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1
Abelha, Fernando José Pereira Alves. "Outcome in surgical critical care patients". Doctoral thesis, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/55332.
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Abelha, Fernando José Pereira Alves. "Outcome in surgical critical care patients". Tese, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/55332.
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Comeau, Odette. "Delirium Screening in Adult Critical Care Patients". ScholarWorks, 2016. http://scholarworks.waldenu.edu/dissertations/1675.
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Delirium is an acute change in cognition accompanied by inattention, which affects up to 88% of adult critical care patients. Delirium causes increased hospital complications, longer lengths of hospital stay, functional disability, cognitive impairment, and increased mortality. The purpose of this evidence-based quality-improvement project was to implement and evaluate a delirium screening process in adult intensive care units at a large medical center. This included education of nurses, implementation of a structured, validated tool, and review of tool use documentation. The implementation of this project was guided by an evidence-based practice model, Disciplined Clinical Inquiry© and Lewin's change theory. Evaluation of this quality-improvement project used audits of the electronic medical record. The audits included the presence and accuracy of delirium screening documentation in the patients' medical records. Results of 3 sequential documentation audits revealed a gradual adoption of this practice change by nurse clinicians. The percentage of charts with missing, incomplete, or inaccurate data decreased from 50% on the first week to 27.9% and 25.0% on the 2nd and 3rd weeks, respectively. These findings were an indication of practice change by validating the requirement for delirium screening on the units. In the first 3 weeks alone, 17 patient audits were positive for delirium, indicating the potential for poor short-term and long-term patient outcomes if not addressed promptly. Implementation of delirium screening ensures the dignity and worth of adult critical care patients by decreasing the poor outcomes associated with the diagnosis, which is an important contribution to positive social change.
4
Doran, Carmen. "Modelling and control of hyperglycemia in critical care patients". Thesis, University of Canterbury. Mechanical Engineering, 2004. http://hdl.handle.net/10092/6478.
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Critically ill patients are known to experience stress-induced hyperglycemia. Inhibiting the physiological response to increased glycemic levels in these patients are factors such as increased insulin resistance, increased dextrose input, absolute or relative insulin deficiency, and drug therapy. Although hyperglycemia can be a marker for severity of illness, it can also worsen outcomes, leading to an increased risk of further complications.
Hyperglycemia has been quantified in critically ill patients showing the need for glucose control. The development of a relatively simple system model and the verification of both generic and patient specific parameters have been successful in control trials and simulations over a range of critically ill patients. Stepwise reduction of blood glucose values by adaptive control was shown to be accurate to within 20%, and average long-term fitting errors are within the measurement error of the glucose sensor.
A control algorithm capable of tight regulation for a glucose intolerant ICU patient would thus reduce mortality, as well as the burden on medical resources and time with current experience-based control approaches used in most critical care units. Overall, the research presented is a significant step towards fully automated adaptive control of hyperglycaemia in critically ill patients.
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Bourne, Richard Stanley. "Melatonin, sleep and circadian rhythms in critical care patients". Thesis, University of Sheffield, 2009. http://etheses.whiterose.ac.uk/15108/.
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Critical care patients commonly experience sleep fragmentation, in which sleep quality is poor and distributed throughout the 24 hour cycle. This irregular sleep wake pattern is a form of circadian rhythm sleep disorder. The causes of sleep disturbances are multifactorial and contribute to patient morbidity. Conventional hypnotic treatment is often ineffective and, indeed, may cause delirium and reduced sleep quality. Administration of exogenous melatonin has been shown to re-enforce circadian rhythm disorders and improve sleep in other patient groups. An open evaluation of 5 mg oral melatonin was undertaken in a group of 12 critical care patients exhibiting sleep disturbances resistant to conventional hypnotics. Melatonin significantly increased observed sleep quantity by night 3, compared to baseline. An oral solution of melatonin was formulated to allow administration by enteral feeding tubes. It was shown to have a 1 year shelf life when refrigerated and protected from light. A randomised controlled trial was undertaken in 24 critical care patients weaning from mechanical ventilation. Melatonin 10 mg orally increased nocturnal bispectral index sleep quantity over nights 3 and 4 compared to placebo. Agreement of the other sleep measurement techniques with the bispectral index was poor. Actigraphy was not a useful measure of sleep in critical care patients and nurse observation overestimated sleep quantity. The clearance of melatonin appeared to be decreased in critical care patients compared to that in healthy subjects. Doses of 1-2 mg should be used in future critical care studies. 11 Acute administration of melatonin did not have a significant effect over placebo on rest-activity rhythms, which remained delayed, fragmented and reduced. Similar disturbances were present in plasma melatonin and cortisol rhythms, which were no longer phase locked. Melatonin therapy may prove beneficial in the treatment of sleep and circadian rhythms in critical care patients, and further larger studies should be pursued.
6
Kaczmarski, Lorelei Jean 1960. "Perceived needs of family members of critical care patients". Thesis, The University of Arizona, 1990. http://hdl.handle.net/10150/558127.
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Appel, Ilse Nadine. "Acquired infections in paediatric patients after cardiac surgery". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/19899.
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Introduction: Hospital acquired infections (HAIs) are an important cause of morbidity and mortality following paediatric cardiac surgery. Aim: To determine the incidence, risk factors for and outcome of postoperative HAIs in the Paediatric Intensive Care Unit (PICU) of the Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town. Methods: A prospective observational study of all postoperative cardiac patients admitted to PICU from September 2011 to March 2012. The definitions of laboratory confirmed blood stream infections (BSI), urinary tract infections (UTI), and surgical site infections were based on the Centres of Disease Control criteria. Ventilator associated pneumonia (VAP) was diagnosed using a modification of the Clinical Pulmonary Infection Score (CPIS). Results: 110 patients (median age 19 months; 43% male) undergoing 126 surgical procedures were enrolled. Sixty HAIs occurred in 43 (39%) patients (68.3% pulmonary; 13.3% blood; 11.7% wound; 3.3% urine; 3.3% tissue). Nine (8.2%) patients died and their deaths were not related to HAIs.
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Oswald, Sharon. "A retrospective case note analysis of the recognition and management of deteriorating patients prior to critical care admission". Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27289.
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This study explores the use of early warning scores (EWS) in deteriorating patients. These are widely used tools to measure vital signs and highlight abnormal physiology in acutely unwell patients. Measurements of the process in the management of the deteriorating patient includes time to first assessment of such patients. The level of clinician involved in the subsequent management is also investigated to determine whether escalation of care was appropriate. This work is a retrospective case note analysis of the recognition and management of deteriorating patients prior to critical care admission. Research Questions 1. What violations in the optimum process are associated with sub-optimal recognition and management of deteriorating patients and delayed critical care admission in patients triggering early warning scores in acute care wards? 2. Are there independent variables which can predict the delay in the recognition and management of deteriorating patients and subsequent critical care admission? Methods The literature was reviewed to determine the optimum process of recognition and management of deteriorating patients in acute care wards. A data collection tool was then specifically designed and locally validated to extract objective data from the case records. A sample of 157 patients admitted to critical care from acute wards over a 6 month period were included in the study. The case records were then retrospectively reviewed and information was extracted using the data collection tool. Results The accuracy and frequency of early warning scores were measured and findings demonstrated that 59% of Early Warning Scores (EWS) were miscalculated. The most frequent of those miscalculated were the intermediate scores (4 or 5) (error rate - 52%) followed by the higher scores (6 or more) (error rate - 32%). The least frequently miscalculated were the lower scores (0 -3) (error rate 15%). Descriptive data from the sample such as age, ward, diagnosis, time of hospital admission, time and day of transfer / EWS triggering were included. From the total case records reviewed, 110 patients had abnormal Early Warning Scores (4 or more) and were included in the inferential data analysis. The independent variables related to the processes objectively measurable in the recognition and management of deteriorating patients were included. After descriptive analysis the independent variables were cross-tabulated with the dependent variable using Pearson chi-square. The dependent variable was identified from the literature. This was whether time from triggering an abnormal EWS to critical care admission was delayed more than 6 hours. The subsequent predictor variables were then entered in to a binary logistic regression model for statistical analysis using SPSS version 21 software. Binominal Logistic Regression Analysis identified three significant variables predicting delay of the recognition and management of deteriorating patients. • Frequency of EWS measurement not increased appropriately • Length of stay prior to critical care admission 12-36 hours • If no consultant review during 6 hours of abnormal EWS Implications for Future Practice This study highlights areas of risk in the detection of patients’ clinical deterioration in acute wards. These findings should guide quality improvement to prevent unnecessary morbidity and mortality. As a key area of patient risk included the lack of frequency and accuracy of EWS measurements, staff education is required to ensure staff are given the appropriate knowledge to understand the use of the tool. Regular review of the frequency of measurement is also required as this was statistically significant in the delay to critical care admission. The high risk time from admission of 12-36 hours needs further investigation. This study also highlights the need for senior decision makers to be involved in the care of deteriorating patients to improve outcomes.
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Pattison, Natalie A. "Cancer patients' care at the end of life in a critical care environment : perspectives of families, patients and practitioners". Thesis, Northumbria University, 2011. http://nrl.northumbria.ac.uk/1009/.
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Innovations in cancer care requiring intensive support, and improved cancer patient survival in and out of critical care, have led to greater numbers of cancer patients than ever accessing critical care. Of these, however, a fair proportion will die. Current research points to around one in six patients dying in general critical care units and even higher numbers for cancer patients. End-of-life care (EOLC) for critically ill patients is problematic and rarely addressed beyond satisfaction or chart review studies, while palliative care is an established domain in cancer. It is not known whether dying, critically ill cancer patients experience good EOLC. In the context of a cancer critical care unit, this thesis explores the provision of EOLC for cancer patients in a critical care unit. Exploring measures for comfort care and palliative principles of care helped identify what is important for patients and families, and what those measures meant for all participants. The diagnosis of cancer and how it impacts on EOLC provision for critically ill cancer patients was also explored from the perspective of patients, families, doctors and nurses. A Heideggerian phenomenological interview approach was undertaken, in order to gain personal experiences. Families of those patients who died after decisions to forgo life-sustaining treatment (DFLSTs) were interviewed. Patients who have experienced critical care were also interviewed, since patients‘ views about EOL care provision are very rarely explored. Doctors and nurses also contribute their vision for, and experiences of, EOL care in a cancer critical care unit. Thirty one interviews with 37 participants were carried out. Cancer prognosis together with critical illness prognosis contributed to difficulties in deciding to move to, and enact EOLC. The nursing voice in DFLSTs was minimal and their role in EOLC depended on experience and confidence. Achieving a good death was possible through caring activities that made best use of technology to prevent prolonged dying. EOLC was an emotive experience. Decision-making and EOLC could be difficult to separate out which, in turn, affects prospects for EOLC. A continuum of dying in cancer critical illness is presented with different participants‘ experiences along that continuum. Three main themes included: Dual Prognostication; The Meaning of Decision-Making; and Care Practices at EOL: Choreographing a Good Death with two organising themes: Thinking the Unthinkable and Involvement in Care. These themes outlined the essence of moving along a continuum toward patients‘ deaths and the impact that had on opportunities for care and a good death. Nurses could use the care of patients dying in critical care as an opportunity to develop specialist knowledge and lead in care, but this requires mastery and reconciliation of both technology and EOLC. This work builds on Seymour‘s (2001) theory of a negotiated and natural death related to achieving a good death in critical care. Trajectories of dying, part of Seymour‘s (2001) theory, are extrapolated on with reference to Glaser and Strauss (1965) and Lofland (1978)‘s theories on dying trajectories. Nursing theory is developed through examination of Falk Rafael‘s (1996) and Locsin‘s (1998) theories of empowered caring. Implications and propositions are presented for nursing and wider practice around EOL care for critically ill cancer patients.
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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.
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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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Parlikar, Tushar Anil 1978. "Modeling and monitoring of cardiovascular dynamics for patients in critical care". Thesis, Massachusetts Institute of Technology, 2007. http://hdl.handle.net/1721.1/40859.
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Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2007.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Includes bibliographical references (p. 231-239).
In modern intensive care units (ICUs) a vast and varied amount of physiological data is measured and collected, with the intent of providing clinicians with detailed information about the physiological state of each patient. The data include measurements from the bedside monitors of heavily instrumented patients, imaging studies, laboratory test results, and clinical observations. The clinician's task of integrating and interpreting the data, however, is complicated by the sheer volume of information and the challenges of organizing it appropriately. This task is made even more difficult by ICU patients' frequently-changing physiological state. Although the extensive clinical information collected in ICUs presents a challenge, it also opens up several opportunities. In particular, we believe that physiologically-based computational models and model-based estimation methods can be harnessed to better understand and track patient state. These methods would integrate a patient's hemodynamic data streams by analyzing and interpreting the available information, and presenting resultant pathophysiological hypotheses to the clinical staff in an effcient manner. In this thesis, such a possibility is developed in the context of cardiovascular dynamics. The central results of this thesis concern averaged models of cardiovascular dynamics and a novel estimation method for continuously tracking cardiac output and total peripheral resistance. This method exploits both intra-beat and inter-beat dynamics of arterial blood pressure, and incorporates a parametrized model of arterial compliance. We validated our method with animal data from laboratory experiments and ICU patient data.
(cont.) The resulting root-mean-square-normalized errors -- at most 15% depending on the data set -- are quite low and clinically acceptable. In addition, we describe a novel estimation scheme for continuously monitoring left ventricular ejection fraction and left ventricular end-diastolic volume. We validated this method on an animal data set. Again, the resulting root-mean-square-normalized errors were quite low -- at most 13%. By continuously monitoring cardiac output, total peripheral resistance, left ventricular ejection fraction, left ventricular end-diastolic volume, and arterial blood pressure, one has the basis for distinguishing between cardiogenic, hypovolemic, and septic shock. We hope that the results in this thesis will contribute to the development of a next-generation patient monitoring system.
by Tushar Anil Parlikar.
Ph.D.
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Sheth, Mallory. "Predicting mortality for patients in critical care : a univariate flagging approach". Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/98560.
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Thesis: S.M., Massachusetts Institute of Technology, Sloan School of Management, Operations Research Center, 2015.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 87-89).
Predicting outcomes for critically ill patients is a topic of considerable interest. The most widely used models utilize data from early in a patient's stay to predict risk of death. While research has shown that use of daily information, including trends in key variables, can improve predictions of patient prognosis, this problem is challenging as the number of variables that must be considered is large and increasingly complex modeling techniques are required. The objective of this thesis is to build a mortality prediction system that improves upon current approaches. We aim to do this in two ways: 1. By incorporating a wider range of variables, including time-dependent features 2. By exploring different predictive modeling techniques beyond standard regression We identify three promising approaches: a random forest model, a best subset regression containing just five variables, and a novel approach called the Univariate Flagging Algorithm (UFA). In this thesis, we show that all three methods significantly outperform a widely-used mortality prediction approach, the Sequential Organ Failure Assessment (SOFA) score. However, we assert that UFA in particular is well-suited for predicting mortality in critical care. It can detect optimal cut-points in data, easily scales to a large number of variables, is easy to interpret, is capable of predicting rare events, and is robust to noise and missing data. As such, we believe it is a valuable step toward individual patient survival estimates.
by Mallory Sheth.
S.M.
13
McLean, Christopher Duncan. "Thinking about patients and talking about persons in critical care nursing". Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/349086/.
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Nursing scholarship and healthcare policy set an expectation that nurses should think about patients as persons. Nevertheless, the literature reveals that critical care nurses can struggle to perceive patients as persons, and thus suggests they may think about patients in different ways. This thesis presents the findings of an ethnographic study undertaken within one critical care unit in the United Kingdom which examined how critical care nurses do think about patients. A purposive sampling strategy recruited 7 participants representing both experienced and inexperienced critical care nurses. Data were collected over a period of 8 months during 2006 to 2007, and primarily comprised the field notes from 92 hours of participant observation supplemented by 13 tape recorded interviews. Data analysis was influenced by Foucault and Goffman and adopted the perspective of linguistic ethnography. Analysis revealed that all participants thought about patients in seven distinct ways: as ‘social beings’, as ‘valued individuals’, as ‘routine work’, as a ‘set of needs’, as a ‘body’, as ‘(un)stable’ or as a ‘medical case’. Accounts of participants’ practice revealed that they had a tacit understanding that these different ways of thinking related to aspects of one coherent whole, but no one way of thinking could be characterised as thinking about this ‘whole person’. Nurses could only think about one aspect of the patient at a time. Nurses’ practice was not guided or explained by their thinking about patients as persons, but rather expert practice was characterised by nurses’ fluid and appropriate movement between different ways of thinking about patients. When participants talked about their practice it was evident that these nurses could only legitimately talk about themselves as giving care to persons. Participants characterised some of the ways in which they had to think about patients as impersonal, and this actively hindered these nurses from describing or reflecting upon elements of their practice. There is therefore conflict and dissonance between nurses’ expectation that they should think about patients as persons, and the fact that delivering nursing care requires them to think about patients in different ways. The development of future critical care nurses will require practitioners and educators to recognise that nurses think about patients in different ways, and that expert practice is characterised by the clinical wisdom which enables nurses to think about patients in ways which are appropriate to the moment. Nurse scholars and educationalists should therefore avoid claims to a unique professional knowledge base which suggest to nurses that some ways of thinking are always inappropriate or inherently reductionist. Instead, there is a need for scholars and policy makers to articulate a vision of person centred care clearly, and in ways which avoid constructing dissonance between nurses’ ideals, and the ways in which they do and must think about patients.
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Rund, Joy E. J. "Investigation of diarrhoea in critically ill patients receiving enteral nutrition". Master's thesis, University of Cape Town, 1989. http://hdl.handle.net/11427/25541.
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The incidence and causes of diarrhoea among critically ill patients receiving enteral tube feeding were investigated. Sixty acutely ill surgical or medical intensive care patients who had had a minimum of 48 hrs bowel rest were entered into the study. They were randomly assigned to receive one of two lactose free liquid formula diets - "Ensure", a commercially available feed containing 825 kCal/L and 34 g/L of protein with an osmolality of 441mOsm/1 or "Casilan Oil", a home-made feed containing 840 kCal /L and 45g/L of protein with an osmolality of 383 mOsm/1. The feeds were administered by constant nasogastric infusion. Patients received 1000ml at a rate of 40ml per hour for the first day and up to 2000ml at 80 ml per hour for the remainder of the study period. Investigations included documentation of medical history, medications administered and clinical details for each patient. Serum albumin was measured and the nutritional status of each patient was assessed using anthropometric measurements. Feeds were tested for bacterial contamination on the three days following the start of feeding and small intestinal bacterial overgrowth was assessed by the 1 g-¹⁴C Xylose breath test of Toskes and King. Twelve of the sixty patients had to be withdrawn from the trial within 24 hours of the start of enteral feeding for medical reasons. The remaining forty eight patients completed at least three days on enteral feeding and thereby became eligible for analysis. In 10/48 patients (21%) diarrhoea was present before enteral feeding began. Four of these 1 O patients continued to pass loose stools when enteral feeding was started while the remaining 6 settled. Diarrhoea developed in a further 10 patients (21%) after enteral feeding began. The overall incidence of diarrhoea in the group of critically ill patients studied was therefore 42% (20/48). However, of the fourteen patients who experienced diarrhoea during enteral feeding four had diarrhoea before feeding began. Therefore, the true incidence of diarrhoea related to enteral feeding was only 10/38 (26%). Furthermore, in 7 of these 10 patients, another possible cause of diarrhoea was present. There was no significant association between diarrhoea and nutritional status, hypoalbuminaemia, sepsis, length of bowel rest, sucralfate and antibiotic therapy other than amikacin. Twenty one patients received Ensure and 27 received Casilan Oil. Despite the differences in the composition of the feeds, the incidence of diarrhoea was similar on the Ensure and the Casilan Oil. No particular factor pertaining to the composition of the feeds was associated with diarrhoea. Significant contamination of feeds was universal but there was no constant relationship between bacterial counts, or types, and the occurrence of diarrhoea. Certain other factors were found to be significantly associated with diarrhoea. Abdominal injury was positively associated with the occurrence of diarrhoea (p<0.05). Diarrhoea could have been attributed to the underlying disease state in 7 of the patients. All three patients who were receiving lactulose as treatment for liver failure developed diarrhoea. While no association was noted between diarrhoea and antibiotic therapy in general, treatment with the antibiotic, amikacin, correlated significantly, albeit marginally, with the occurrence of diarrhoea (p<0.05). Twenty six patients were tested for small intestinal bacterial overgrowth. Only one patient, with an elevated excretion of ¹⁴CO₂, indicative of small intestinal bacterial overgrowth, developed diarrhoea. There was, however, a positive association between diarrhoea and decreased excretion of ¹⁴CO₂. It would appear that the bacterial flora was suppressed in patients with diarrhoea. Amikacin therapy was also associated with decreased excretion of ¹⁴CO₂. This may suggest that amikacin could have altered the bowel flora with resultant development of diarrhoea. While abdominal injury and disease were associated with the development of diarrhoea and amikacin was a possible factor associated with diarrhoea, the results of the present study indicate that enteral tube feeding with either the commercial feed, Ensure or the home-made feed, Casilan Oil was not a cause of diarrhoea in the majority of critically ill patients assessed. Furthermore, in most patients who commenced the trial with diarrhoea, improvement was noted on enteral feeding.
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Martin, Kristy Ann. "The effect of earplugs on perceived sleep quality of acute care patients". Thesis, Montana State University, 2008. http://etd.lib.montana.edu/etd/2008/martin/MartinK0508.pdf.
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The purpose of this study was to evaluate the use of earplugs to improve perceived sleep quality in hospitalized patients. Sleep disruption is a common problem for hospitalized patients and has been shown to lead to physical and emotional complications. A variety of factors such as pain, illness, stress, worry, noise, lights and patient care activities contribute to disturbed sleep. Studies on sound in hospitals have shown that levels exceed recommendations by the Environmental Protection Agency. Limited research has shown that earplugs are a cost-effective, nonpharmacologic intervention with clinical usefulness to improve sleep quality. The study design was a quasi-experimental pilot study using a pre-test and post-test with the participants serving as their own control. Participants were recruited from a telemetry unit at St. Vincent Healthcare in Billings, Montana. The Verran and Snyder-Halpern Sleep Scales were selected to measure sleep quality. Ten participants were able to complete the two nights of study. The proposed hypothesis was supported for the sleep characteristic, soundness of sleep, with an improvement greater than 15 mm on the night with the ear plugs. Subjective findings identified positive comments with only one participant unable to tolerate the earplugs. The improvement in sleep was clinically significant for these participants. Hospitals should consider creating a sleep promotion policy and re-evaluating their night care practices. Earplugs could be included as an option for patients, and patients experiencing sleep difficulties should be encouraged to try earplugs. Further research is needed with a variety of populations and a large sample size. Research should also be done on nurses\' knowledge and beliefs regarding sleep and sleep interventions. This information could provide useful information on areas where additional education is needed.
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Saihi, Kaouther. "Computerized protocols for the supervision of mechanically ventilated patients in critical care". Thesis, Paris Est, 2014. http://www.theses.fr/2014PEST1164.
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Dans le secteur de la santé et particulièrement en unité des soins intensifs, diverses situations cliniques sont rencontrées et l'interprétation d'une grande quantité de données, y compris celles fournies par les équipements tels que moniteurs et ventilateurs, est exigée pour une prise de décision appropriée. La disparité entre cette quantité importante d'information et la capacité humaine limitée crée une variabilité inutile à la décision clinique. Pour faire face au problème, les experts médicaux ont défini des stratégies en vue de promouvoir une pratique fondée sur les données probantes. Cette méthode est devenue un standard pour la pratique clinique et a montré beaucoup d'avantages en menant à la définition de directives spécifiques ou des protocoles précis à appliquer dans certaines situations. Cependant, l'utilisation de directives/protocoles, particulièrement dans les soins intensifs, exige une participation continue des professionnels au chevet du malade et est ainsi difficile à appliquer en pratique clinique. La définition d'assistants informatisés est une solution technologique intéressante à explorer pour faciliter l'introduction des protocoles dans la routine clinique. En ventilation mécanique, on assiste à une prise de conscience croissante sur le potentiel de l'informatisation et son applicabilité au-delà de la recherche et plus concrètement dans le soutien du clinicien dans sa prise de décision quotidienne. Ceci à travers la prise en charge des tâches répétitives et la proposition de suggestions. Ce domaine constitue un environnement idéal pour de telles applications surtout que les ventilateurs de réanimation son aujourd'hui des équipements électroniques sophistiqués qui peuvent embarquer des protocoles informatisés. L'objectif de cette thèse était d'explorer les aspects de développement, déploiement et d'efficacité des « contrôleurs intelligents » en ventilation mécanique afin d'accélérer leur création et leur adoption. Pour examiner les phases de développement et de déploiement, nous nous sommes concentrés sur l'utilisation et l'extension du SmartCare®, une plateforme logicielle qui facilite l'automatisation des procédures thérapeutiques en ventilation mécanique à partir de la modélisation des connaissances expertes jusqu'à leur exécution en temps réel dans un équipement médical. A travers une approche ascendante, en se basant particulièrement sur notre expérience pratique dans le design de contrôleurs intelligents et après l'examen de divers contrôleurs existants, l'objectif était de définir un catalogue de pièces maitresses pour la représentation des protocoles en ventilation mécanique. L'utilisation d'une ontologie du domaine assure une formalisation saine de ces pièces.Sur base de cette approche, nous avons développé un contrôleur pour l'oxygénation testé au chevet du malade. Nous rapportons ses performances comparées à la pratique standardIn healthcare, especially in critical care, various clinical situations are encountered and a huge amount of data, including those provided by equipment such as monitors and ventilators, are required for an appropriate decision-making. The mismatch between this vast amount of information and the human capability creates unnecessary variability in clinical decision. To cope with this problem, medical experts have defined specific strategy called evidence based medicine. This method has become the standard of practice and showed many benefits by leading to the definition of specific guidelines or precise protocols to follow in specific situations. However, the use of guidelines/protocols, especially in critical care, requires the continuous involvement of professionals at the patient's bedside strongly limiting their application in practice. The introduction of computerized assistants for implementing such guidelines/protocols may be an interesting technological solution. In mechanical ventilation where various protocols are available there is a growing acceptance that such computerization might be useful beyond research, in assisting clinicians in their daily decision making by taking over some routine tasks or providing suggestions. Moreover, this domain constitutes an ideal environment because mechanical ventilators are presently powerful electronic equipments in which computerized protocols can be efficiently embedded. The objective of this thesis was to explore several aspects of the development, deployment, and effectiveness of computerized protocols or smart controllers in mechanical ventilation in order to accelerate their creation and adoption. For this purpose, we focused on the use and the extension of SmartCare®, a computer framework for the automation of respiratory therapy starting from clinical knowledge modelling to execution in real time of specific routines embedded into medical products [1]. Through a reengineering approach, from practical experience in smart controller design and investigation of existing controllers, the objective was to define a catalogue of building blocks to facilitate the creation of new controllers. The modeling of such blocks using dedicated domain ontology ensures a sound formalization. To prove the effectiveness of such a generic approach, we built a smart controller for oxygenation tested on the patient's bedside. We reported its performance compared to standard therapy
17
Ezennaya, Chidiogo. "Critical care Nurses Experiences of Taking Reports of Patients From Other Units". Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-21489.
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The critical care unit (CCU) is a unit where different health care professionals work together to care for the patient efficiently. A lot of studies in the past have shown that good communication and transfer of information from one health care professional to the other is an essential aspect in the transfer of a patients care. Most of these studies are concentrated on the reporter or informant. Lapses in communication and information transfer could result in unnecessary suffering both for the patient and for the health care worker. There are very few studies on how well the recipient of the information or report understands or comprehends the information passed. The aim of this study was to illuminate the critical care nurses (CCN) experiences of receiving report of patients transferred from other units. A qualitative design was chosen and five CCNs in a particular CCU were interviewed. The analysis was done using the content analysis method. The analysis resulted in four main categories which are: The patient’s situation-a determinant factor, the work environment, communication deficit creates uncertainty and structure enhances report and ten subcategories. The findings showed that CCNs' experience a feeling of uncertainty as a result of lapses in communication and their work environment and its attendant distractions has a great influence on the quality of the report they receive. To ensure a good quality of care that promotes patient’s safety and job satisfaction, it would be necessary to address the factors that hinder effective communication during handover in nurses' education programs and clinical practices.
18
Qaid, Rafa T. A. "Patients' and nurses' perspectives on patients' experience for coronary care unit stressors using a mixed method approach". Thesis, Brunel University, 2011. http://bura.brunel.ac.uk/handle/2438/6359.
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Background: Getting admitted to CCU is viewed as a stressful event by patients. However, numerous studies have indicated that nurses do not always accurately perceive the stressors of their clients. Therefore, it is important for nurses to know what seems most stressful from the patients‘ perspective so that appropriate nursing measures can be directed towards minimizing such stressors. Objectives: The purpose of this study was to explore the perception of CCU stressors experienced by patients from both patients and nurses perspective and to compare between them, identify the effect of socio-demographic characteristics of participant's on the level of stress perception and to what extent clinical guidelines fulfil CCU needs. Methodology: A mixed method approach (qualitative and quantitative) was applied. Purposive random sampling was used to recruit data. Ethical approval was obtained prior to data collection. Data was collected from three CCUs within the West and Northwest NHS Trusts. Participants who met the inclusion criteria were interviewed and asked to rank the Environmental Stressor Questionnaire (ESQ). Qualitative data was analyzed using Gorgi's method of analysis. A quantitative data was analyzed using the SPSS software version 15. Results: There was some consistency in the data where patients and nurses provided same ranking for CCU stressors. Consistently nurses ranked physiological stressors higher than psychological stressors. Patients showed consistency in the findings between what they ranked in the ESQ and their narratives more than their counterparts. Perception of stress was affected by participant's socio-demographic characteristics. A key finding is that the current guidelines do not serve patients and nurses needs. Conclusions: Nurses should be well equipped with knowledge and experience to overcome stressful situations. Educational programs should be made available for nurses to improve stress management. Nurses should assess patient's needs by applying effectively communication skills.
19
Berg, Agneta. "Glutamine to ICU patients /". Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-423-5/.
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Gibbons, Patric. "Follow Your Heart: Evaluating Cardiac Function to Predict Outcomes Among ICU Patients with Traumatic Brain Injury". eScholarship@UMMS, 2018. https://escholarship.umassmed.edu/gsbs_diss/977.
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Introduction: Traumatic Brain Injury (TBI) remains a significant public health burden in the United States. Persons afflicted with more severe TBIs are usually admitted to an ICU, where they are at risk for a number of complications throughout their hospitalization. Recent literature has attempted to describe such complications from a cardiovascular perspective as part of a “cardio-cerebral syndrome.” We described the frequency of cardiac complications in the ICU among patients with a TBI and compared patients with and without measured cardiac dysfunction. We investigated the potential impact of cardiac dysfunction on in-hospital mortality.
Methods: This was a retrospective review of a prospective cohort study in adult ICU patients with moderate-to-severe TBI (GCS≤12). We measured cardiac dysfunction using initial EKG echocardiography findings and peak serum troponin levels during hospitalization. Primary outcome was in-hospital mortality for patients with and without cardiac dysfunction using multivariable adjusted Cox Proportional Hazards Regression. Secondary outcomes examined the relationship between severity of brain injury and degree of cardiac dysfunction.
Results: Ordinal logistic regression showed patients with more indicators of cardiac injury were significantly more likely to have greater brain injury as reflected by lower GCS scores (OR 0.76; 95%CI 0.58-0.99). There was a significantly increased multivariable adjusted risk of dying for each increase in measured cardiac injury (HR 2.41; 95% CI 1.29-4.53).
Conclusions: Cardiac dysfunction was frequently observed in patients with TBI and we showed an association between increasing TBI severity and development of cardiac injury. Cardiovascular dysfunction was associated with an increased risk of in-hospital death. Adverse outcomes from TBI could potentially be mediated by cardiac injury, which could be used as a target for therapeutic intervention.
21
Ascencao, Cherie Je'Taime. "Exploring the implementation of post-operative interventions to prevent a paralytic ileus in abdominal surgery patients". Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/79318.
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Background: Critically ill abdominal surgery patients are at risk of developing a paralytic ileus. Multidisciplinary interventions aim to prevent post-operative complications in the intensive care unit; including interventions to prevent the development of a paralytic ileus. However, the implementation of preventative interventions occurs ad hoc and these high risk patients still develop a post-operative paralytic ileus.
Aim: The aim of the study was to explore the implementation of post-operative interventions used in the critical care unit to prevent a paralytic ileus in patients following major open abdominal surgery.
Research design and methods: A quantitative, exploratory retrospective research design was used to answer the research question. Patient medical records were retrieved from a specialised intensive care unit situated in a private hospital in Gauteng. A unit of analysis represented the study population and a sample frame was used for choosing patient medical files in the study. Data was collected using a data collection sheet developed from literature. Data was analysed using descriptive statistics (frequency tables, odds ratio, relative risks, Pearson Chi-square test and Fisher’s exact test).
Results and Conclusions: After data analysis, the results of the study were documented. Conclusions deducted from this study highlighted three significant interventions associated with the incidence of a post-operative paralytic ileus. Further research on these three interventions may possibly prevent a paralytic ileus in critically ill abdominal surgery patients in the future. Implementation of specific evidence-based post-operative interventions has been recommended to critical care providers of the private hospital group.Dissertation (MCur)--University of Pretoria, 2020.
Nursing Science
MCur (Nursing Sciences)
Unrestricted
22
Nuby, Sona. "Risk factors associated with acute kidney injury in patients who underwent cardiac surgery : a retrospective review". Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/79322.
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Background: Acute kidney injury occurs in one out of ten cardiac surgery patients. Cardiac surgery-associated acute kidney injury not only increases patients’ mortality rate but the length of stay in intensive care unit and hospital. Cardiac surgery patients’ long- term risk for chronic kidney disease and heart failure increases with the incidence of acute kidney injury. Various preoperative, intraoperative and postoperative risk factors are associated with the development of cardiac surgery-associated acute kidney injury.
Aim: The aim of the study was to identify the risk factors associated with acute kidney injury in patients who underwent cardiac surgery. The identified risk factors were categorized into modifiable, partially modifiable and non-modifiable risks. The frequency of acute kidney injury among cardiac surgery patients was also assessed.
Research design: The researcher chose a quantitative correlational retrospective design and conducted a retrospective chart review to assess the risk factors associated with AKI in patients that had undergone cardiac surgery.
Methods: Non-probability purposive sampling was used to select the records of patients that underwent cardiac surgery between January 2014 and December 2018. Data collection was done using a self-developed audit tool. Descriptive and inferential statistics were used for data analysis.
Significance: The study enabled the researcher to identify and categorize the risk factors into modifiable, partially modifiable and non-modifiable categories. Early recognition and mitigation of risk factors could prevent patients from developing cardiac surgery- associated acute kidney injury.
Research findings: The study found a 22.7% frequency of CSA-AKI. Anaemia, hypoalbuminemia, hyperglycaemia, use of N-acetylcysteine and fluid overload were identified as modifiable risk factors. Bicarbonate level <22mmol/L, use of diuretics, use of antibiotics, longer duration of surgery, fresh frozen plasma use >500ml on the day of surgery, red blood cell transfusion >1L on the day of surgery and prolonged use of mechanical ventilation were partially modifiable risk factors. No non-modifiable risk factors were identified.
Keywords: Cardiac surgery-associated acute kidney injury; risk factors; modifiable, partially modifiable and non-modifiable.Dissertation (MCur (Critical Care Nursing))--University of Pretoria, 2020.
Nursing Science
MCur (Critical Care Nursing)
Unrestricted
23
Garwood, Bruce. "Nurses' perceptions of caring for dying patients in critical care| A phenomenologic study". Thesis, University of Phoenix, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10240722.
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Dying with dignity in the critical care unit (CCU) is a difficult process to define and limited information is available to assist with that definition. The purpose of this descriptive phenomenological study was to explore the critical care nurses lived experiences of caring for the dying patient in CCU. Understanding nurses’ perceptions and lived experiences of the phenomena will contribute to nursing knowledge, new insights for nurse leaders, and the possible development of a nursing model to guide nurses who are providing care to the dying patient. A qualitative, descriptive phenomenological methodology was used to guide this study. Twelve critical care nurses were recruited and interviewed, exploring their lived experiences of caring for the dying patient in the critical care setting. Three board questions comprised the interview guide allowing each nurse an opportunity to share their lived experiences of caring for the dying patient. Five themes emerged from the data: communication, family, technology, lack of education, and dying with dignity. Recommendations included early discussions with patients and families regarding end-of-life wishes as well as, strategies for nurses providing end-of-life care. The study participants also noted the need for increased awareness and education for patients, families and health care providers regarding end-of-life care, dying with dignity, and palliative and hospice referrals. Community education was also noted as an integral part of the awareness process. For nurses and physicians, the education should start during their basic education program and continue throughout their career especially those working in high acuity areas in health care. As in life, death and dying are important aspects of all of health care providers. Facilitating quality end-of life care could relieve pain and suffering for the dying patient and assist family members with allowing their loved one, the patient to die with dignity.
24
Robinson, David J. M. D. "Antithrombotic Regimens and Need for Critical Care Interventions among Patients with Subdural Hematomas". University of Cincinnati / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1617107950021541.
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Morton, Ben. "An augmented passive immunotherapy for patients admitted to critical care with severe sepsis". Thesis, University of Liverpool, 2016. http://livrepository.liverpool.ac.uk/3004373/.
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Introduction: Antimicrobial resistance threatens to undermine treatment for severe infection; new therapeutic strategies are urgently needed. Pre-clinical work shows that augmented passive immunotherapy with P4 peptide increases phagocytic activity and shows promise as a novel therapeutic strategy. My aim was to determine how P4 peptide stimulation influenced ex vivo phagocytic cells from a target population of patients admitted to critical care with severe infection. Methods: Patients were prospectively recruited from two UK critical care units with severe sepsis. Clinical course was then observed (≥3 months post discharge). Blood samples were taken in early (≤48hrs post-diagnosis, n=54), latent (seven days post-diagnosis, n=39) and convalescent (3-6 months post-diagnosis, n=18) phases of disease. The primary outcome measure was killing of opsonised S.pneumoniae by neutrophils with and without P4 peptide stimulation. In addition, a flow cytometric whole blood phagocytosis assay was used to determine phagocyte association and oxidation of intraphagosomal reporter beads. Results: P4 peptide increased neutrophil killing of opsonised pneumococci by 8.6% (C.I. 6.35 . 10.76, p < 0.001) in all phases of sepsis, independent of infection source and microbiological status. This represented a 54.9% increase in bacterial killing compared to unstimulated neutrophils (15.6%) in early phase samples. Similarly, P4 peptide treatment significantly increased neutrophil and monocyte intraphagosomal reporter bead association and oxidation, independent of infection source. Conclusions: I have extended pre-clinical work to demonstrate that P4 peptide significantly increases phagocytosis and bacterial killing in samples from a target patient population with severe sepsis. This study supports the rationale for augmented passive immunotherapy as a therapeutic strategy in severe sepsis.
26
Kruger, Jeanne-Marié. "Efficacy and safety of acidified enteral formulae in tube fed patients in an intensive care unit /". Link to online version, 2006. http://hdl.handle.net/10019/564.
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Nickels, Marc. "Exercise interventions with critically ill patients in an Australian tertiary intensive care unit". Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/206174/1/Marc_Nickels_Thesis.pdf.
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This thesis investigated the physical impairments experienced by critically ill patients in intensive care. Clinicians’ perceptions regarding exercise with critically ill patients were explored, and medical records analysed to illustrate that despite clinicians’ positive perceptions regarding exercise, critically ill patients rarely completed exercise interventions whilst admitted to the intensive care unit. A preliminary randomised control trial was conducted that evaluated the effectiveness of an innovative in-bed cycling intervention. In-bed cycling with critically ill patients was found to be safe, feasible and acceptable to patients, families and clinicians. Promising patient outcomes were identified that justify a future multi-centre randomised control trial.
28
Khalil, Ashraf Khalil Abduni. "Perceptions of physiotherapists on their role in the management of intensive care patients in Khartoum, Sudan". University of the Western Cape, 2020. http://hdl.handle.net/11394/8082.
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Magister Scientiae (Physiotherapy) - MSc(Physio)The professional status of physiotherapists in Sudan is reported to be low even though the profession was established in Khartoum, Sudan in 1969. Intensive care units are operating in Khartoum, Sudan. Physiotherapists have been reported to be integral to the management of intensive care patients. Globally, the role of ICU physiotherapists in the management of ICU patients have been explored and described; however, this information is lacking for Khartoum, where the profession is still in its infancy. Therefore, this study aimed to explore and describe the physiotherapists’ perceptions of their role in the management of intensive care patients in Khartoum, Sudan.
2022
29
Binns, Michelle. "Factors associated with critical care nurses' communication with non-communicative patients in the ICU". FIU Digital Commons, 1998. http://digitalcommons.fiu.edu/etd/1680.
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Hospitalized individuals are isolated from their familiar environment at the onset of illness. Those individuals who are non-communicative are detached from the world and from life, as they previously knew it. Although nurses have long since recognized the importance of communication, patients still report the lack of iy. This study was done to identify factors influencing critical care nurses to communicate with their noncommunicative patients.
The overall results of the study indicate that nurses are aware of the importance of verbal communication with patients who may be intubated, paralyzed, unconscious, comatose or neurologically impaired and are not deterred by them. Despite these results, some significant observations emerged identified. CCRN certified nurses and nurses with more years of experience were less likely to have verbal communication with noncommunicative patients. Nurses with children, spouses and those working full-time were more likely to communicate with non-communicative patients.
30
Coetzee, Saskia. "A retrospective review of patients admitted to the Paediatric ICU at Red Cross War Memorial Children's Hospital during 2010 with the clinical diagnosis of measles or measles-related complications". Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/6017.
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Johnson, Patricia Lee, i n/a. "Being At Its Most Elusive: The Experience of Long-Term Mechanical Ventilation in a Critical Care Unit". Griffith University. School of Nursing, 2003. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20030926.154232.
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This research study explored the meanings former patients attributed to being on long-term mechanical ventilation in a critical care unit (CCU). An interpretive phenomenological-ontological perspective informed by the philosophical tenets of Heidegger (1927/1962) was used to examine the lived experience of a group of people who had previously been hospitalised in one of three critical care units in southeast Queensland, Australia, during which time they were on a mechanical ventilator for a period of seven days or more. Data were collected using 14 unstructured audio-taped interviews from participants, who had indicated that they were willing and able to recall aspects of their critical care experience. The data were analysed using the method developed by van Manen (1990). A total of nine people participated in the study, of which six were male and three female. Their ages ranged from 21 to 69 years. Thematic analysis of the data revealed four themes: Being thrown into an uneveryday world; Existing in an uneveryday world; Reclaiming the everyday world; and Reframing the experience. Throughout the description of these themes, excerpts from the interviews with the participants are provided to demonstrate, and bring to light the meaning and interpretations constructed. From this thematic analysis, a phenomenological description drawing on Heidegger's tenets of Being was constructed. Titled Being at its most elusive, this description showed that participants experienced momentary lapses of: situation, engagement, concern and care, temporality, and the ability to self-interpret. These findings highlight and affirm the relevance of Heidegger's ontological tenets to reveal Being. The findings of this study served as a basis for a number of recommendations relating to nursing practice, education and research. Recommendations relating to practice include: constructing a more patient-friendly critical care environment, increased involvement of patients and their families in decision making and patient care activities; ensuring adequate critical care nursing staff levels; ensuring and maintaining appropriate skill level of critical care nurses; enhancing methods of communication with patients; planning for effective patient discharge and adoption of a designated nurse position for discharge planning; providing opportunities for follow up contact of patients once they are discharged from CCU; and promoting the establishment of follow up services for former CCU patients, and their families. Recommendations relating to critical care education include: incorporating more in-depth information of the psychological and social aspects of patient and family care into care planning; incorporating communication and counselling education and training to assist nurses caring for mechanically ventilated patients, and their families; further education regarding the role and responsibilities of patient discharge planning from CCU; incorporating more advanced research skills training and utilisation of research findings into practice; and the provision of appropriate and ongoing training and education in areas such as manual handling and communication skills for all health care staff involved in the direct care of CCU patients. This study also recommended that further research be undertaken to: examine and compare different sedative and analgesic protocols and their effects on the incidence of nightmares and hallucinations reported by CCU patients; replicate this study in a group of patients from different cultural or ethnic backgrounds; evaluate the efficacy of current methods for communicating with intubated and mechanically ventilated patients in the CCU; develop, test and evaluate the efficacy of new methods for communicating with intubated and mechanically ventilated patients in the CCU; examine CCU patients' perceived level of control and power; explore the extent and type of involvement patients would like to have in their care whilst in the CCU; investigate the extent and type of problems experienced by CCU patients after discharge; explore the usefulness and appropriateness of personal diaries for individual patients as an aid to assist in understanding and resolving their CCU experience; and examine the value of follow up contacts by CCU staff to former patients and their families. In summary, the findings from this study add substantial knowledge to critical care nurses' understanding and knowledge about what it means to be on long-term mechanical ventilation in a critical care unit. Findings will help inform future critical care nursing practice and education, and the provision of holistic and evidenced-based care.
32
Johnson, Patricia Lee. "Being At Its Most Elusive: The Experience of Long-Term Mechanical Ventilation in a Critical Care Unit". Thesis, Griffith University, 2003. http://hdl.handle.net/10072/368088.
Pełny tekst źródłaStreszczenie:
This research study explored the meanings former patients attributed to being on long-term mechanical ventilation in a critical care unit (CCU). An interpretive phenomenological-ontological perspective informed by the philosophical tenets of Heidegger (1927/1962) was used to examine the lived experience of a group of people who had previously been hospitalised in one of three critical care units in southeast Queensland, Australia, during which time they were on a mechanical ventilator for a period of seven days or more. Data were collected using 14 unstructured audio-taped interviews from participants, who had indicated that they were willing and able to recall aspects of their critical care experience. The data were analysed using the method developed by van Manen (1990). A total of nine people participated in the study, of which six were male and three female. Their ages ranged from 21 to 69 years. Thematic analysis of the data revealed four themes: Being thrown into an uneveryday world; Existing in an uneveryday world; Reclaiming the everyday world; and Reframing the experience. Throughout the description of these themes, excerpts from the interviews with the participants are provided to demonstrate, and bring to light the meaning and interpretations constructed. From this thematic analysis, a phenomenological description drawing on Heidegger's tenets of Being was constructed. Titled Being at its most elusive, this description showed that participants experienced momentary lapses of: situation, engagement, concern and care, temporality, and the ability to self-interpret. These findings highlight and affirm the relevance of Heidegger's ontological tenets to reveal Being. The findings of this study served as a basis for a number of recommendations relating to nursing practice, education and research. Recommendations relating to practice include: constructing a more patient-friendly critical care environment, increased involvement of patients and their families in decision making and patient care activities; ensuring adequate critical care nursing staff levels; ensuring and maintaining appropriate skill level of critical care nurses; enhancing methods of communication with patients; planning for effective patient discharge and adoption of a designated nurse position for discharge planning; providing opportunities for follow up contact of patients once they are discharged from CCU; and promoting the establishment of follow up services for former CCU patients, and their families. Recommendations relating to critical care education include: incorporating more in-depth information of the psychological and social aspects of patient and family care into care planning; incorporating communication and counselling education and training to assist nurses caring for mechanically ventilated patients, and their families; further education regarding the role and responsibilities of patient discharge planning from CCU; incorporating more advanced research skills training and utilisation of research findings into practice; and the provision of appropriate and ongoing training and education in areas such as manual handling and communication skills for all health care staff involved in the direct care of CCU patients. This study also recommended that further research be undertaken to: examine and compare different sedative and analgesic protocols and their effects on the incidence of nightmares and hallucinations reported by CCU patients; replicate this study in a group of patients from different cultural or ethnic backgrounds; evaluate the efficacy of current methods for communicating with intubated and mechanically ventilated patients in the CCU; develop, test and evaluate the efficacy of new methods for communicating with intubated and mechanically ventilated patients in the CCU; examine CCU patients' perceived level of control and power; explore the extent and type of involvement patients would like to have in their care whilst in the CCU; investigate the extent and type of problems experienced by CCU patients after discharge; explore the usefulness and appropriateness of personal diaries for individual patients as an aid to assist in understanding and resolving their CCU experience; and examine the value of follow up contacts by CCU staff to former patients and their families. In summary, the findings from this study add substantial knowledge to critical care nurses' understanding and knowledge about what it means to be on long-term mechanical ventilation in a critical care unit. Findings will help inform future critical care nursing practice and education, and the provision of holistic and evidenced-based care.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing
Full Text
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Lin, Jessica. "Robust Modelling of the Glucose-Insulin System for Tight Glycemic Control of Critical Care Patients". Thesis, University of Canterbury. Mechanical, 2007. http://hdl.handle.net/10092/1570.
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Hyperglycemia is prevalent in critical care, as patients experience stress-induced
hyperglycemia, even with no history of diabetes. Hyperglycemia has a significant
impact on patient mortality, outcome and health care cost. Tight regulation
can significantly reduce these negative outcomes, but achieving it remains clinically
elusive, particularly with regard to what constitutes tight control and what
protocols are optimal in terms of results and clinical effort.
Hyperglycemia in critical care is not largely benign, as once thought, and has
a deleterious effect on outcome. Recent studies have shown that tight glucose
regulation to average levels from 6.1–7.75 mmol/L can reduce mortality 17–45%,
while also significantly reducing other negative clinical outcomes. However, clinical
results are highly variable and there is little agreement on what levels of
performance can be achieved and how to achieve them.
A typical clinical solution is to use ad-hoc protocols based primarily on experience,
where large amounts of insulin, up to 50 U/hr, are titrated against
glucose measurements variably taken every 1–4 hours. When combined with the
unpredictable and sudden metabolic changes that characterise this aspect of critical
illness and/or clinical changes in nutritional support, this approach results
in highly variable blood glucose levels. The overall result is sustained periods
of hyper- or hypo- glycemia, characterised by oscillations between these states,
which can adversely affect clinical outcomes and mortality. The situation is exacerbated
by exogenous nutritional support regimes with high dextrose content.
Model-based predictive control can deliver patient specific and adaptive control,
ideal for such a highly dynamic problem. A simple, effective physiological
model is presented in this thesis, focusing strongly on clinical control feasibility.
This model has three compartments for glucose utilisation, interstitial insulin and its transport, and insulin kinetics in blood plasma. There are two patient
specific parameters, the endogenous glucose removal and insulin sensitivity. A
novel integral-based parameter identification enables fast and accurate real-time
model adaptation to individual patients and patient condition.
Three stages of control algorithm developments were trialed clinically in the
Christchurch Hospital Department of Intensive Care Medicine. These control
protocols are adaptive and patient specific. It is found that glycemic control utilising
both insulin and nutrition interventions is most effective. The third stage of
protocol development, SPRINT, achieved 61% of patient blood glucose measurements
within the 4–6.1 mmol/L desirable glycemic control range in 165 patients.
In addition, 89% were within the 4–7.75 mmol/L clinical acceptable range. These
values are percentages of the total number of measurements, of which 47% are
two-hourly, and the rest are hourly. These results showed unprecedented tight
glycemic control in the critical care, but still struggle with patient variability and
dynamics.
Two stochastic models of insulin sensitivity for the critically ill population
are derived and presented in this thesis. These models reveal the highly dynamic
variation in insulin sensitivity under critical illness. The stochastic models can deliver
probability intervals to support clinical control interventions. Hypoglycemia
can thus be further avoided with the probability interval guided intervention assessments.
This stochastic approach brings glycemic control to a more knowledge
and intelligible level.
In “virtual patient” simulation studies, 72% of glycemic levels were within
the 4–6.1 mmol/L desirable glycemic control range. The incidence level of hypoglycemia
was reduced to practically zero. These results suggest the clinical
advances the stochastic model can bring. In addition, the stochastic models reflect
the critical patients’ insulin sensitivity driven dynamics. Consequently, the
models can create virtual patients to simulated clinical conditions. Thus, protocol
developments can be optimised with guaranteed patient safety.
Finally, the work presented in this thesis can act as a starting point for many
other glycemic control problems in other environments. These areas include the
cardiac critical care and neonatal critical care that share the most similarities to
the environment studied in this thesis, to general diabetes where the population is growing exponentially world wide. Furthermore, the same pharmacodynamic
modelling and control concept can be applied to other human pharmacodynamic
control problems. In particular, stochastic modelling can bring added knowledge
to these control systems. Eventually, this added knowledge can lead clinical
developments from protocol simulations to better clinical decision making.
34
Baumhover, Nancy Catherine. "The Process of Death Imminence Awareness by Family Members of Patients in Adult Critical Care". Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/311478.
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Quality end-of-life care in the adult critical care remains a high priority for numerous professional agencies and organizations due to advanced technologies that sustain or extent life, regardless of life quality. The purpose of this study was to describe how family members of patients in adult critical care attain awareness that their loved one is dying or near death in the adult critical care setting. Two research questions were addressed: 1) What is the human-environment health process of knowing that end-of-life is imminent by family members of patients in the adult critical care area?, and 2) What factors influence the human-environment health process of knowing that end-of-life is imminent by family members in the adult critical care area? A Glaserian grounded theory design was utilized to conduct this retrospective study. Both primary (interviews) and secondary (poem, nursing art, song, media and film) data sources supported the emerging theory. The Process of Death Imminence Awareness by Family Members of Patients in Adult Critical Care contained six phases: Patient's Near Death Awareness, Dying Right in Front of Me, Turning Points in the Patient's Condition, No Longer the Person I Once Knew, Doing Right by Them, and Time to Let Go. Influencing factors associated with this process were discussed as process facilitators and hindrances. Supportive nursing behaviors and actions as well as family member's emotional, behavioral, and physical reactions to having a critically ill family member were also discussed. This substantive theory will guide nursing education, practice, and research in the creation of nursing interventions, instrumentation, protocols, and policies and procedures aimed at providing cost effective quality end-of-life care in this specialized area of care.
35
Pather, Priscilla. "Incidence and measurement of incontinence-associated dermatitis in adult intensive care patients". Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/115804/1/Priscilla_Pather_Thesis.pdf.
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This thesis investigated how many critically ill patients in intensive care intensive care (ICU) in a single Australian metropolitan hospital developed incontinence-associated dermatitis (IAD). It also determined the severity of IAD using a newly developed IAD categorisation tool, the time to onset to IAD development, the association between IAD and faecal incontinence and diarrhoea, the association between patient characteristics and IAD development and severity and the association between disposable faecal containment devices and clean-up products with the development of IAD. It provides a benchmark for IAD exploration in the intensive care setting.
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Hayes, Michelle Amanda. "Elevated oxygen delivery and consumption compared with normal haemodynamics as targets for treatment in high risk intensive care patients". Thesis, Queen Mary, University of London, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297188.
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Natt, B. S., J. Malo, C. D. Hypes, J. C. Sakles i J. M. Mosier. "Strategies to improve first attempt success at intubation in critically ill patients". OXFORD UNIV PRESS, 2016. http://hdl.handle.net/10150/622528.
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Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first attempt success the goal for airway management in these patients. Patient-related factors often make visualization of the airway and placement of the tracheal tube difficult. Physiologic derangements reduce the patient's tolerance for repeated or prolonged attempts at laryngoscopy and, as a result, hypoxaemia and haemodynamic deterioration are common complications. Operator-related factors such as experience, device selection, and pharmacologic choices affect the odds of a successful intubation on the first attempt. This review will discuss the 'difficult airway' in critically ill patients and highlight recent advances in airway management that have been shown to improve first attempt success and decrease adverse events associated with the intubation of critically ill patients.
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O’Brien, Jennifer L. "Comparison of anxiety assessment between patients and their clinicians in acute myocardial infarction patients hospitalized in the cardiac critical care unit". The Ohio State University, 2000. http://rave.ohiolink.edu/etdc/view?acc_num=osu1191535019.
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O'Brien, Jennifer L. "Comparison of anxiety assessment between patients and their clinicians in acute myocardial infarction patients hospitalized in the cardiac critical care unit /". Connect to resource, 2000. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1191535019.
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Pryor, James Russell. "Improving Sepsis Care for Non-Critical Care Hospitalized Patients by Using the Three Hour Treatment Bundle from the Surviving Sepsis Campaign". Thesis, Brandman University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10253593.
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Purpose: The purpose of this clinical scholarly project was to plan and execute a sepsis education presentation on identifying sepsis and using the three hour treatment bundle from the Surviving Sepsis Campaign to treat sepsis. The target audience is non-critical care inpatient nurses in a medium sized acute care community hospital.
Methods: Nurses were assigned a course over HealthStream, a web-based platform, which included the presentation along with a pre-test and post-test, and a consent statement to have their score reports analyzed. A descriptive analysis of group pre-test and post-test scores, compliance with completing each component of the three hour treatment bundle, sepsis mortality, and sepsis length of stay was completed.
Findings: There were 586 nurses who completed the course. A total of 172 nurses consented to having their test scores analyzed. The same test was used for the pre-test and the post-test. Overall, the mean test score for the pre-test was 75% and the mean post-test score was 92.6%. Completion compliance with each of the four components of the three hour treatment bundle increased in the 90 days following the education. Unfortunately, sepsis mortality and sepsis length of stay increased in the 90 days following the education using an outcome/expected variance ratio.
Conclusions: This project increased the post-test scores over pre-test scores. There was a linear relationship between increased post-test scores and at least one component (initial lactate vii measurement) of the three hour treatment bundle. There were confounding factors that might contribute to increased compliance of the treatment bundles. This method of education delivery proved useful for one person to provide education to a large group of nurses over a short period of time and allowed for the nurses to complete the course when they had time to do so.
Recommendations: This project should be expanded to include other areas of the hospital such as wound care, surgery clinic, emergency department, and other outpatient areas. In addition, the program could be modified for critical care unit nurses to include training on the six hour treatment bundle which focuses on critical care interventions.
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Fok, Sin Mai. "Self-care in patients undergoing renal replacement therapy : a critical evaluation of the application of Orem's self-care model of nursing". Thesis, Glasgow Caledonian University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.341696.
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Abdul, Razak Normy Norfiza. "Robust Modelling of the Glucose-Insulin System for Tight Glycaemic Control of Less Critical Care Patients". Thesis, University of Canterbury. Department of Mechanical Engineering, 2012. http://hdl.handle.net/10092/7039.
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In the intensive care units, hyperglycaemia among the critically ill is associated with poor outcomes. Many studies have been done on managing hyperglycaemia
in the critically ill. Patients in the ICU continue to benefit from the outcome of extensive studies including several randomized clinical trials on glycaemic control
with intensive insulin therapy. Tight glycaemic control has now emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and cost. Although the debate on tight glycaemic control is
on going, managing glycaemic level in ICUs is gaining widespread acceptance as the adverse effects are well known. However, in the less acute wards, to date there have only been a single randomized, controlled study to examine the
benefit of glycaemic control. Patients in the less acute wards do not receive the same level of care, as glycaemic control is not regarded as important and not a priority. Glycaemic goals in the less acute wards are often judged based on clinical experience rather than adhering to a standard protocol or a treatment guideline. It is important that patients in the less acute wards received the level of care as practised in the ICU. If hyperglycaemia worsens outcome in the ICU, a similar effect is seen within less acute wards. Hence, tight glycaemic control needs to be
extended in the less critical setting as well. To support the establishment of a control protocol for patients in less acute wards, a method that has been successful in the critical care and can be adapted to the less acute wards, is the model based or model-derived control protocol. Model-based protocol can deliver a safe and effective patient-specific control, which means the glycaemic control protocol
can be devised to each individual patient. Hence, a physiological model that represents the glucose-insulin regulatory system is presented in this thesis. The
developed model, Intensive Control Insulin-Nutrition-Glucose (ICING) is based on the best aspects of two previous clinically-validated glucose-insulin models.
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Mooi, Nomaxabiso Mildred. "Investigating the provision of nutritional support to critically ill hospitalised patients by registered nurses in East London public and private hospitals in the Eastern Cape". Thesis, University of Fort Hare, 2014. http://hdl.handle.net/10353/d1015533.
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Critical illness is typically associated with a catabolic stress state in which patients commonly demonstrate a systemic inflammatory response that brings about changes in their body systems. Changes in the body systems make the critically ill dependent on mechanical ventilation and inotropic support for longer periods in order to survive. However, this inflammatory response can be attenuated by the timely introduction of nutritional support to provide energy and nutrients to diminish catabolism and promote anabolism. The result could be a decrease in the morbidity and mortality rates, as well as the financial burden on the patients, institutions and the state. Since registered nurses initiate and utilise feeding protocols to achieve target goals, there is a strong need for nurse-initiated feeding protocols. These protocols should be coupled with a comprehensive nurse-directed nutritional educational intervention that will focus on their safe and effective implementation. This focus on nursing nutrition education represents a major shift away from traditional education which has focused on dietitians and physicians. Evidence suggests that incorporating guideline recommendations into nurse-initiated protocols for starting and advancing enteral feedings is an effective strategy to improve the delivery of nutritional support. The study was aimed at exploring the provision of nutritional support to critically ill hospitalised patients by registered nurses to identify and describe possible gaps in the practice, through determining the potential relationship between the provision of nutritional support and characteristics of its providers. A quantitative, descriptive correlational study was undertaken. Seventy registered nurses working in neonatal/paediatric and adult critical care units in two public and three private hospitals in East London in the Eastern Cape participated in the study. The sample also included public critical care students. The results showed that registered nurses in private hospitals have more knowledge about the importance of nutritional support than their public hospital counterparts and students. The mean score was on the question was 80.3% with the highest score of 91% which was for the private hospital nurses, followed by 77.2% for public and 71.4% for students. Again, the mean score for knowledge on timing of initiating nutritional support was 48%, the highest score being 69.4% for students followed by private hospital nurses with 49.6%. Close to 63% (n = 44) of these nurses were either unsure about the availability of nutritional protocols or clearly attested to their non-availability. This is seen as an issue of concern because a protocol is meant to be a standard document with which all members of the ICU should be familiar. It is meant to guide and facilitate the manner of working in the unit. While facilitation of maintenance of nutritional support to patients is the responsibility of registered nurses, according to Regulation 2598(1984) section 45 (1) (q) of the South African Nursing Council, 68% (n = 48) of the respondents felt that this was in the practising scope of doctors and dietitians. The study concluded that the nurses are knowledgeable about the importance of nutritional support but knowledge gaps have been identified as far as the timing of initiating nutritional support is concerned. Some attested to unavailability of standard guidelines that are tailored into protocols guiding the provision of nutritional support by registered nurses in the critical care units. Nutrition should be prioritised as an important therapy for improving the outcomes of critically ill patients. Nurses need to analyse its provision, identify barriers to nutritional strategies and engage in nutritional education to empower themselves regarding the practice. Most importantly, there is a need for nurse-initiated nutritional protocols that are tailored from the broad nutritional guidelines and aligned with the local context and ways of practising. Nutritional support should be included as a key component of the curriculum in academic programmes that specialise in critical care nursing.
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Knapp, Sandra. "Effects of an Evidence-Based Intervention on Stress and Coping of Families of Critically ill Trauma Patients". Doctoral diss., University of Central Florida, 2009. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2952.
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Problem/Purpose: Critical care nurses are frequently exposed to the stress experienced by their patients' families, yet they often do not have the knowledge or skills to help family members cope with the stress of critical illness. While needs and stressors of families of the critically ill have been researched extensively, no prior studies have been conducted to determine the effects of an evidence-based nursing intervention for reducing family members' stress and improving their coping skills. The purpose of this study was to determine if an evidence-based nursing intervention designed to address the needs of family members would reduce stress and improve coping skills in family members of critically ill trauma patients. Additionally, the study assessed the family members' perceptions of how well their needs were met while their loved one was hospitalized in the surgical intensive care unit (SICU). Methods: Using a quasi-experimental, nonequivalent control group design, an evidence-based intervention for critical care nurses was implemented to test its effect on stress and coping of family members of critically ill trauma patients. The study setting was the SICU at a tertiary university hospital in north central Florida. Subjects were family members of critically ill trauma patients who had been hospitalized in the SICU for at least 48 hours. Participants in the control group were given a packet containing instruments that measured 1) anxiety as an indicator of stress (Spielberger's State-Trait Anxiety Inventory ); 2) coping (Lazarus and Folkman's Ways of Coping Questionnaire ); and 3) assessment of family members' perception of having their needs met while their family member was in the SICU (Family Care Survey ). An evidence-based family bundle was implemented over an eight-week period and included an educational program for the nurses. After eight weeks, participants in the experimental group were given the same instruments previously administered to the control group. Anxiety levels, coping skills, and family members' perception of having needs met were compared between the two groups to determine the effectiveness of the evidence-based intervention. Results: A total of 84 family members participated in the study (control = 39; experimental = 45). The majority were women (n=60), spouse or parent of the patient (n=47), and Caucasian (n=70). Mean ages were 45.9 years for the control group and 47.4 years for the experimental group. No differences were noted in the demographic characteristics between the control and experimental groups. Using an independent samples t-test, no significant differences (p > .05) were noted between groups for either state or trait anxiety, although the mean anxiety score was lower in the experimental group. Significant differences between groups were noted on two of the eight coping subscales: Distancing and Accepting Responsibility. Improved coping, although not statistically significant, was noted on four additional subscales: Confrontive Coping, Self-Controlling, Planful Problem-Solving, and Positive Reappraisal. Overall coping scores also improved, but not statistically, for the total Ways of Coping Scale (both 50 and 66 item totals). Although not statistically significant, participants in the experimental group rated four out of eight items higher on the FCS, indicating an increased perception that more of their needs were met, greater overall satisfaction with the care that family members received, increased nurses' consideration of family members' needs and the inclusion of those needs in planning nursing care, and greater encouragement for family members to participate in care. Although findings were not statistically significant, the trend implies increased satisfaction with family care in areas involving family care and family member needs, including needs in planning care and encouragement to participate in care. In areas regarding information and communication, there was overall less satisfaction in both groups. Conclusions: This study provides data that can be used as a guide in developing programs that help families function and adapt to the extremely stressful experience of having a loved one who is critically ill. The information can be used to develop future research on larger scales with a longer and more extensive plan for implementation of the intervention to assist in a unit culture change. Nurses can use the results to facilitate practice changes in caring for families of critically ill patients. Modifying the interventions to focus on an interdisciplinary approach to meet families' needs, reduce stress, and improve coping also warrants further development and testing. Funding acknowledgement: Florida Nurses Foundation and the American Association of Critical Care Nurses. College of Nursing, University of Central FloridaPh.D.
School of Nursing
Other
Nursing PhD
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Claridge, Jeffrey A. "The Development of SIC-IR© to Assist with Diagnosing Infections in Critically Ill Trauma Patients: Moving Beyond the Fever Workup". Cleveland, Ohio : Case Western Reserve University, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=case1213634730.
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Gilson, Sheryl L. "Promoting Early Mobility of Patients in the Intensive Care Unit". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6433.
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Deconditioning occurs in critically ill patients as early as 4 days after entering the intensive care unit (ICU) resulting in a loss of up to 25% peripheral muscle tone and 18% body weight by the time the patient is discharged. Early mobility (EM) has been shown to reduce complications such as neuromuscular weakness, muscle wasting, pneumonia, and the effects of prolonged periods of time on the ventilator. No formal education on EM had been provided to nurses at the clinical site. The purpose of this project was to develop an educational program on EM to promote early ambulation of critically ill ICU patients. The theory of knowledge to action was used to guide the development of the educational program. The practice-focused question addressed whether an educational program would improve nurses' perceptions of their knowledge of EM and if they would promote the use of EM among ICU patients. After a literature review to identify evidence-based practices and a protocol on EM, an educational program was developed that included a 25-item Likert-style pretest and posttest to measure percent agreement with perceptions of knowledge gained and likelihood of behavior change related to the practice of EM. Participants included 60 ICU nurses. Results demonstrated improvement in perceptions of knowledge of EM (from 74% before education to 88% after) and in likelihood of behavior change related to EM (from 69% before education to 91% after). Findings may be used to integrate EM into the ICU setting to reduce complications such as neuromuscular weakness, muscle wasting, and pneumonia. Results may also include improved patient outcomes, reduced length of stay, and increased quality of life for patients and their families, and thereby promote positive social change.
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McMoon, Michelle. "Patients' Perceptions of Quality of Life and Resource Availability After Critical Illness". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7558.
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Physical, psychological, and social debilities are common among survivors of critical illness. Survivors of critical illness require rehabilitative services during recovery in order to return to functional independence, but the structure and access of such services remains unclear. The purpose of this qualitative study was to explore the vital issues affecting quality of life from the perspective of critical illness survivors and to understand these patients' experiences with rehabilitative services in the United States. The theoretical framework guiding this study was Weber's rational choice theory, and a phenomenological study design was employed. The research questions focused on the survivors' experiences with rehabilitative services following critical illness and post-intensive care unit quality of life. Participants were recruited using purposeful sampling. A researcher developed instrument was used to conduct 12 semistructured interviews in central North Carolina. Data from the interviews were coded for thematic analysis. The findings identified that aftercare lacked unity, was limited by disparate information, and overuses informal caregivers. In addition, survivors' recovery depended on being prepared for post-intensive care unit life, access to recovery specific support structures, and the survivors' ability to adapt to a new normalcy. Survivors experienced gratitude for being saved, which empowered them to embrace new life priorities. The implications for social change include improved understanding of urgently needed health care policies to provide essential therapies and services required to support intensive care unit survivors on their journey to recovery.
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Corbett, Gina M. "The Corbett Pain Scale : a multidimensional pain scale for adult intensive care patients /". VCU Scholars Compass, 2006. http://hdl.handle.net/10156/1432.
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McCulloch, Corrienne. "Critical Care Diaries : a qualitative study exploring the experiences and perspectives of patients, family members and nurses". Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/25735.
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This thesis describes a qualitative study exploring the use of critical care diaries from the experiences and perspectives of patients, family members and nurses in a Scottish Intensive Care Unit (ICU). Diaries are currently used in some ICUs across Europe, the UK, Australia and other countries to help patients come to terms with the experience of critical illness. Started in the ICU, the diary is written at the bedside by nurses and family members providing an account of what happened when the patient was in ICU. Following discharge, the diary is handed over to the patient for them to read and refer to during their recovery. Therefore, the diary is used by different people, at different times and in different ways throughout the critical illness journey. However, until recently, research has mainly focused on the diary being read by the patient after ICU as an aid to recovery with little known about family members and nurses despite them being the main authors during the time in ICU. This doctoral research was designed to explore critical care diaries from multiple perspectives and experiences to gain a greater understanding of the different ways in which diaries can be used. Furthermore, it is the first known research study in this area to have been undertaken in NHS Scotland where the use of diaries remains a relatively new practice. The theoretical perspective of Symbolic Interactionism helped to inform the development and design of the research study. A focused ethnographic approach was taken to explore the use of critical care diaries from the different groups identified, during and after a stay in ICU. The setting was an Adult ICU in Scotland where diaries were being used as part of a follow up service for patients and family members after ICU. Data were collected from February 2013 to June 2014. Semi-structured interviews were the main method of data collection. A purposive sampling strategy was adopted to recruit participants in triads with a related patient, family member and nurse involved in their care during the time in ICU. This is a novel and unique approach to research in this area. Four complete triads and two incomplete triads were recruited giving a total of sixteen interviews with four patients, six family members and six nurses. Interviews were supplemented with a small number of formal observations of nurses carrying out diary related activities (n=9) and field notes from time spent at the site. Transcribed interview data were analysed using a thematic approach, uncovering five main themes: (1) Information; (2) Communication; (3) Emotion; (4) Person Centered and (5) Gender. The concept of ‘Stories as joint actions’ developed by the sociologist Ken Plummer in 1995 was used as a framework to discuss and explain the findings. Diaries were found to support information sharing and facilitate communication interactions between nurses, family members and patients in the ICU as well as promoting and demonstrating a person centered approach to care. Emotional support was experienced by family members from writing in and reading the diary during the time in ICU whereas patients experienced emotional support from reading diary entries after the time in ICU. However emotional effort was associated with reading and writing in the diary during and after the time in ICU for patients, family members and nurses. Male family members were found to be less likely to write in the diary compared to female family members. Factors such as gender and literacy appeared to influence diary use however this requires further investigation. A new conceptual model ‘Critical Care Diaries as Joint Actions’ was created to address the complex nature of experiences with critical care diaries. Exploring the use of diaries from multiple perspectives and experiences has provided valuable insight into the different ways in which diaries are used during and after the time in ICU demonstrating that although the diary is primarily written for the patient, family members, nurses and patients use the diary in different ways to support their needs and others needs throughout the experience of critical illness.
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Goldberg, Miriam A. "Design and Testing of a Novel Communication System for Non-Vocal Critical Care Patients With Limited Manual Dexterity". eScholarship@UMMS, 2020. https://escholarship.umassmed.edu/gsbs_diss/1095.
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Nonvocal alert patients in the intensive care unit setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. A novel communication tool, the Manually-Operated Communication System (MOCS), was developed for use in intensive care settings for patients unable to speak due to mechanical ventilation. It is a speech-generating device designed for patients whose limited manual dexterity precludes legible writing.
In a single-arm device feasibility trial, 14 participants (11 with tracheostomies, 2 with endotracheal tubes, and 1 recently extubated) used MOCS. Participants, family members, and observing nurses were interviewed whenever possible. Interviews included a modified version of the System Usability Scale (SUS) as well as open-ended questions; a qualitative immersion/crystallization approach was used to evaluate these responses.
Participants with a tracheostomy and their family members/care providers rated MOCS on the SUS questions as consistently “excellent” (average rating across all groups was 84 +/- 17; all subgroups also rated the device highly). Through a qualitative interview process, these stakeholders expressed support for the use of MOCS in the ICU. Based on these data, MOCS has the potential to improve communication for nonvocal patients with limited manual dexterity.