may play in healing, social interaction is found to be more important for improving patient outcomes and the well-being of families and caregivers. The study focuses on six healing design interventions to increase the chances for positive social interaction and collaboration. These are programmatic (provisional, scale, locational), functional, ambient, symbolic, social and psychological interventions.
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Bezerra, Rosana Mendes. "O SIGNIFICADO DE CUIDAR NA UNIDADE DE TERAPIA INTENSIVA PEDIÁTRICA." Pontifícia Universidade Católica de Goiás, 2012. http://localhost:8080/tede/handle/tede/2984.
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Previous issue date: 2012-12-05The Pediatric Intensive Therapy Unit of is characterized as highly technological environment with specialized professionals. It is permeated by feelings of loss, anguish and at the same hopes on the expectation of stability and recovery of a child. The nursing team sets a team that plans, implements and develops the process of caring basead on healthpublic policies. To assure a critical pediatric patient and its family a humanized, integrated and systematic care with quality in its entirety is a matter to be questioned along with the understanding of nursing about the meaning of child caring into a critical unit. Therefore, it was chosen to develop a qualitative case study in which the target was to comprehend the meaning of taking care at the PITU from the nursing components perspective team. Six nursing assistants, six nursing technician and two nurses participated. The data collection happened from December of 2010 to August of 2011 through semi structured interviews and participant observation held on a private place inside its own health institution. Through the study and interpretation of data, it is noted that the attributed feelings from the participants in the meaning of caring in the Pediatric Intensive Therapy Units is associated with the dimensions techniques of humanization, the pressure and the love for caring. The participants mentioned that caring is composed by assistance activities concerning the eating, the hygienization, the medication, the elimination and the ventilator support. It was also added that characteristics of humanization emerges strongly in the sense of giving warmth, affection and to dialogue. They shower love for what they do, and the fulfillment to work with critical children and families, in addition to personal accomplishment, recalling the existence of the old nursing. Team work and the concern of taking care of who also takes, was identified as well, just like therecognition fo the family by the care carried out. To take care like a creator of tension was referred as harmful for health development actions. They are represented by the overwork, by the absence of hiring for a position, human resources and insufficient materials, impossibility of helping a family, specially a mother during the process of hospitalization beside suffering from seeing the affliction of ones and the nurse s frustration for not seeing the pediatrical patient and their family through the systematized assistance. Results show that tensions are overcame by the satisfaction of caring in a critical pediatric atmosphere, but also leaves the nursing team in its working limits. The need of managers to suit an actual policy assistance model for health should be accomplished when a nursing service fragmentation doesn t provide the care guided in its integrality, in humanization and the sysmatization of the nursing assistance.
A Unidade de Terapia Intensiva Pediátrica é caracterizada como ambiente altamente tecnológico e com profissionais especializados. É permeada por sentimentos de perda, angústia e ao mesmo tempo esperança na expectativa da estabilização e recuperação da criança. A equipe de enfermagem configura um grupo que planeja, implementa e desenvolve o processo de cuidar embasado nas políticas públicas de saúde. Garantir ao cliente crítico pediátrico e sua família o cuidado humanizado, integralizado, sistematizado e com qualidade em sua totalidade é hoje um ponto a ser questionado juntamente a compreensão da enfermagem sobre o significado de cuidar de criança em unidade crítica. Neste sentido, optouse por desenvolver um estudo de caso qualitativo com o objetivo de compreender o significado de cuidar na UTIP na perspectiva dos componentes da equipe de enfermagem Participaram seis auxiliares de enfermagem, seis técnicas de enfermagem e 2 enfermeiras. A coleta de dados ocorreu de dezembro de 2010 a agosto de 2011 por meio de entrevista semiestruturada e observação participante, em local privativo, dentro da própria instituição de saúde. Através da análise e interpretação dos dados, ficou constatado que os sentidos atribuídos pelas participantes ao significado do cuidar em unidade de terapia intensiva pediátrica está relacionada as dimensões técnicas, de humanização, das tensões e do gostar para cuidar. Os participantes mencionaram que o cuidar é composto por atividades assistenciais relacionadas a alimentação, higienização, medicação, eliminações, suporte ventilatório. Acrescentaram ainda que as características de humanização estão fortemente presente no sentido de dar carinho, dar aconchego e dialogar. Apontaram gostar do que fazem, sentir muita satisfação para trabalhar com criança crítica e com sua família além da realização pessoal, lembrando o sacerdócio existente na enfermagem antiga. O trabalho em equipe, a alteridade e a preocupação de cuidar de quem cuida também foram identificados bem como o reconhecimento da família pelo cuidado desenvolvido. Cuidar como gerador de tensões foram citadas como prejudiciais ao desenvolvimento das ações de saúde. Estão representadas pela sobrecarga de trabalho, desvio de contratação de função, recursos humanos e materiais insuficientes, impossibilidade de acolher a família, principalmente a mãe durante todo o processo de hospitalização além de sofrer ao ver o sofrimento do outro e a frustração do enfermeiro por não assistir o cliente pediátrico e sua família através da assistência sistematizada. Os resultados apontam que as tensões são superadas pela satisfação em cuidar neste ambiente crítico pediátrico, mas que deixa a equipe de enfermagem em seu limite laboral. A necessidade dos gestores adequarem o modelo de assistencial vigente as políticas de saúde deve ser realizado uma vez que a fragmentação do serviço de enfermagem não proporciona o cuidado pautado na integralidade, na humanização e na sistematização da assistência de enfermagem.
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Parslow, Roger Charles. "Children receiving intensive care in England and Wales epidemiology and health services research." Thesis, University of Leeds, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.485312.
Full textAbstract:
The epidemiology of children a'dmitted to paediatric intensive care units (I?tcUs) in England and Wales is described, focussing on the effect of deprivation and ethnicity on admission prevalence and mortality. The effects on mortality of size of the admitting unit, admission time, day of the week and season on mortality are investigated. The performance of the mortality risk-adjustment model is discussed in relation to other casemix factors including diagnosis, genetic ancestry and institutional characteristics. An analysis of the epidemiology of children admitted to intensive care with severe traumatic brain injury provides more detailed insight into this important subset of the paediatric intensive care population. In 2004-2005, there were 27859 admissions to paediatric intensive care in England and Wales involving over 20,000 children (under 16 years), 10% of whom ~ere classified as south Asian. Nearly half of all children admitted were under one year of age. Incidence for admission was 55% higher for south Asian children and was 71% higher in the most deprived fifth of the population compared with the least deprived. Deprivation is also associated 'Yith higher admission rat~s to paediatric intensive care for severe traumatic brain injury. Risk-adjusted mortality did not significantly increase with increasing deprivation but mortality in south Asian children was raised, especially in the least deprived fifth of the population. ~isk-adjusted mortality is higher in winter in I~Jrger PICUs and weekend admissions have higher mortality compared to weekdays in smaller PICUs. Mortality following admission to· PICU with a severe traumatic brain injury is highest in those injuries involved with motor vehicles but does not increase with deprivation. The data and analyses represent noveJ'information on the population characteristics of childre[l receiving paediatric intensive care in England and Wales, the effect of these on mortality, and the relationship between service provision and mortality.
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LeBlanc, Allana E. "The Experience of Intensive Care Nurses Caring for Patients with Delirium." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/34266.
Full textAbstract:
The purpose of this research was to seek a deep understanding of the lived experience of intensive care nurses caring for patients with delirium.
Delirium affects a large proportion of adult patients in the intensive care unit (ICU). Delirium has been linked to increased morbidity and mortality, longer intensive care and hospital length of stay, long-term cognitive impairments, short-term and long-term psychological distress, and increased hospital and health system costs. Critical care nurses play central roles in preventing, identifying, and treating ICU patients with delirium.
Semi-structured interviews were conducted with eight intensive care nurses working in an ICU in a tertiary level, university-affiliated hospital in Ontario, Canada. The researcher analyzed the interviews using an interpretive phenomenological approach as described by van Manen (1990).
The essence of the experience of critical care nurses caring for ICU patients with delirium was revealed to be finding a way to help them come through it. Six main themes emerged: It's Exhausting; Making a Picture of the Patient's Mental Status; Keeping Patients Safe: It's a Really Big Job; Everyone Is Unique; Riding It Out With Families; and Taking Every Experience With You. The findings describe how intensive care nurses find a way to help patients and their families through this complex and often distressing experience. This study has contributed to the understanding of the lived experience of ICU nurses caring for patients with delirium.
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Berube, Kristyn M. "Parents’ Experience of the Transition with their Child from a Pediatric Intensive Care Unit (PICU) to the Hospital Ward: Searching for Comfort Across Transitions." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/23846.
Full textAbstract:
The pediatric intensive care unit (PICU) has been described as a stressful place for parents of critically ill children. Research to date has examined parents’ needs and stressors with a child in PICU. There is a paucity of research examining the experience for parents of a child who is transferred from the PICU to the hospital ward. Open-ended interviews were conducted with 10 parents within 24-48 hours after transfer from a PICU to a hospital ward at a children’s hospital in Canada to understand this experience. Parents revealed that the experience involved a search for comfort through transitions as expressed through the themes of: ‘being a parent with a critically ill child is exhausting’, ‘being kept in the know’, ‘feeling supported by others’, and ‘being transferred’. The findings from this study can help nurses and other health professionals working with parents to support them through the transition from PICU. Recommendations are made for the inclusion of family-centered care practices to assist parents through transitions.
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Holmgren, Erik, and Oskar Sandqvist. "Barns beteenden inom barnintensivvård : en fokuserad etnografisk observationsstudie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-295035.
Full textAbstract:
Bakgrund: När sjukvården till stor del förlitar sig på medicinsk teknik och läkemedelsbehandling är det lätt att omvårdnadsåtgärder som syftar till att förebygga och lindra lidande inte ges tillräckligt utrymme. Intensivvårdsdelirium är ett förhållandevis outforskat område inom barnintensivvården. Idag finns inga riskskattningsinstrument översatta till svenska. Syfte: Syftet var att studera barns beteenden när de vårdades på en barnintensivvårdsavdelning. Dessutom undersöktes om dessa beteenden kunde användas för att besvara frågor från ett engelskspråkigt riskskattningsinstrument för delirium. Metod: Studien utfördes som en fokuserad etnografisk observationsstudie där sju patienter på en barnintensivvårdsavdelning observerades under tre timmar vardera. Utifrån observationernas fältanteckningar gjordes en innehållsanalys med fokus på manifest innehåll. I ett andra steg utfördes en deduktiv analys där kategorierna från fältanteckningarna jämfördes mot frågor från riskskattningsinstrumentet för delirium. Resultat: Innehållsanalysen av fältanteckningarna resulterade i åtta kategorier som representerade barnens beteende under observationerna: reagerar på vårdhandling, förmedlar fysiska behov, förmedlar smärta, svarar på fråga, sysselsätter sig själv, stimuleras av underhållning, uppmärksammar omgivningen och väcks av stimuli. Den deduktiva innehållsanalysen visade att fyra av de åtta frågorna från riskskattningsinstrumentet kunde besvaras med hjälp av kategorierna. Slutsats: Urvalet bestod av en homogen subgrupp där inga beteenden med tydlig koppling till risk för delirium kunde observeras. Miljörelaterade riskfaktorer för delirium i form av frekventa vårdhandlingar, höga ljud och störd sömn förekom. Trots att denna grupp patienter inte visade tecken på delirium kan förebyggande av dessa störningar leda till minskat vårdlidande. Barnintensivvården kan ytterligare minska vårdlidande genom att öka föräldrarnas möjligheter att vara hos sitt sjuka barn dygnet runt.Background: Nursing and preventive measures may be overlooked when health care in large relies on medical technology and medical treatment. Intensive care delirium is a relatively unexplored area in pediatric intensive care. There are currently no risk assessment tools translated to Swedish. Aim: The objective was to study children's behaviour when they were cared for in a pediatric intensive care unit. In addition, it was questioned whether these behaviours where able to answer questions originating from an English language risk assessment tool for delirium. Method: Using focused ethnographic observation seven patients were observed during three hours each. Content analysis was performed on the field notes from the observations with focus on manifest content. As a second step, a deductive analysis compared the categories with questions from the risk assessment tool for delirium. Findings: The content analysis of field notes resulted in eight categories which represented the children’s behavior during the observations: reacting to care, expressing physical needs, expressing pain, answering question, occupying oneself, stimulated by entertainment, observing the surroundings and awakened by stimulus. The deductive analysis showed that four of the eight questions from the risk assessment tool could be answered with the categories. Conclusion: The selection consisted of a homogenous subgroup where no obvious behaviors related to risk of delirium was observed. Environmental risk factors for delirium such as frequent care related interventions, loud noise and disturbed sleep where observed. Despite that, prevention of these disturbances could reduce health care related suffering even though this group of patients did not show signs of delirium. Pediatric intensive care units can further reduce healthcare related suffering by enabling families to be present with their sick child during all hours of the day and night.
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Andersson, Papadogiannakis Nina. "Nurses in paediatric care competence, professional identity and research utilization /." Stockholm, 2010. http://diss.kib.ki.se/2010/978-91-7409-854-9/.
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Sproat, Louise Jane. "Implementing change in infection control practice : an action research study in two intensive care units." Thesis, University of Sheffield, 1999. http://etheses.whiterose.ac.uk/3481/.
Full textAbstract:
The increased emergence of bacterial resistance to antibiotics means that primary prevention of all hospital-acquired infections is essential, but ensuring that infection control practice is evidence-based requires reliable measurement of endemic hospital-acquired infections. The research sought to develop a comprehensive method for combining surveillance of infection with improved infection control by incorporating a problem solving approach within nursing process documentation. Prior to the research there was little evidence of nursing documentation of infection risk assessment, evaluation or outcomes monitoring. Development of the documentation matched the aspirations for a clear, objective complete system to support infection control care planning and audit. The documentation was designed to collect and collate only routine items of clinical information that the nurse at the bedside on an ICU would already know or be able to access in a very short time. The data items were successfully incorporated within the audit documentation for measuring incidence of each of the four site-specific infections. The system provided a framework for case-mix identification, case definitions, data collection and identification of indicators for measurement of ICU-acquired infection. It was shown to be feasible to incorporate the audit tool within routine documentation of clinical care. The method has potential application for surveillance of endemic hospital-acquired infections in a wide range of clinical specialities and could be adapted by others facing similar difficulties in determining priorities for monitoring and controlling endemic hospital-acquired infections within limited resources.