Rozprawy doktorskie: „Critical care units”

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Almansour, Issa Mohammad Ali. "Transitioning towards end-of-life care in Jordanian critical care units : health care professionals' perspectives". Thesis, University of Nottingham, 2015. http://eprints.nottingham.ac.uk/29464/.

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This study explored the experiences of Jordanian critical care staff about the transition to, and provision of, end of life care. It examined the difficulties they encountered, and how they sought to care for and communicate with the families of patients who were approaching the end of life. The study took place in two University hospitals in different cities. A mixed methods design in two phases was adopted. The first phase employed the “National Survey of Critical Care Nurses' Perceptions of End-of-Life Care” (adapted with permission) to elicit the views of critical care staff (N=104) about the obstacles and facilitators to providing end of life care for critically ill patients and their families. In the second phase, qualitative interviews were conducted with staff (15 nurses; 10 junior doctors; 5 head nurses). The key overarching finding from the study is that staff experience moral distress when working with critically ill patients whom they perceive to be dying. There were three main dimensions to the experience of moral distress: First, nurses experience moral distress when they are aware when the patients are likely to die, know that continuing life sustaining treatment is futile and yet are expected to continue to provide treatment as normal to the patients. Aggressive modalities of treatments are usually pursued for most terminally ill patients, with both nurses and doctors perceiving there to be no planned, clear or distinct transition from curative focused care to end of life care. Second, with regard to their relationship with patients’ families, the staff found themselves to be in a problematic and paradoxical situation. One the one hand, they expected patients’ families to take the lead in the care decision making process and perceived that the power in decision-making should lie with patients’ relatives; but on the other hand, they also perceived that it is difficult and sometimes impossible to disclose bad news openly to families meaning that families are not fully informed in a way that would enable them to take the lead in the care decision making process. Third, staff have an appreciation of the principles of end of life decision making as a team activity and as a collaborative venture, but they are not able to put these principles into practice for many reasons, ranging from difficulties in their relationships with each other to health care system factors. This study sheds light on two central ethical problems in end of life decision-making in Jordan: the problem of disclosure of terminal prognosis at the end of life and limited involvement of nurses and junior doctors in the process of end of life communication and decision making. The study recommendations focus on developing practice in and disseminating understanding of ethically sound end of life decision-making.

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Singleton, Alsy R. "Patient satisfaction with nursing care : a comparison analysis of critical care and medical units". Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1061875.

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Patient satisfaction is an outcome of care that represents the patient's judgment on the quality of care. An important aspect of quality affecting patient's judgment can be attributed to patients' expectations and experiences regarding nursing care according to type of unit. The purpose of this study was to examine differences between patients' perceptions of satisfaction with nursing care in critical care units and medical units in one Midwestern hospital.The conceptual framework was "A Framework of Expectation" developed by Oberst in 1984, which asserted that patients have expectations of hospitals and health care professionals regarding satisfaction and dissatisfaction with care. The instrument used to measure patient satisfaction was Risser's Patient Satisfaction Scale, with three dimensions of patient satisfaction: (a) Technical-Professional, (b) Interpersonal-Educational, (c) Interpersonal-Trusting. The convenience sample included 99 patients50 from critical care units and 49 from medical wards. Participation was voluntary. The study design was comparative descriptive and data was analyzed using a t-test.The demographic data showed that the majority of patients had five or more admission. About one-third of the patients were 45-55, 56-65, 66-75, respectively. Findings related to the research questions were that: (a) 84 percent of the respondents rated overall satisfaction in the satisfactory to excellent range, (b) results of a t-test showed significant differences in overall patient satisfaction with patients being more satisfied with care in critical care units. Significant differences were found in three subscales with critical care being more satisfied. No relationship was found between patient satisfaction and age/and/or type of unit.Conclusions were that in both medical and critical care units patients were more satisfied with Technical-Professional and Interpersonal-Trusting than with Interpersonal-Educational. Also noted was that patients in the units where nurse-to-patient ratio was higher participants perceived that nurses had more time, energy and ability to meet patient expectation. Implications call for analysis of nurse/patient ratio in relation to patient satisfaction and nurses in relation to patient education as well as patient's perceptions of getting their needs met.
School of Nursing

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Anthonie, Ramona F. G. "The experiences of critical nurses regarding staffing management in critical care units in private hospitals of the Cape Metropole". Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71776.

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Thesis (MCurr)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: Nurse managers are responsible to staff different hospital units and departments with sufficient, trained and experienced personnel. Most critical care units in the private healthcare in South Africa are staffed below maximum workload levels and additional staff is supplemented when needed. Current staffing management strategies comprises the application of the patient acuity score, the utilisation of contracted agency staff and ward staff who assist occasionally in the critical care unit (CCU). The aim of the study was to explore the experiences of critical care nurses regarding staffing management within critical care units in private health care institutions in the Western Cape. The following objectives were set to: - explore the experiences of CCNs regarding staffing management strategies such as o the patient acuity score o the employment of ad hoc agency staff and o the utilization of ward staff A descriptive design with a qualitative approach was applied. A sample size of n=15 was drawn from a total population of N=377, using purposive sampling technique. A pilot-test was also completed. The trustworthiness of this study was assured with the use of Lincoln and Guba’s criteria of credibility, transferability, dependability and confirmability. All ethical principles were met. The findings of the study demonstrated that nurses perceive the workload in critical care units as heavy. The utilisation of the acuity score does not really assist in relieving the workload as managers tend not to consider the staffing requirements as predicted by the acuity score due to budget constraints. The enrolled nurses who assist occasionally in the critical care unit require supervision as well as ongoing development to ensure safe and quality patient care. Yet agency nurses were perceived as either extraordinary good or incompetent.
AFRIKAANSE OPSOMMING: Verpleegbestuurders het die verantwoordelik om verskillende hospitaaleenhede en departemente met voldoende opgeleide en ervare personeel te voorsien. Die meeste kritieke sorgeenhede in Suid-Afrika word met minder as dan die maksimum werkladingsvlak beman en addisionele personeel word aangevul wanneer nodig. Huidige personeelbestuurstrategieë behels die toepassing van die pasiënt akuïteit telling, die gebruik van ingekontrakteerde agentskap-personeel en saalpersoneel wat per geleentheid in die kritiekesorgeenheid help. Die doel van die studie was om die ervaringe van kritieke-sorgverpleegsters ten opsigte van personeel bestuur binne die kritiekesorgeenhede in die privaat gesondheidsorginstellings in die Weskaap, te ondersoek. Die volgende doelwitte is gestel: - Om die ervaringe van kritieke-sorgverpleegsters aangaande personeelbestuur-strategieë te ondersoek, soos: o die pasiënt akuïteit telling o die gebruik van agentskapverpleegpersoneel en o die gebruik van saal personeel, te ondersoek ’n Beskrywende kwalitatiewe studie is toegepas. ’n Steekproef van n=15 is uit ’n totale populasie van N=377 getrek deur die doelgerigte steekproeftegniek te gebruik. ’n Loodstoetsing van die semi-gestruktureerde vraelys is ook gedoen. Die betroubaarheid van hierdie studie was verseker deur van Lincoln en Guba se kriteria vir geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestigbaarheid gebruik te maak. Daar is aan alle etiese vereistes voldoen. Die bevindings van die studie toon dat die verpleegpersoneel die werklading in die kritiekesorgeenheid as veeleisend ervaar. Die aanwending van die pasiënt akuïteit-telling dra nie werklik by tot verligting van die werklading nie, aangesien bestuurders weens begrotingsbeperkings neig om nie die personeelbenodigdhede soos deur die akuïteit-telling voorspel in ag neem nie. Die ingeskrewe verpleegsters wat per geleentheid in die kritieke-sorgeenheid hulp verleen, benodig toesig asook volgehoue ontwikkeling ten einde veilige en kwaliteit pasiëntsorg te verseker. Die agentskapverpleegpersoneel is egter as baie bekwaam of onbevoeg beskou.

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Mallory, Caitlin Brook. "Critical Care Nurses' Experiences of Family Behaviors as Obstacles in End-of-Life Care". BYU ScholarsArchive, 2017. https://scholarsarchive.byu.edu/etd/6903.

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Background: Critical care nurses (CCNs) frequently provide end-of-life care for critically ill patients. CCNs may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care. Objective: What are the predominant themes noted when CCNs share their experiences of common obstacles, relating to families in providing EOL care? Methods: A random geographically dispersed sample of 2,000 members of the American Association of Critical-Care Nurses was surveyed. Responses from a qualitative question on the questionnaire were analyzed. Results: Sixty-seven EOL obstacle experiences surrounding issues with families' behavior were analyzed for this study. Experiences were categorized into 8 themes. Top three common obstacle experiences included families in denial, families going against patient wishes and advance directives, and families directing care which negatively impacted patients. Conclusions: In overcoming EOL obstacles, it may be beneficial to have proactive family meetings to align treatment goals and to involve palliative care earlier in the ICU stay.

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Pretorius, Ronel. "Positive practice environments in critical care units : a grounded theory / Ronel Pretorius". Thesis, North-West University, 2009. http://hdl.handle.net/10394/4005.

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INTRODUCTION AND AIM: The current shortage of nurses is a concern shared by the healthcare industry globally. Whilst the reasons for these shortages are varied and complex, a key factor among them seem to involve an unhealthy work environment. The demanding nature of the critical care environment presents a challenge to many nursing professionals and it carries the risk of a high turn over rate due to the stress and intensity of the critical care environment. The critical care nurse is responsible for caring for the most ill patients in hospitals and the acute shortage of critical care nurses contributes to the intensity and pressures of this environment. Little evidence exists of research conducted to explore and describe the practice environment of the critical care nurse in South Africa. The main aim of this research study was to construct a theory for positive practice environments in critical care units in South Africa, grounded in the views and perceptions of critical care nurses working in the private hospital context. In recognition of the fact that a positive practice environment is considered to be the foundation for the successful recruitment and retention of nurses, it was clear that issues related to staff shortages will not be resolved unless the unhealthy work environment of nurses is adequately addressed. RESEARCH DESIGN AND METHOD: A constructivist grounded theory design was selected to address the inquiry at hand. The study was divided into two phases and pragmatic plurality allowed the use of both quantitative and qualitative data collection methods to explore, describe and contextualise the data in order to achieve the overall aim of the study. In phase one, a checklist developed by the researcher was used to describe the demographic profile of the critical care units (n=31) that participated in the study. The perceptions of critical care nurses (n=298) regarding their current practice environment was explored and decribed by using a valid and reliable instrument, the Practice Environment Scale of the Nursing Work Index (PES-NWI). In phase two, the elements of a positive practice environment were explored and described by means of intensive interviews with critical care nurses (n=6) working in the critical care environment. Concepts related to the phenomenon under investigation were identified by means of an inductive analysis of the data through a coding process and memo-writing. One core conceptual category and six related categories emerged out of the data. In the final phase of the theoretical sampling of the literature, a set of conclusions relevant to the phenomenon under study was constructed. The conclusions deduced from the empirical findings in both phases of the research process were integrated with those derived from the literature review to provide the foundation from which the theory was constructed. FINDINGS: The findings from the first phase of the research process provided information about the context in which the participants operate and assisted in discovering concepts considered relevant to the phenomenon under investigation. A grounded theory depicting the core conceptual category of "being in controi" and its relation to the other six categories was constructed from the data in order to explain a positive practice environment for critical care units in the private healthcare sector in South Africa.
Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2010.

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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.

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Lamoreaux, Nicole. "Critical Care Nurses' Perceptions of End-of-Life Care: Comparative 17-year Data". BYU ScholarsArchive, 2016. https://scholarsarchive.byu.edu/etd/6382.

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BACKGROUND: Nurses working in intensive care units (ICUs) frequently care for patients and their families at the end-of-life (EOL). Providing high quality EOL care is important for both patients and families, yet ICU nurses face many obstacles that hinder EOL care. Researchers have identified various ICU nurse-perceived obstacles, but no studies have been found addressing the progress that has been made over the last 17 years.OBJECTIVE: To determine the most common and current obstacles in EOL care as perceived by ICU nurses and then to evaluate whether or not meaningful changes have occurred since data were first gathered in 1998.METHODS: A quantitative-qualitative mixed methods design was used. A random, geographically dispersed sample of 2,000 members of the American Association of Critical-Care Nurses was surveyed.RESULTS: Five obstacle items increased in mean score and rank as compared to 1999 data including: (1) family not understanding what the phrase "life-saving measures" really means; (2) providing life-saving measures at families' requests despite patient's advance directive listing no such care; (3) family not accepting patient's poor prognosis; (4) family members fighting about use of life support; and, (5) not enough time to provide EOL care because the nurse is consumed with life-saving measures attempting to save the patient's life. Five obstacle items decreased in mean score and rank compared to 1999 data including (1) physicians differing in opinion about care of the patient; (2) family and friends who continually call the nurse rather than calling the designated family member; (3) physicians who are evasive and avoid families; (4) nurses having to deal with angry families; and, (5) nurses not knowing their patient's wishes regarding continuing with tests and treatments.CONCLUSIONS: Obstacles in EOL care, as perceived by critical care nurses, still exist. Family-related obstacles have increased over time and may not be easily overcome as each family, dealing with a dying family member in an ICU, likely has never experienced a similar situation. Based on the current top five obstacles, recommendations for possible areas of focus may include (1) improved nursing assessment regarding the health literacy of families followed with directed, appropriate, and specific EOL information, (2) improved care coordination between physicians and other health care providers to facilitate sharing care plans, (3) advanced directives that are followed as written by patients, (4) designated family contact communicating with family and friends regarding patient information, and, finally, (5) earlier, transparent discussions of patient prognoses as disease processes advance and patient conditions deteriorate.

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Ramsey, Priscilla W., James Cathelyn, Beverly Gugliotta i L. Lee Glenn. "Visitor and Nurse Satisfaction With a Visitation Policy Change in Critical Care Units". Digital Commons @ East Tennessee State University, 1999. https://dc.etsu.edu/etsu-works/7530.

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Studies have addressed the visitation needs of visitors and patients and the impact of visitation policies on nurses, but few studies compare the level of satisfaction between visitors and nurses when visitation policies change. The objectives of this study were to investigate whether a more liberal intensive care unit visitation policy satisfactorily met the needs and expectations of visitors and nurses. © 1999 Lippincott Williams and Wilkins, Inc.

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Raduma-Tomás, Michelle Amondi. "Doctors' shift handovers in acute medical units". Thesis, University of Aberdeen, 2012. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=186875.

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Aim and objectives: To describe the ideal doctors' shift handover process in a systematic fashion, and to identify tasks that should be performed, but are not consistently done. To understand the types of communication problems that may occur during the handover process, their causes, their likelihood of occurrence and their effect on patient safety. Method: Three studies were conducted in two, Scottish Acute Medical Units. A Hierarchical Task Analysis was performed and data was collected by means of interviews and focus groups. Observations of doctors' actual shift handover process were compared against the description of doctors' ideal handover process. To examine potential failures modes, a Healthcare Failure Modes and Effects Analysis was performed using focus group interviews. Results: The handover process entailed the pre-handover, the handover, and the post- handover phases. Multiple critical steps in the process were omitted by outgoing shift doctors. The pre-handover was particularly vulnerable to information omission, with over 50% of its critical tasks not being performed across a total of 62 observations. Nonetheless, most of these omissions were typically caught during the handover meeting, especially if incoming doctors participated in pre-handover activities. Post-handover activities involved prioritizing and delegating clinical tasks. However these were observed not to happen consistently due to multiple interruptions. Thirty-four failure modes were identified, with eight of them posing a significant risk to patient safety. The studies found that interruptions, patient workload, and a lack of standardised procedures were the biggest causes for information loss during the handover process. Conclusions: There are key critical tasks necessary for an ideal doctors' shift handover process. A simple, handover process checklist may ensure critical handover tasks have been achieved prior to any shift change. Interruptions, patient workload, peer trust, and a lack of standard operating procedures are areas that future handover research should examine.

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Fataar, Danielle. "Endotracheal tube verification in the mechanically ventilated patient in a critical care unit". Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1008057.

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Critically ill patients often require assistance by means of intubation and mechanical ventilation to support their spontaneous breathing if they are unable to maintain it. Mechanical ventilation is one of the most commonly used treatment modalities in the care of the critically ill patient and up to 90% of patients world-wide require mechanical ventilation during some or most parts of their stay in critical care units Management of a patient’s airway is a critical part of patient care both in and out of hospital. Although there are many methods used in verifying the correct placement of the endotracheal tube, the need and ability to verify placement of an endotracheal tube correctly is of utmost importance, because many complications can occur should the tube be incorrectly placed. Since unrecognized oesophageal intubation can have many disastrous effects on patients, various methods for verifying correct endotracheal tube placement have been developed and considered. Some of these methods include direct visualization, end-tidal carbon dioxide measurement and oesophageal detector devices. This research study aimed to explore and describe the existing literature on the verification of endotracheal tubes in the mechanically ventilated patient in the critical- care unit. A systematic review was done in order to operationalize the primary objective. Furthermore, based on the literature collected from the systematic review, recommendations for the verification of the endotracheal tube in the mechanically ventilated patient in the critical care unit were made. Ethical considerations were maintained throughout the study and the quality of the systematic review was ensured by performing a critical appraisal of the evidence found.

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Dunsdon, Jeananne. "Professional nurses experiences of a team nursing care framework in critical care units in a private healthcare group". Thesis, Nelson Mandela Metropolitan University, 2011. http://hdl.handle.net/10948/1444.

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A critical care unit is a dynamic and highly technological environment. Professional nurses who have been working in the critical care unit for a period of time are passionate about the environment in which they work. They find their on duty time challenging and stimulating. The critical care environment is slowly changing. Due to the fact that there are fewer professional nurses with an additional qualification in critical care available to work in the critical care units. The utilisation of an increasing number of agency nurses leads to an increase in sub-standard nursing care as well as dissatisfied doctors and patients. The shortage of critical care staff has resulted in the need to find an alternative human resources framework and still provide cost effective, safe quality patient care. This leads to the design and implementation of a team nursing care framework for critical care. The research objectives for this study were: - To explore and describe the experiences of professional nurses with regard to a team nursing care framework in private critical care units. - Develop guidelines to optimize the team nursing care framework in critical care units in a private hospital group. The research is based on a qualitative, explorative, descriptive and contextual research design. The study is based on a phenomenological approach to inquiry. Eleven in-depth semi structured face-to-face phenomenological interviews were utilized as the main means of collecting data. A purposive, criterion based, sampling method was used. Specific inclusion criteria were met and consent was obtained from the participants and from the management of the private clinic where the research was conducted. Two central themes were identified:- Theme One: The professional nurses experienced the team nursing care framework in the critical care unit as a burden. Six sub-themes were identified. - Theme Two: Professional nurses made recommendations for improvement of the team nursing care framework in the critical care unit. By describing the lived experiences of the professional nurses in the critical care units, based on research interviews, the researcher painted a clear picture of the team nursing care framework in the critical care unit. Guidelines were developed based on the identified themes. The broad guidelines are aimed at ensuring that the nurses are competent to care for critical care patients prior to them commencing work in the critical care unit. The researcher concludes this study by making recommendations for Nursing practice, education and research.

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Collier, Vasanthi. "Agency nurses’ perceptions of job satisfaction within critical care units in private healthcare institutions". Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/6567.

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Thesis (MCur)--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: Agency-nursing work refers to nursing services provided by agency nurses employed on a casual, contracted basis. Agency-nursing has become more common in nursing practice in South Africa. This group of nurses play a significant role within the health care industry for both public and private sector. Given the pivotal role that nurses play in caring for the health of others, it is important to understand what motivates agency nurses in terms of job satisfaction. The aim of the study was to explore the perceptions of agency nurses regarding job satisfaction within critical care units in private health care institutions in the Western Cape. A qualitative research design with a phenomenological approach was applied. A sample size of n=10 was drawn from a total population of N=553, using random sampling technique. A semi-structured interview guide was designed based on the objectives of the study and validated by experts in the field before data collection. Ethical approval for the study was obtained from the Ethics Committee at the Faculty of Health Sciences, University of Stellenbosch. Permission to conduct the research was obtained from the participating nursing agency and consent was given in writing. The presentation of the results was categorised into themes and sub-themes emerged from the data analysis. The five clusters of themes that emerged were reasons for doing agency work, experiences with hospital staff, allocation of agency nurses, communication of information and staff development. The findings support Herzberg’s theory on motivation factors in terms of what motivates workers to excel in their performance. Agency nurses experienced both positive and negative aspects with regards to job satisfaction. The results of the study suggest the need to include revision and implementation of human resource policies and practices to include the nurses’ “voice” in an effort to provide a more supportive work environment. Further research is recommended. Key Words: Agency nurse, nursing agency, job satisfaction.
AFRIKAANSE OPSOMMING: Agentskapverplegingswerk verwys na verplegingsdienste wat voorsien word deur agentskapverpleegsters wat op ’n tydelike, gekontrakteerde basis in diens geneem word. Agentskapverpleging het meer algemene gebruik in die verpleegpraktyk in Suid-Afrika geword. Hierdie groep verpleegsters speel ’n belangrike rol in die gesondheidsbedryf vir beide die openbare en die private sektor. Gegee die deurslaggewende rol wat verpleegsters speel in die gesondheidsversorging van ander mense, is dit belangrik om te verstaan wat agentskapverpleegsters motiveer vanuit die oogpunt van werksbevrediging. Die doel van die studie was om die persepsies en ervarings van agentskapverpleegsters ten opsigte van werksbevrediging te ondersoek binne die waakeenhede in private gesondheidsorg-inrigtings in die Wes-Kaap. ’n Kwalitatiewe navorsingsontwerp met ’n fenomenologiese benadering is toegepas. ’n Monstergrootte van n=10 is geneem uit ’n populasie van N= 553 deur die ewekansige steekproeftegniek te gebruik. ’n Semi-gestruktureerde onderhoudgids was ontwerp en gebaseer op die doelwitte van die studie en was deur deskundiges op hierdie gebied, voor die insameling van data, gelding verklaar. Etiese goedkeuring vir die studie was verkry van die Etiese Komitee van die Fakulteit van Gesondheidswetenskappe, Stellenbosch Universiteit. Goedkeuring om die navorsing te doen, was verkry van die deelnemende agentskap en toestemming was op skrif geplaas. Die voorgelegde resultate was gekategoriseer in temas en subtemas wat uit die data-analise voortgespruit het. Die vyf groepe van temas wat hieruit gespruit het, is redes vir die keuse om agentskapwerk te doen, ervarings met hospitaalpersoneel, die toewysing van agentskapverpleegsters, kommunikasie van inligting en personeelontwikkeling. Die bevindinge het onthul dat Herzberg se teorie oor motiveringsfaktore werkers aangemoedig het om te presteer in die uitvoering van hulle pligte. Werksbevrediging is volgehou deur die agentskapverpleegster. Die bevindings dui op die behoefte om die hersiening en implementering van menslike hulpbronbeleidsverklarings en -praktyke in te sluit sodat die verpleegster se stem gehoor kan word in ’n poging om ’n meer ondersteunende werkomgewing te voorsien. Verdere navorsing word aanbeveel. Sleutelwoorde: Agentskapverpleegster, verplegingsagentskap, werksbevrediging.

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Spencer, Jessye Davis. "Competencies needed for the beginning level coronary critical care nurse : a Delphi study /". Diss., This resource online, 1994. http://scholar.lib.vt.edu/theses/available/etd-06062008-163419/.

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Emmons, Margaret M. "Exploring the Enteral Feeding Practices Used by Critical Care Nurses: A Dissertation". eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsn_diss/34.

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Mechanically ventilated critically ill patients treated in the intensive care unit (ICU) require enteral feedings to maintain adequate nutrition during critical illness. Delivery of adequate enteral nutrition is also critical to the recovery of critically ill patients. Enteral nutrition has been shown to decrease length of time on the ventilator, decrease length of stay and ICU and decrease mortality. Despite all the evidence regarding the benefits of enteral nutrition, critically ill patients continue to receive less than their prescribed calories and protein. Nurses are in a unique position to influence the delivery of enteral nutrition. Nursing practices that contribute to underfeeding must be identified and corrected to ensure adequate delivery of nutrients is achieved. The purpose of the study was to describe the professional practice of critical care nurses regarding enteral feeding in mechanically ventilated critically ill patients. Several barriers were identified by the participants in the study that contributed to underfeeding including inconsistent practice regarding gastric residual volume, holding feeds when changing patient position and lack of a standardized protocol for enteral feeding. Also identified in the study was the idea that nurses do not see enteral feeding as a life-saving intervention. It is not the “sexy part” of what ICU nurses do. Enteral feeding guidelines need to be developed to include those interventions that are important to nursing practice in order to increase enteral feeding times and improve patient outcomes.

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Moon, Mikyung. "Relationship of nursing diagnoses, nursing outcomes, and nursing interventions for patient care in intensive care units". Diss., University of Iowa, 2011. https://ir.uiowa.edu/etd/3356.

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The purpose of the study was to identify NANDA - I diagnoses, NOC outcomes, and NIC interventions used in nursing care plans for ICU patient care and determine the factors which influenced the change of the NOC outcome scores. This study was a retrospective and descriptive study using clinical data extracted from the electronic patient records of a large acute care hospital in the Midwest. Frequency analysis, one-way ANOVA analysis, and multinomial logistic regression analysis were used to analyze the data. A total of 578 ICU patient records between March 25, 2010 and May 31, 2010 were used for the analysis. Eighty - one NANDA - I diagnoses, 79 NOC outcomes, and 90 NIC interventions were identified in the nursing care plans. Acute Pain - Pain Level - Pain Management was the most frequently used NNN linkage. The examined differences in each ICU provide knowledge about care plan sets that may be useful. When the NIC interventions and NOC outcomes used in the actual ICU nursing care plans were compared with core interventions and outcomes for critical care nursing suggested by experts, the core lists could be expanded. Several factors contributing to the change in the five common NOC outcome scores were identified: the number of NANDA - I diagnoses, ICU length of stay, gender, and ICU type. The results of this study provided valuable information for the knowledge development in ICU patient care. This study also demonstrated the usefulness of NANDA - I, NOC, and NIC used in nursing care plans of the EHR. The study shows that the use of these three terminologies encourages interoperability, and reuse of the data for quality improvement or effectiveness studies.

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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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Mitchell, Pamela Holsclaw. "Clinical and organizational impact of multiple changes in critical care : a case study /". Thesis, Connect to this title online; UW restricted, 1991. http://hdl.handle.net/1773/10317.

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Flippies, Emirenthia Emogin Elouise, i D. J. L. Venter. "The relationship between organisational contextual factors and clinical practice guideline implementation in private critical care units". Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/12583.

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Clinical practice guidelines are one way of ensuring that healthcare is based on the evidence-based practices. In a dynamic unit, like the critical care unit, where sound decision-making and critical thinking are required in the care of critically ill patients, the implementation of such guidelines for care is of utmost importance. Guideline implementation is however not so simplistic, and various studies have proven that there are various barriers linked to guideline implementation. However, most the barriers have proven to be related to individual factors. Therefore, a greater focus has been placed on organisational contextual factors that might have an influence on clinical practice guideline implementation. The research study followed a positivistic, quantitative paradigm, where the hypothesised relationship between the organisational contextual factors and clinical practice guideline implementation were investigated. A structured pre-existing questionnaire, namely the Alberta Context Tool, was used to collect data from 65 registered nurses in private critical care units. Descriptive and inferential statistics were used to analyse the data. The findings revealed that although the organisational contextual factors were prevalent in the private critical care units sampled, some factors like leadership and culture scored higher than the other factors. Positive relations were reported between the organisational contextual factors and clinical practice guideline implementation. The results imply that the alternative hypothesis H1 is supported, and thus proved that there are significant relationships between organisational contextual factors and clinical practice guideline implementation in private critical care units in the East London area.Recommendations were made on how to enhance organisational contextual factors in the implementation of clinical practice guidelines. Ethical principles were maintained throughout the study.

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Shubane, Nancy. "Black critical care nurses' perceptions of organ donation and organ transplantation". Pretoria : [s.n.], 2009. http://upetd.up.ac.za/thesis/available/etd-10262009-185326/.

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Cretikos, Michelle School of Anaesthetics Intensive Care &amp Emergency Medicine UNSW. "An evaluation of activation and implementation of the medical emergency team system". Awarded by:University of New South Wales. School of Anaesthetics, Intensive Care and Emergency Medicine, 2006. http://handle.unsw.edu.au/1959.4/25720.

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Problem investigated: The activation and implementation of the Medical Emergency Team (MET) system. Procedures followed: The ability of the objective activation criteria to accurately identify patients at risk of three serious adverse events (cardiac arrest, unexpected death and unplanned intensive care admission) was assessed using a nested, matched case-control study. Sensitivity, specificity and Receiver Operating Characteristic curve (ROC) analyses were performed. The MET implementation process was studied using two convenience sample surveys of the nursing staff from the general wards of twelve intervention hospitals. These surveys measured the awareness and understanding of the MET system, level of attendance at MET education sessions, knowledge of the activation criteria, level of intention to call the MET and overall attitude to the MET system, and the hospital level of support for change, hospital capability and hospital culture. The association of these measures with the intention to call the MET and the level of MET utilisation was assessed using nonparametric correlation. Results obtained: The respiratory rate was missing in 20% of subjects. Using listwise deletion, the set of objective activation criteria investigated predicted an adverse event within 24 hours with a sensitivity of 55.4% (50.6-60.0%) and specificity of 93.7% (91.2-95.6%). An analysis approach that assumed the missing values would not have resulted in MET activation provided a sensitivity of 50.4% (45.7- 55.2%) and specificity of 93.3% (90.8-95.3%). Alternative models with modified cut-off values provided different results. The MET system was implemented with variable success during the MERIT study. Knowledge and understanding of the system, hospital readiness, and a positive attitude were all significantly positively associated with MET system utilisation, while defensive hospital cultures were negatively associated with the level of MET system utilisation. Major conclusions: The objective activation criteria studied have acceptable accuracy, but modification of the criteria may be considered. A satisfactory trade-off between the identification of patients at risk and workload requirements may be difficult to achieve. Measures of effectiveness of the implementation process may be associated with the level of MET system utilisation. Trials of the MET system should ensure good knowledge and understanding of the system, particularly amongst nursing staff.

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Befile, Nomawethu. "The relationship between organisational culture, transformational leadership and organisational change outcomes in public intensive care units". Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/14576.

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Organisational change in any organisation, including the healthcare industry, implies a change in organisational culture. The concept of organisational culture refers to those values and norms within an organisation that are prescribed by both the employer and the employees as to how to behave. However, organisational culture should not be viewed in isolation, as culture and leadership are intertwined. Transformational leadership within an organisational culture serves to achieve its goal, missions and aims by influencing, motivating and creating a mutual relationship between employees and employers, which brings about effective organisational change. The alignment of organisational culture and leadership with a hospital’s vision is important to ensure optimal healthcare delivery and organisational change outcomes. A positivistic research paradigm, with a quantitative, explorative, descriptive and contextual approach, was used to conduct the research study. The research study explored whether a supportive organisational culture, transformational leadership and organisational change outcomes were prevalent in public intensive care units. Secondly, the study aimed to investigate the relationship between organisational culture, transformational leadership and organisational change outcomes in public intensive care units in the Nelson Mandela Bay. Data was collected by means of a structured and previously validated questionnaire with a Cronbach’s alpha of more than 0.80. The target population was registered nurses who work in the intensive care units in the public hospitals. The sample was composed of 56 registered nurses and 4 enrolled nurses who were selected from public hospital intensive care units in Nelson Mandela Bay. Descriptive statistics, linear regression analysis, correlation and a Chi-square test were used to describe the hypothesised relationship between organisational culture and transformational leadership (independent) with organisational change outcomes (dependent variable). The results of this study revealed that the alternative hypothesis was accepted as the P value, was less than 0.05 in all variables. This proved that there was a significant relationship between organisational culture, transformational leadership and organisational change outcomes in the public intensive care units which were sampled. Recommendations are made as to how organisational culture can enhance and support transformational leadership and organisational change outcomes to promote a positive change outcome in public intensive care units. Ethical considerations were maintained throughout the research study.

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Adams, Bernardene Lucreshia. "The experiences of registered nurses' of their work environment in a critical care unit". Thesis, Nelson Mandela Metropolitan University, 2009. http://hdl.handle.net/10948/1057.

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Critical care nursing is a vital and significant part of health care provision to critically ill patients. It is a specialty area of nursing that requires registered nurses who are highly motivated, knowledgeable and skilled to provide optimal care to critically ill patients. These patients are nursed in a complex environment consisting of specialised equipment (such as ventilators, defibrillators, intravenous pumps, and cardiac monitors) that is not found in any other field of nursing. Collegial support and an adequate registered nurse: patient ratio is vital in critical care units in order to provide optimal quality care to critically ill patients. However, an understaffed work environment, the demands of critical care nursing and other work-related problems, such as conflict with physicians, inadequate remuneration packages and an increased workload can cause serious distress and dissatisfaction amongst registered nurses in this specific environment (Carayon & Gürses, 2005:287). The objectives of this study therefore are to explore and describe the experiences of registered nurses of their work environment in a critical care unit and to make recommendations that will assist registered nurses working in a critical care unit. A qualitative, explorative, descriptive and contextual research design will be utilised. Data will be collected by means of semi-structured interviews and analysed according to the framework provided by Tesch (in Cresswell, 2003:192). Purposive sampling will be used to select a sample of registered nurses working in a critical care environment. Guba’s model (in Krefting, 1991) will be utilised to verify data and to ensure trustworthiness of the study. Ethical considerations will be adhered to throughout the study. Once data has been analysed, recommendations will be made that will assist registered nurses working in a critical care unit.

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James, Alison. "High Dependency Care provision in Obstetric Units remote from tertiary referral centres and factors influencing care escalation : a mixed methods study". Thesis, University of Plymouth, 2017. http://hdl.handle.net/10026.1/9487.

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Background Due to technological and medical advances, increasing numbers of pregnant and post natal women require higher levels of care, including maternity high dependency care (MHDC). Up to 5% of women in the UK will receive MHDC, although there are varying opinions as to the defining features and definition of this care. Furthermore, limited evidence suggests that the size and type of obstetric unit (OU) influences the way MHDC is provided. There is robust evidence indicating that healthcare professionals must be able to recognise when higher levels of care are required and escalate care appropriately. However, there is limited evidence examining the factors that influence a midwife to decide whether MHDC is provided or a woman’s care is escalated away from the OU to a specialist unit. Research Aims 1. To obtain a professional consensus regarding the defining features of and definition for MHDC in OUs remote from tertiary referral units. 2. To examine the factors that influence a midwife to provide MHDC or request the escalation of care (EoC) away from the OU. Methods An exploratory sequential mixed methods design was used: Delphi survey: A three-round modified Delphi survey of 193 obstetricians, anaesthetists, and midwives across seven OUs (annual birth rates 1500-4500) remote from a tertiary referral centre in Southern England. Round 1 (qualitative) involved completion of a self-report questionnaire. Rounds 2/3 (quantitative); respondents rated their level of agreement or disagreement against five point Likert items for a series of statements. First round data were analysed using qualitative description. The level of consensus for the combined percentage of strongly agree / agree statements was set at 80% for the second and third rounds Focus Groups: Focus groups with midwives across three OUs in Southern England (annual birth rates 1700, 4000 and 5000). Three scenarios in the form of video vignettes were used as triggers for the focus groups. Scenario 1; severe pre-eclampsia, physiologically unstable 2; major postpartum haemorrhage requiring invasive monitoring 3; recent admission with chest pain receiving facial oxygen and continuous ECG monitoring. Two focus groups were conducted in each of the OUs with band 6 / 7 midwives. Data were analysed using a qualitative framework approach. Findings Delphi survey: Response rates for the first, second and third rounds were 44% (n=85), 87% (n=74/85) and 90.5% (n= 67/74) respectively. Four themes were identified (conditions, vigilance, interventions, and service delivery). The respondents achieved consensus regarding the defining features of MHDC with the exceptions of post-operative care and post natal epidural anaesthesia. A definition for MHDC was agreed, although it reflected local variations in service delivery. MHDC was equated with level 2 care (ICS, 2009) although respondents from the three smallest OUs agreed it also comprised level 1 care. The smaller OUs were less likely to provide MHDC and had a more liberal policy of transferring women to intensive care. Midwives in the smaller OUs were more likely to escalate care to ICU than doctors. Focus Groups: Factors influencing midwives’ EoC decisions included local service delivery, patient specific / professional factors, and guidelines to a lesser extent. ‘Fixed’ factors the midwives had limited or no opportunity to change included the proximity of the labour ward to the ICU and the availability of specialist equipment. Midwives in the smallest OU did not have access to the facilities / equipment for MHDC provision and could not provide it. Midwives in the larger OUs provided MHDC but identified varying levels of competence and used ‘workarounds’ to facilitate care. A woman’s clinical complexity and potential for physiological deterioration were influential as to whether MHDC was assessed as appropriate. Midwifery staffing levels, skill mix and workload (variable factors) could also be influential. Differences of opinion were noted between midwives working in the same OUs and varying reliance was placed on clinical guidelines. Conclusion Whilst a consensus on the defining features of, and definition for MHDC has been obtained, the research corroborates previous evidence that local variations exist in MHDC provision. Given midwives from the larger OUs had variable opinions as to whether MHDC could be provided, there may be inequitable MHDC provision at a local level. Organisationally robust systems are required to promote safe, equitable MHDC care including MHDC education and training for midwives and precise EoC guidelines (so workarounds are minimised). The latter must take into consideration local service delivery and the ‘variable’ factors that influence midwives’ EoC decisions.

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Vanderspank, Brandi. "The Social Construction of Intensive Care Nursing, 1960-2002: Canadian Historical Perspectives". Thèse, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/30922.

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Intensive care units (ICUs) emerged across Canada during the early 1960s, significantly contributing to the image of Western hospitals as places of scientific advancement that predominated over much of the twentieth century. ICUs rapidly became both a resource intensive and expensive type of care as the number and size of units increased to accommodate diverse patient populations and treatment options. Nurses enabled the formation and growth of ICUs through their constant presence and skilled care. There has been limited research, however, regarding the historical development of Canadian ICUs, the relationships between nurses and other personnel in such units, how they developed an identity as ICU nurses, or how ICU nursing became a specialty practice. Situated within the broader histories of hospitals, healthcare, and nursing, this study uses a social history approach to examine nurses’ experiences within Canadian ICUs between 1960 and 2002. Berger and Luckmann’s Social Construction of Reality provided a lens for analysis and interpretation of oral histories, photographs, professional literature of the time period under study, and both archival and organizational records. This thesis argues that ICU nurses’ relationships with one another, in the context of a technologically complex environment, socially constructed their knowledge and skill acquisition, their socialization as ICU nurses, and the development of a specialized body of knowledge that ultimately led to formal recognition of ICU nursing as a specialty in Canada.

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Van, Wyk Annemarie. "The relationship between burnout and the safety and quality of patient care in private critical care units in Gauteng province / Annemarie van Wyk". Thesis, North-West University, 2010. http://hdl.handle.net/10394/4951.

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INTRODUCTION AND AIM: Research recognises the clear links between nurses’ experience of professional burnout and the quality of the work environment. To that end it is extremely important for nurse managers to create an organisational climate that promotes the emotional stability of nurses. This could help to improve global patient safety by reducing the frequency of adverse events. Many of the factors commonly associated with burnout, also causes unsafe patient care, and poor quality of care. Effectively managing patient safety must be a priority in units where nurses face high pressure. Staff in critical care units (CCUs) spends a tremendous amount of time with people, including the patient, family members, physicians, and other members of the multidisciplinary team that might lead to emotional and physical exhaustion and burnout. The aim of this study was to investigate the relationship between nurse burnout and the safety and quality of patient care in private critical care units in Gauteng. RESEARCH DESIGN AND METHOD: A quantitative correlational design was selected to address the research question at hand. A previously developed checklist was used to describe the demographic characteristics of the critical care units that participated in the study (n=31). A total of 298 critical care nurses participated in the study (n=298). Burnout among registered nurses working in these units was explored by means of the Maslach Burnout Inventory Scale (MBI). The registered nurses’ perceptions of the safety and quality of patient care in their units were explored by means of the RN4CAST questionnaire. Data was analysed using descriptive and inferential statistics. FINDINGS: The mean scores for emotional exhaustion measured 2.69, for depersonalisation 1.55 and for personal accomplishment 4.43. From the mean scores of each of the sub–scales of the MBI it was evident that registered nurses working in private critical care units in Gauteng province did not experience burnout. The relationship between burnout and the safety and quality of patient care was investigated by means of a Spearman rank correlation coefficient. The results indicated that emotional exhaustion demonstrated a negative relationship with the quality of nursing care in the unit (r = –0.275; p=0.00), and patient safety in the unit (r = –0.245; p=0.00). Depersonalisation demostrated a negative relationship with the quality of care in the nursing unit (r = –0.249; p=0.00 and patient safety in the unit (r = –0.205; p=0.00). Personal accomplishment demonstrated a weak positive relationship with the quality of nursing care in the unit (r = 0.197; p=0.003) and a moderate positive relationship with patient safety in the unit (r = 0.204; p=0.00). The results demonstrated a relationship between burnout and the safety and quality of patient care in private critical care units in Gauteng.
Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.

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Love, Janine Ann. "Respiratory management of the mechanically ventilated spinal cord injured patient in a critical care unit". Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1008451.

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Background: Spinal Cord Injuries (SCIs) are traumatic, life-changing injuries that can affect every aspect of an individual's life and can lead to death if not treated timeously and appropriately. Respiratory complications occur frequently after the SCI and are the leading cause of mortality and morbidity. Respiratory complications are predictable based on the neurological level of impairment of the spinal cord lesion; the higher the neurological injury, the more severe the respiratory complication. Changes in pulmonary function, poor cough, hypersecretion, immobility and bronchospasm all contribute to the development of respiratory complications. If the patient is unable to protect his/her airway or if respiratory failure occurs, mechanical ventilation is often required. Many patients require prolonged ventilation and subsequently need to go for tracheostomies. The critical care nurse plays an important role in the early identification of complications and can, therefore, act to limit and prevent these complications, which may be a direct result from the injury or treatment modality such as mechanical ventilation. Respiratory management has been promoted in preventing and treating respiratory complications and is associated with better prognosis in the SCI patient. Design and method: The research study aims to explore and describe existing literature and to make recommendations for the respiratory management of a mechanically ventilated spinal cord injured patient in a critical care unit (CCU). A systematic review was undertaken with clear inclusion and exclusion criteria. Ethical principles were maintained throughout the study. The quality of the study was ensured by critically appraising data that was utilized in the systematic review. It is envisaged that the results from this systematic review will improve the respiratory management of the SCI patient and prevent any variations in practice. Results: Were presented under the following themes: priorities of care for the SCI patient in the acute phase, during the critical care phase and preventative care. Conclusion: The SCI patient regardless of the neurological level or completeness of injury should be admitted to the CCU for intensive ventilatory, cardiopulmonary support and hemodynamic monitoring in order to detect and prevent respiratory complications. The use of larger tidal volumes is associated with improved comfort and less dyspnea however if a patient has acute lung injury or ARDS the use of low tidal volumes 6ml/kg is recommended. Prevention and early identification of respiratory complications is associated with improved outcomes for the SCI patient.

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Hibbert, Clare Louis. "Development and application of a method for estimating daily case-mix adjusted costs of adult critical care units". Thesis, University of Sheffield, 2007. http://etheses.whiterose.ac.uk/15060/.

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Patients referred for treatment in an adult critical care unit are in, or at imminent risk of developing single or multiple organ failure. Despite the high treatment costs, knowledge of the costs of care is limited. The aims of this thesis were to synthesise current knowledge about the different methods used to estimate costs and to develop and apply a method for estimating daily case-mix adjusted costs for developing a set of Healthcare Resource Groups (HRGs) and for use in a trial-based economic evaluation. HRGs were required to support the Department of Health's new policy on reimbursing adult critical care called 'Reforming NHS Financial Flows: Introducing Payment By Results'. A systematic review of 20 published studies provided the background to, and justification for the methods employed in two empirical studies. The first empirical study was performed in a single critical care unit and using very detailed data on individual patients evaluated factors that had the potential to correlate with daily costs of critical care. Univariate and multivariate statistical analyses were undertaken using two different data sets. Patients' daily organ supports were identified as the key 'cost generating events'. A prospective, observational, longitudinal multi-centre study involving a volunteer sample of 70 critical care units followed, where organ support data on 7,243 consecutive admissions and monthly data on critical care unit expenditure were collected. Different ways of modelling the organ support and expenditure data were explored. The overall R2 for the chosen model- the daily number of organs supported was 0.52. Daily organ support weights for the average daily costs of critical care were 0.577 for 0 or 1 organ supported, 1.137 for 2 organs supported and 1.156 for 3 or more organs supported. These weights were then applied to average daily costs estimated for patients recruited to a clinical trial of Extracorporeal Membrane Oxygenation (ECMO) vs. conventional therapy for severe, but potentially reversible, respiratory failure.

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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.

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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.

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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.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing
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Bjurlefält, Peter. "Erfarenhet av debriefing inom akutsjukvården". Thesis, Högskolan i Gävle, Avdelningen för vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-30487.

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Samfattning Bakgrund: I vår vardag världen över drabbas människor oavsett kön och ålder av olyckor, dödsfall och andra traumatiska händelser. Vissa yrken medför en större risk att utsättas för traumatiska händelser. Exempel på dessa är ambulans, räddningspersonal, polis och vårdpersonal inom främst akutsjukvård. Dessa händelser kan ibland bli personen övermäktigt. Ett sätt att motverka bl.a. utbrändhet och posttraumatiskt stressymptom (PTSD) hos vårdpersonalen är att genomföra debriefingsamtal. Detta genomförs med den vårdpersonal som varit delaktig i en traumatisk händelse. Syfte: Syftet med denna studie var att beskriva erfarenheten av debriefing hos vårdpersonal inom akutsjukvården i samband med traumatiska händelser i sin yrkesutövning. Metod: Litteraturstudie som totalt innehåller 10 vetenskapliga artiklar varav fem är kvalitativa och fem är kvantitativa. Resultat: Studieresultatet påvisar att debriefing uppfattas som ett positiv redskap när det gäller avlastning efter en traumatisk händelse för vårdpersonalen inom akutsjukvården. De främsta faktorerna som lyfts i studien är tid och plats för debriefing, debriefingens inverkan på kommunikationen mellan vårdpersonalen, val av debriefingledare och behovet av väl utformade riktlinjer för debriefingen. Slutsats: I föreliggande studie påvisas att debriefing bör betraktas som ett effektivt verktyg att motverka psykisk ohälsa hos vårdpersonalen och att debriefing även förstärker kommunikationen mellan de olika professionella yrkesgrupperna inom akutsjukvården. Studien visar även att det är viktigt med väl utformade riktlinjer för att debriefingens syfte skall uppnås.
Abstract Background: In our everyday lives worldwide, people are affected regardless of gender and age by accidents, deaths and other traumatic events. Some professions involve a greater risk of being exposed to traumatic events. Examples of these are ambulance, emergency personnel, police and health care personnel, primarily in emergency care. These events can sometimes become overpowering. One way to counteract burnout and post-traumatic stress symptom (PTSD) in healthcare professionals is to carry out debriefing talks. This is done with the healthcare staff who has participated in a traumatic event. Aim: The purpose of this study was to describe the experience of debriefing in healthcare professionals in emergency care in connection with traumatic events in their professional practice. Method: Literature study that contains a total of 10 scientific articles, five of which are qualitative and five are quantitative. Results: The study results show that debriefing is perceived as a positive tool when it comes to unloading after a traumatic event for the healthcare staff in emergency care. The main factors raised in the study are time and place for debriefing, debriefing impact on the communication between the healthcare staff, the choice of debriefing leader and the need for well-designed guidelines for debriefing. Conclusion: The present study demonstrates that debriefing should be regarded as an effective tool for counteracting mental illness in the healthcare staff and that debriefing also reinforces communication between the various professional occupational groups in emergency care. The study also shows that well-designed guidelines are important for achieving the purpose of the debriefing.

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Hillman, Ken School of Medicine UNSW. "CONCEPTUALISATION, DEVELOPMENT AND IMPLEMENTATION OF THE MEDICAL EMERGENCY TEAM (MET) AS A SYSTEM OF MANAGEMENT TO IMPROVE OUTCOMES FOR SERIOUSLY ILL PATIENTS". Awarded by:University of New South Wales. School of Medicine, 2006. http://handle.unsw.edu.au/1959.4/30408.

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This thesis covers research around the Medical Emergency Team (MET) system, describing its development, evaluation and other related research that evolved as a result of the MET concept. The basic problem that prompted development of the MET system was related to the inadequate care given to the seriously ill in acute hospitals. This thesis contains background research on some of the reasons why a MET system may be useful, including the limited skills and knowledge of medical training and the sort of acute problems encountered in a hospital at night. Research then describes how the MET system works, including published data on when and how often the team is called, the type of patient the team is called to, the interventions performed by the team, and the outcome of patients on whom a MET was called. At the same time research was being performed around outcome indicators used to measure the effectiveness of the MET system, resulting in the use of cardiac arrests, deaths and unanticipated admission to the Intensive Care Unit (ICU) as common end-points for research in this area. Further research demonstrated that potentially preventable antecedents were common before serious illness The thesis then concentrates on how effective the MET system was in reducing death and serious adverse events. The first study compared a hospital where a MET system had been implemented to two control hospitals and found there was a reduction in admissions to the ICU but after adjustment, not for deaths and cardiac arrests. The second study used a cluster randomised methodology, enrolling 23 hospitals across Australia, comparing the three end-points described above. The study found no difference between both groups. It did highlight some interesting areas around the importance of effective implementation in determining the effectiveness of systems in health. Other publications have described the importance of developing effective ways of caring for the seriously ill outside traditional areas such as ICUs. The MET system, or variations on it, is now implemented in many hospitals in Australia and around the world and there have been two international MET conferences held in North America and international guidelines on the MET concept established.

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Williams, Teresa Ann. "Long-term outcomes for patients treated in the Intensive Care Unit (ICU) : a cohort study using linked data". University of Western Australia. School of Population Health, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0005.

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Royal Perth Hospital is the largest hospital in Western Australia and also has the largest intensive care unit (ICU) in the State. It was the first public hospital to provide intensive care services in Western Australia. This thesis examines the intermediateand long-term outcomes of patients admitted to the Royal Perth Hospital ICU between 1987 and 2002. Intermediate-term survival, defined as survival after discharge from hospital to one year and long-term survival, that exceeding one year after discharge, are important outcomes. Information on outcomes can be used by ICU staff in discussions with patients and their families and to inform policy decision-making and future research. The aim of this research was to examine one-year and long-term outcomes of patients admitted to the ICU between 1987 and 2002 and explore the factors that might be associated with the outcomes for 22,298 patients admitted to the ICU. A clinical ICU database was linked to morbidity and mortality databases by Data Linkage WA. A wide range of demographic and clinical factors were examined for their effect on outcome. These included age, sex, comorbidity, severity of illness, organ failure, ICU diagnostic groups, type of admission (medical, elective surgical and non-elective surgical), length of stay in ICU and era of admission (1987-1990, 1991-1994, 1995-1998, 1999-2002). Patients were followed-up to study end, 31st December 2003 or death if it occurred before study end, that is, up to 17 years after the index ICU admission. Kaplan Meier survival curves and Cox regression models were used to examine intermediate and long-term survival for patients who survived to hospital discharge. A comparison of admissions to hospital before and after the index ICU admission was made using descriptive statistics and logistic regression. Throughout the study period survival for the ICU cohort was shorter when compared to the Australian population. This was consistent throughout the follow-up period. The most important determinants of long-term survival were age, comorbidity, severity of illness and diagnostic group but the strength of association varied with the duration of follow-up. Although age, comorbidity and severity of illness increased among the critically ill survival improved over time. Hospital admissions were more frequent after a discharge from hospital that required an admission to ICU than before the index admission, even after adjusting for the ageing of the cohort. This study provides unique information about the survival and other outcomes of patients discharged from a hospital admission that included an ICU stay. The strength of this study lies in the follow-up to 17 years and the more comprehensive range of explanatory factors than in previous studies. This thesis demonstrates that follow-up studies after intensive care should be of sufficient duration to account for the changes that occur in survival over time and indicates the range of factors that should be taken into account when making comparisons of long-term survival.

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Wildman, Martin James. "Outcome prediction for patients with obstructive lung disease considered for admission to critical care units in England, Wales and Northern Ireland". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2005. http://researchonline.lshtm.ac.uk/682336/.

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Objective. To develop an outcome prediction score for patients with obstructive lung disease considered for admission to critical care. Design. Prospective cohort study using multivariate logistic regression for model building followed by score development and bootstrapping to adjust for over fitting. Setting. Critical care and respiratory high dependency units in England Wales and Northern Ireland. Participants. Patients aged 45 years and older with a clinical diagnosis of breathlessness, respiratory failure or change in mental status due to an exacerbation of COPD, asthma or a combination of COPD and asthma. Main outcome measures. The primary outcome was survival at 180 days and the model was constructed to predict this. The secondary outcomes were the accuracy of clinicians' predictions at the time of critical care admission and 180-day health-related quality of life Results. Ninety two critical care units and three respiratory high dependency units took part. Eight hundred and thirty two patients were recruited and the 651 patients without treatment limitations were used to develop the outcome score. Of the 651 patients 450 were intubated and 107 (16.4%) died in critical care, another 66 (10.1%) died in hospital and a further 47 (7.2%) had died by 180 days follow-up, giving a cumulative 180-day mortality of 33.8% (220 deaths). 420 of 518 (81.1%) survivors provided quality of life data and 400 (96.4%) would want ICU again under similar circumstances. A score using length of stay, age, sex, acute physiology, functional capacity, mid-arm circumference, atrial fibrillation, intubation status and diagnosis had an area under the receiver operating characteristic curve of 0.75 after bootstrapping and was well calibrated. Clinicians' predictions had an ROC area of 0.71 and were less well calibrated with a tendency towards pessimism. Conclusions. This study has produced an outpome prediction score with reasonable discrimination and good calibration that has the potential to support clinicians in understanding the prognosis of patients with obstructive lung disease considered for critical care

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Rippin, Allyn Sager. ""Challenging families": the roles of design and culture in nurse-family interactions in a high acuity intensive care unit". Thesis, Georgia Institute of Technology, 2011. http://hdl.handle.net/1853/43614.

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The trend towards patient-and family-centered care (PFCC) invites families of critically ill patients to participate more fully in the care and recovery of their loved ones through partnerships with the medical team and personalized care that respects the values, beliefs and experiences of the individual. In response to the growing needs of families, healthcare institutions are re-designing the way patient and family care is delivered in terms of policy, culture and the physical environment. Despite the many benefits that come with closer collaboration, nurses report that "challenging" families are a key source of workplace stress. This exploratory case study documents some of these challenges as perceived by staff nurses at Emory University Hospital's Neuro ICU while examining the role the built environment plays in shaping such perceptions. Through a series of ethnographic interviews and observational methodologies, the study identifies some of the challenges and benefits that come with balancing patient and family needs. Nurse strategies developed to reassert spatial and temporal control over work environments are also identified. The second phase of research compares communication patterns generated from two different ICUs to explore the link between unit design and the frequency and quality of nurse-family interactions. Findings suggest that space plays a role in moderating the degree of nurse exposure to the often unstructured and unpredictable aspects of family interactions. These encounters, set within a highly charged critical care setting, may contribute to these perceived challenges. Healthcare stands at an important moment of transition in which attitudes, behaviors and expectations are changing. Together these results reinforce the need for adequate tools, training and education to further support nurses in the transition to this new care culture.

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Larsson, Jonna, i Ann-Charlotte Johansson. "Den initiala informationen till närstående – En studie om intensivvårdssjuksköterskans bemötande". Thesis, Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-48370.

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Introduktion: I intensivvårdssjuksköterskans ansvarsområde ingår det att bemöta och informera närstående. Att vara närstående på en intensivvårdsavdelning innebär en skrämmande och chockartad situation, där flera beskriver maktlöshet och oro för sin närståendes liv. Intensivvårdssjuksköterskan kan utveckla sin kunskap i att bemöta och informera de närstående i den utsatta situationen. Syfte: Syftet var att beskriva intensivvårdssjuksköterskans bemötande i samband med den initiala information som ges till den respiratorbehandlade patientens närstående. Metod: Studien genomfördes med en kvalitativ metod med deskriptiv design. Data insamlades med halvstrukturerade intervjuer där nio intensivvårdssjuksköterskor från tre olika sjukhus med minst tre års erfarenhet deltog. Data bearbetades med en kvalitativ innehållsanalys inspirerad av Graneheim och Lundman. Resultat: I resultatet framkom ett tema med fyra huvudkategorier: Intensivvårdssjuksköterskans roll i bemötandet av närstående, intensivvårdssjuksköterskans roll i givandet av information till de närstående, förhållanden som gynnar och försvårar bemötande och givande av information. Under huvudkategorierna framkom elva underkategorier. Det framkom också att intensivvårdssjuksköterskorna inte gjorde någon skillnad i bemötande och i givande av information där närstående var barn. Konklusion: Intensivvårdssjuksköterskorna beskrev olika tillvägagångssätt för att bemöta och ge information till de närstående initialt. De ansåg att det var viktigt att göra barnen delaktiga, men bemötte och gav information till dem på ett liknande sätt som till de vuxna. Resultatet mynnade i många givna tillvägagångssätt, men också faktorer som både gynnar och försvårar bemötandet och givandet av information.
Introduction: The responsibilities of intensive care nurses include receiving and informing related parties in the event of a crisis. To be a relative in a case of intensive care involves a frightening and shocking situation, in which many describe powerlessness and concern for their relatives lives. Intensive care nurses can develop their knowledge of how to receive and inform the related parties in this vulnerable situation. Purpose: The purpose of this study was to describe the behavior of intensive care nurses, in relation to the initial information given to relatives of patients dealing with respiratory treatment. Method: The study was conducted by a qualitative method with descriptive design. Data were collected with semi-structured interviews in which nine intensive care nurses from three hospitals participated, each with at least three years of experience. Data were processed with a qualitative content analysis inspired by Granheim and Lundman. Findings: The result showed a theme with four main categories: Intensive care nurses role in receiving related parties, critical care nurses role in the giving of information to the related and conditions that favor and complicate treatment and representation of information. From the main categories, another eleven subcategories emerged. It was also noted that intensive care nurses did not behave differently when the ones being received and informed were children related to the patient. Conclusion: Intensive care nurses described various approaches to initially receive and provide information to relatives of intensive care patients. They felt it was important to make the children involved, but received and informed them in a similar way as to adults. The result of the study lead to many obvious approaches, but it also illuminated factors that both benefits and complicates the handling and representation of information.

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Corrêa, Volpini Bruna. "Development of an Ambient Intelligence Environment to improve Patient Safety in Critical Care". Doctoral thesis, Universitat de Barcelona, 2021. http://hdl.handle.net/10803/673228.

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In the late 1990's, when sophisticated personal computers and electronic devices with miniaturized sensors were being mass produced, the concept of ambient intelligence (AmI) emerged. An environment that has AmI is a space containing objects which includes technologies that are not visible to users, and which generates intelligent responses when appropriate. When people interact with an AmI environment, they intuitively use technologies according to their own needs and gain more awareness of their actions, thereby improving their quality of life, comfort, and empowerment. Currently, healthcare professionals work inside a complex adaptive system in which the clinical environment and the health status of patients vary dynamically, and resources are limited. This can generate an increasing number of adverse events as well as medical errors and consequently patients are more exposed to potential harm during a hospital stay. Many researchers are creating new AmI tools to overcome these challenges. This is especially important in intensive care units (ICUs), where there are seriously ill patients who need advanced infrastructure and equipment to receive continuous clinical monitoring and treatment in as safe a way as possible. Three out of every ten patients in an ICU suffer some type of clinical safety issue, which puts their lives at risk. In this context, the main aim of the work I present in this thesis is to develop an AmI environment for improving the efficiency of processes related to patient safety in ICUs. I have written this thesis with the collaboration of the clinical and engineering team of the Smart ICU at the Hospital Cl(n ic in Barcelona (HCB). That AmI environment is equipped mainly with technologies related to the Internet of Things (IoT) that provide an adaptive and dynamic distribution of clinical information based on the role and location of each professional as well as the clinical health status of patients. I divided the development of this thesis into three phases. Firstly, I designed, built, and tested a prototype to simulate the AmI environment in a laboratory setting, considering the main patient safety issues which arise in ICUs. I considered 5 patient safety issues: a code blue, a code red, a code pink, control of nosocomial infections and drug-related errors. Secondly, that prototype was adapted and implemented in a Smart ICU at HCB. Thirdly, I collected and analysed data generated by the AmI. It is important to highlight that part of the data collection and analysis related to the AmI environment took place during the SARS-CoV-2 epidemic (Covid- 19). To summarize, my thesis evaluates the efficiency of the use of new technologies to improve patient safety processes in critical care. It improves clinical and educational standards in terms of patient safety processes at the unit concerned. Moreover, it enables quantification of events related to patient safety as well as heightening awareness of them.
A finales de la década de 1990, cuando las computadoras personales y los dispositivos electrónicos se producían en masa, el concepto de inteligencia en el entorno (AmI – Ambient Intelligence en inglés) surgió. Un entorno que contiene AmI es un espacio con objetos que incluyen tecnologías, invisibles para los usuarios, y que les generan respuestas inteligentes cuando sea necesario. Actualmente, los profesionales sanitarios están trabajando dentro de un sistema complejo adaptativo en el que el entorno clínico y el estado de salud del paciente varían dinámicamente. Esto es especialmente importante en las Unidades de Cuidados Intensivos (UCIs), donde hay pacientes gravemente enfermos que necesitan infraestructuras y equipos avanzados para recibir monitorización de la forma más segura posible. En este contexto, el objetivo principal del trabajo que presento en esta tesis es desarrollar un entorno AmI para mejorar la eficiencia en los procesos relacionados con la seguridad del paciente en las UCIs. He elaborado esta tesis con la colaboración del equipo de la UCI inteligente del Hospital Clínic de Barcelona (HCB). El desarrollo de esta tesis se ha dividido en tres fases. En primer lugar, he diseñado, construido y probado un prototipo para simular el entorno AmI en un escenario de laboratorio considerando los principales problemas de seguridad clínica que ocurren en las UCIs. En segundo lugar, este prototipo ha sido adaptado e implementado en una UCI inteligente del HCB. En tercer lugar, he recogido y analizado los datos generados por el entorno inteligente. En conclusión, mi tesis evalúa la eficiencia del uso de nuevas tecnologías para mejorar los procesos de seguridad clínica en cuidados críticos, mejora los estándares clínicos y educativos sobre los procesos de seguridad del paciente en esta unidad y, finalmente, permite cuantificar los eventos relacionados con la seguridad clínica, así como ganar más conciencia sobre ellos.

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Souza, Thieli Lemos de. "Confusão aguda relacionada ao delirium : desenvolvimento e validação de protocolo multiprofissional de cuidados para paciente crítico". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2017. http://hdl.handle.net/10183/173731.

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A Confusão Aguda é um diagnóstico de enfermagem (DE) frequentemente estabelecido nas Unidades de Terapia Intensivas (UTI) devido à elevada incidência de delirium, 21% a 73% dos pacientes críticos. Ainda, desencadeia importante declínio funcional, maior morbidade, mortalidade, período de internação, tempo de ventilação mecânica e custos. Assim, este estudo objetivou desenvolver e validar um protocolo multiprofissional para manejo de pacientes com o DE Confusão Aguda relacionado ao delirium internados em UTI a partir das evidências encontradas na literatura e na Classificação das Intervenções de Enfermagem (NIC). O estudo foi composto de três etapas: elaboração de uma revisão integrativa (RI) para a identificação das evidências no que tange aos cuidados para delirium, a seguir foi realizado o mapeamento cruzado entre estas e as intervenções da NIC. A segunda etapa foi à construção do protocolo com os cuidados identificados e, por fim, a validação de conteúdo pelos peritos, sendo considerados validados cuidados com índice de validade de conteúdo (IVC) ≥ 0,90. No desenvolvimento da RI foram encontrados 17 artigos originais. Os cuidados identificados na RI foram relacionados a duas intervenções e quatro atividades da NIC, dentre as prioritárias, 10 intervenções e 28 atividades nas sugeridas e quatro intervenções e oito atividades nas essenciais. Nenhuma intervenção opcional foi mapeada. Dos 48 cuidados selecionados a partir da RI e mapeamento cruzado, os quais foram submetidos à validação de conteúdo, apenas quatro não obtiveram consenso pelo IVC. O protocolo multiprofissional de cuidados validado pelos peritos para pacientes com DE Confusão Aguda relacionado ao delirium internados em UTI englobou cuidados referentes ao diagnóstico de delirium, pausa de sedação e mobilização precoce (segundo o bundle ABCDE), diretrizes para dor, agitação e delirium, agitação psicomotora, orientação cognitiva, promoção do sono, ambiente e participação da família. A partir da construção do protocolo assistencial proposto é esperado qualificar a assistência prestada ao paciente crítico em delirium. No entanto, ainda são necessárias mais pesquisas a fim de determinar evidências mais robustas dos cuidados farmacológicos e não farmacológicos.
Acute Confusion is a nursing diagnosis (ND) frequently established in Intensive Care Units (ICU) due to the high incidence of delirium, 21% to 73% of critical patients. Still, it triggers important functional decline, higher morbidity, mortality, period of hospitalization, time in mechanical ventilation and costs. Thus, this study was aimed to develop and validate a health care protocol to manage patients with the ND of Acute Confusion related to delirium and hospitalized in the ICU, from the evidences found in the literature and Nursing Interventions Classification (NIC). The study was composed by three phases: elaboration of an integrative review (IR) to identifying the evidences in what concerns delirium care. Following to that, a cross-mapping was made between those and the NIC interventions. The second phase was the construction of a protocol with the identified care, and finally the validation per content by the experts, being considered validated care the ones with content validity index (CVI) ≥ 0.90. In the development of the IR, 17 original articles were found. The care identified at IR were related to two interventions and four activities of the NIC, among the priorities, 10 interventions and 28 activities in the suggested ones, and 4 interventions and 8 essential activities. No optional intervention was mapped. Of the 48 care selected from IR and crossmapping, which were submitted to content validation, only four did not obtain consensus by the CVI. The health care protocol validated by the experts for patients with the ND of Acute Confusion related to delirium hospitalized in the ICU encompassed care referent to the diagnosis of delirium. These are pause in sedation and early mobilization (according to bundle ABCDE), orientation for pain, agitation and delirium, psychomotor agitation, cognitive orientation, sleep promotion, environment and family participation. From the construction of the proposed health care protocol, qualifying the assistance to the critical patient under delirium is expected. However, more researches are necessary in order to determine robust evidences in the pharmacological and non-pharmacological care.

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Shin, Ji Won. "Feasibility, Acceptability, and Preliminary Efficacy of VidaTalk^TM Communication Application with Family Caregivers of Mechanically Ventilated ICU Patients". The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1565972032500865.

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Favretto, Débora Oliveira. "Aspiração endotraqueal em pacientes críticos adultos intubados sob ventilação mecânica: revisão sistemática". Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-31102011-082522/.

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Este estudo trata-se de uma revisão sistemática da literatura e tem como referencial teórico a prática baseada em evidência. Buscou-se identificar e analisar na literatura evidências oriundas de ensaios clínicos controlados e randomizados sobre os cuidados relacionados à aspiração de secreções endotraqueais em pacientes adultos, em estado crítico, intubados e sob ventilação mecânica. Os passos metodológicos desta revisão foram guiados pelas recomendações da Colaboração Cochrane. A busca foi realizada nas bases de dados PUBMED, EMBASE, CENTRAL, CINAHL e LILACS. Das 631 referências encontradas, 17 estudos foram selecionados após a análise dos títulos e resumos. Foi realizada a extração dos dados e análise do risco de viés por dois revisores, para cada estudo selecionado. Os 17 estudos foram publicados no período de 1987 à 2009. Ao todo, foram investigados 2.890 pacientes adultos, intubados e sob ventilação mecânica. Foram encontradas evidências quanto a seis categorias de intervenções relacionadas à aspiração endotraqueal: aspiração endotraqueal baseada em pesquisa x aspiração endotraqueal usual, em um estudo; aspiração endotraqueal de rotina x aspiração endotraqueal minimamente invasiva, em dois estudos; aspiração endotraqueal de sistema aberto x aspiração endotraqueal de sistema fechado, em oito estudos; troca do sistema fechado em 24 horas x 48 horas, em dois estudos; troca diária do sistema fechado x troca não rotineira, em um estudo; e instilação de soro fisiológico x não instilação de soro fisiológico, em três estudos. As intervenções foram realizadas analisando desfechos referentes a alterações hemodinâmicas, alterações dos gases sanguíneos, colonização microbiana e infecção nosocomial, e outros desfechos. Foram encontradas evidências relevantes quanto à prática da aspiração endotraqueal, entretanto, as limitações metodológicas e riscos de viés encontrados nos estudos selecionados reduzem a confiabilidade de tais evidências, demonstrando a necessidade de estudos futuros. Também, foi observada a necessidade da realização de ECCRs que contemplem os demais passos da aspiração endotraqueal e desfechos.
This systematic review of literature used the evidence-based practice as the theoretical framework. This study aimed to identify and analyze in the literature the evidence of randomized controlled trials on care related to the endotracheal secretions suctioning in critically ill adult patients who were intubated and undergoing mechanical ventilation. The methodological steps were guided by the recommendations of the Cochrane Collaboration. The search was conducted in the PUBMED, EMBASE, CENTRAL, CINAHL and LILACS databases. Of the 631 found references, 17 studies were selected after the analysis of titles and abstracts. The data extraction and the analysis of the risk of bias by two reviewers for each selected study were performed. The 17 studies were published in the period from 1987 to 2009. In the total, 2,890 adult patients who were intubated and undergoing mechanical ventilation were investigated. Evidences for six categories of interventions related to endotracheal suction were found: research-based endotracheal suction x usual endotracheal suction, in one study; routine endotracheal suction x minimally invasive endotracheal suction, in two studies; open endotracheal suction system x closed endotracheal suction system, in eight studies; change of closed system in 24 hours x 48 hours, in two studies; daily change of closed system x non-routine change, in one study; and instillation of saline x non-instillation of saline, in three studies. The interventions were performed through the analysis of outcomes related to hemodynamic alterations, blood gas alterations, microbial colonization and nosocomial infection, and other outcomes. Relevant evidences related to the practice of endotracheal suction were found; however, methodological limitations and risks of bias found in selected studies reduce the reliability of such evidences, demonstrating the need for further studies. Also, the need for the realization of ECCRs that address the remaining steps of endotracheal suction and outcomes were observed.

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Almerud, Sofia. "Vigilance & Invisibility : Care in technologically intense environments". Doctoral thesis, Växjö : Växjö University Press, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:vxu:diva-1506.

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Crespo, Jeiel Carlos Lamonica. "Hipoglicemia e fatores de risco em pacientes críticos com controle glicêmico: estudo de coorte". Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-17042015-122810/.

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Introdução: No âmbito da assistência ao paciente crítico, ainda persiste uma intensa e controversa discussão acerca da dificuldade da manutenção da normoglicemia, especialmente a fim de evitar episódios hipoglicêmicos. A hipoglicemia consiste em importante evento adverso e fator limitante para o controle glicêmico (CG) ideal. Objetivo: Este trabalho teve por objetivo analisar a hipoglicemia e os fatores associados em pacientes críticos. Método: Coorte retrospectiva conduzida com pacientes críticos internados nas unidades de terapia intensiva, e clínica semi-intensiva do Hospital Universitário da Universidade de São Paulo. A amostra foi composta por 106 adultos, que apresentaram CG, por, pelo menos, 48 h, e cujo seguimento foi de 72 h. A variável dependente foi hipoglicemia (70mg/dl) e independentes foram idade, dieta, uso de insulina, catecolaminas, hemodiálise, carga de trabalho de enfermagem e SAPSII. Na análise dos dados utilizaram-se os testes t de student, Exato de Fisher e regressão logística, com significância de p 0,05. Resultados: A incidência de hipoglicemia 70mg/dl foi de 14,2%. A média de idade foi 63,3 anos, com internação clínica em 67% dos casos, cerca de 40% dos pacientes tinham diabetes mellitus 39% insuficiência renal e 8% insuficiência hepática. A hipoglicemia foi associada a média da glicemia (p=0,013) variabilidade glicêmica (p=0,000), uso de catecolaminas (p=0,040), óbito na UTI (p=0,008). Foram fatores de risco a ausência de dieta via oral, OR 5,11; IC 1,04 -25,10, e a realização de hemodiálise OR 4,28; IC 1,16-15,76. O intervalo de medida glicêmica mais frequente foi de 6/6h, com poucas medidas em horários de troca de turno de trabalho e no período das 4 h às 7 h. A correlação entre medidas glicêmicas prescritas e realizadas foi de 0,880 (p=0,000). Conclusão: A hipoglicemia persiste como evento adverso no contexto das unidades críticas. A prescrição do CG, com maior ênfase na monitorização nos grupos de risco, ou seja, nos pacientes submetidos a hemodiálise e aqueles que não recebem dieta VO, pode ajudar a prevenir episódios hipoglicêmicos
Introduction: Within the context of critical patients care, there remains an intense and controversial discussion over the difficulty of maintaining normoglycemia, especially to avoid hypoglycemic episodes. Hypoglycemia is an important adverse event and a limiting factor for an ideal glycemic control (GC). Objective: This study aimed to analyze the factors associated to hypoglycemia in critically ill patients. Methods: Retrospective cohort study conducted in critically ill patients from intensive and semi-intensive care units, of the University Hospital University of São Paulo. The sample consisted of 106 adults who had GC, for at least 48 h, and whose follow-up was 72 h. The dependent variable was hypoglycemia (70mg / dl) and independent variables were age, diet, insulin, catecholamines, hemodialysis, nursing workload and SAPSII. In the data analysis we used Students t and Fishers Exact tests and logistic regression, with significance of p 0,05. Results: The incidence of hypoglycemia 70mg / dl was 14.2%. The average age was 63.3 years, 67% were clinical patients, about 40% had diabetes mellitus, 39% had renal failure and 8% liver failure. Hypoglycemia was associated with mean blood glucose (p = 0.013) glycemic variability (p = 0.000), use of catecholamines (p = 0.040), and death in the ICU (p = 0.008). Risk factors were the absence of oral diet, OR 5.11; CI 1.04 -25.10, and hemodialysis OR 4.28; CI 1.16 to 15.76. The most frequent range of glucose measurement was 6 / 6 h, with few readings in the hours of the nursing work shift change, and from 4 h to 7 h am. The correlation between prescribed and performed glucose measurements was 0.880 (p = 0.000). Conclusion: Hypoglycemia persists as an adverse event in the context of critical units. Prescription of GC, with greater emphasis on monitoring in risk groups, namely, patients undergoing hemodialysis and those not receiving VO diet, can help prevent hypoglycemic episodes

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Oliveira, Raphael Augusto Gomes de. "Influência das alterações bioquímicas urinárias e séricas sobre o índice de resistividade renal em pacientes críticos e evolução durante injúria renal aguda". Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5169/tde-14122017-132039/.

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Objetivos: Nesta tese, a influência de fatores laboratoriais, sistêmicos e renais sobre o índice de resistividade renal ao Doppler (IR renal) em pacientes críticos foi avaliada. Da mesma forma, a acurácia do IR renal na predição da ocorrência e da reversibilidade da injúria renal aguda em pacientes críticos também foi analisada. Métodos: Estudo prospectivo observacional realizado entre Novembro de 2013 e Outubro de 2014, numa unidade de terapia intensiva (UTI) de 14 leitos. Dados clínicos, IR renal, exames laboratoriais de sangue e de urina foram coletados. Injúria renal aguda foi avaliada quanto a sua reversibilidade, e categorizada em transitória (normalização da função renal em 3 dias) e persistente (ausência de normalização da função renal em 3 dias ou necessidade de terapia de substituição renal). Um modelo linear misto foi realizado para avaliar a influência das variáveis de interesse no IR renal, a saber: presença de sepse, Simplified Acute Physiology Score 3 (SAPS 3), idade, cloreto sérico, uso de drogas vasoativas, pressão de pulso, frequência cardíaca, lactato, presença de injúria renal aguda de acordo com sua reversibilidade (transitória ou persistente). Resultados: 83 pacientes foram incluídos. 65% eram do sexo masculino e 51% apresentavam diagnósticos clínicos como causa de internação hospitalar. SAPS 3 foi de 47 ± 16. Não foram observadas diferenças significantes em relação a idade, gênero, necessidade de vasopressor e de ventilação mecânica entre as diferentes categorias de IRA à admissão na UTI. 53 pacientes já apresentavam critérios de IRA na admissão na UTI. A presença de choque circulatório foi o fator de risco para desenvolvimento de IRA mais prevalente (41%). Os valores de pressão de pulso, lactato e cloreto séricos não foram diferentes entre as categorias de IRA durante o período de observação. Os valores de IR renal foram estatisticamente superiores nos pacientes com IRA persistente (0,70 ± 0,08), quando comparados aos pacientes com IRA transitória (0,64 ± 0,07) ou sem IRA (0,64 ± 0,06; p < 0,01). O IR renal também revelou uma boa acurácia em predizer IRA persistente nos pacientes com diagnóstico de IRA na admissão na UTI (AUC= 0,78; IC 95% 0,65-0,91). As variáveis identificadas no modelo linear misto associadas a variações de IR renal foram idade, pressão de pulso, lactato sérico e categoria de IRA (IRA persistente) (p < 0,05). Conclusão: O IR renal apresentou uma boa acurácia em predizer a reversibilidade da IRA em pacientes críticos. Contudo, uma série de fatores sistêmicos e renais (idade, pressão de pulso, lactato sérico e a categoria da IRA) podem influenciar seus resultados
Introduction: In the present thesis, the influence of systemic, biochemical and renal factors on renal Doppler resistive index (RI) was evaluated. The accuracy of RI to predict acute kidney injury (AKI) and its reversibility was also appraised. Methods: Prospective observational study performed at medical-surgical ICU from November 2013 to October 2014. Information regarding clinical data, doppler RI, blood and urinary laboratory data was obtained during the observation period. AKI\'s reversibility was categorized into transient (normalization of renal function within 3 days of AKI onset) and persistent (nonresolution of AKI within 3 days of onset or need for renal replacement therapy). Linear mixed model was performed to evaluate the factors that could influence RI analysis. The variables evaluated on model were presence of sepsis, Simplified Acute Physiology Score 3 (SAPS 3), age, serum chloride, vasoactive drugs requirement, pulse pressure, heart rate, serum lactate and AKI categories (transient or persistent). Results: Eighty-three consecutive patients were included. 65% were male and 51% were admitted due to medical reasons. SAPS 3 were 47 ± 16. No differences were observed in age, gender, mechanical ventilation requirement and vasopressor therapy requirement between AKI groups at ICU admission. 53 patients had already AKI at ICU admission. Circulatory shock was the most common factor associated with AKI (41%). Serum lactate, pulse pressure and serum chloride was not different between groups during observation period. Doppler RI was statistically different between no-AKI (0.64 ± 0.06), transient AKI (0.64 ± 0.07) and persistent AKI patients (0.70 ± 0.08, p < 0.01). RI also showed a good accuracy to predict persistent AKI on patients with AKI at ICU admission (AUC= 0.78, 95% CI 0.65- 0.91). Variables associated with RI variations were pulse pressure, lactate, age, and AKI category (persistent AKI) (p < 0.05). Conclusions: Although renal resistive index had showed good accuracy to predict AKI reversibility in critically ill patients, several factors (age, pulse pressure, lactate levels and AKI category) could influence its values

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Pires, Ana Beatriz Mateus. "Custo direto da passagem de cateter central de inserção periférica por enfermeiros em Unidade de Terapia Intensiva Pediátrica e Neonatal". Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/7/7140/tde-18102017-172449/.

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Introdução: Os pacientes críticos necessitam de um acesso venoso central (AVC) para realização de terapia intravenosa (TIV) prolongada. Dentre as opções de AVC, o cateter central de inserção periférica (CCIP) vem conquistando espaço, progressivamente, nas organizações hospitalares brasileiras. A passagem de CCIP requer recursos humanos especializados, materiais, medicamentos e soluções específicas tornando-se fundamental a apuração dos custos envolvidos para subsidiar a eficiência alocativa destes insumos. Objetivo: Identificar o custo direto médio (CDM) do procedimento de passagem de CCIP, realizado por enfermeiros, em uma Unidade de Terapia Intensiva Pediátrica e Neonatal (UTIPN). Método: Trata-se de pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único. O procedimento objeto de estudo foi estruturado em três fases: pré-inserção do cateter, inserção do cateter e pós-inserção do cateter. A amostra constituiu-se da observação não participante de 101 passagens de CCIP na UTIPN. O CDM foi calculado multiplicando-se o tempo (cronometrado) despendido por enfermeiros e técnicos de enfermagem pelo custo unitário da mão de obra direta (mob), somando-se ao custo dos materiais e soluções. A moeda brasileira real (R$), utilizada originalmente nos cálculos, foi convertida para a moeda norte-americana dólar (US$). Resultados: Obteve-se o CDM do procedimento ( ) de passagem de CCIP correspondente a US$ 226.60 (DP=82.84), variando entre US$ 99.03 e US$ 530.71, com mediana de US$ 313.21. O CDM com material, US$ 138.81(DP=75.48), e o CDM com mob de enfermeiro, US$ 78.80 (DP=30.75), foram os valores mais expressivos para a composição do . Os kits de cateteres corresponderam aos itens de maior impacto na composição do CDM com material e de maior custo unitário, com destaque para cateter epicutâneo + introdutor, kit - 2FR/duas vias (US$ 208.82/unidade); cateter epicutâneo + introdutor, kit - 2FR (US$ 74.09/unidade) e cateter epicutâneo + introdutor, kit - 3FR (US$ 70.37/unidade). O CDM com mob da equipe de enfermagem foi mais elevado na Fase 2: inserção do cateter (US$ 43.26 - DP=21.41) e na Fase 1 pré-inserção do cateter (US$ 37.96 - DP=14.89). Houve predomínio do CDM com mob de enfermeiro, especialmente pelo protagonismo dos enfermeiros executantes, US$ 40.40 (DP=20.58) e US$ 34.05 (DP=15.03), respectivamente. Conclusão: Este estudo de caso além de propiciar a mensuração do de passagem de CCIP, conferiu visibilidade aos insumos consumidos na perspectiva de contribuir com o seu uso racional. Favoreceu inclusive a proposição de estratégias visando incrementar a TIV prolongada, por meio do CCIP, e, consequentemente, auxiliar na contenção/minimização de custos e na diminuição de custos intangíveis aos pacientes.
Introduction: Critical patients require central venous access (CVA) for prolonged intravenous (IVT) therapy. Among the AVC options, the peripherally inserted central catheter (PICC) has been progressively gaining a position into the Brazilian hospital organizations. The passage of PICC requires specialized human resources, materials, medicines and specific solutions, being crucial to calculate the costs involved to subsidize the allocative efficiency of these inputs. Objective: To identify the average direct cost (ADC) of the PICC procedure performed by nurses, in a Pediatric and Neonatal Intensive Care Unit (PNICU). Method: This is a quantitative, exploratory-descriptive single-case study. The procedure was arranged into three phases: \"pre-insertion of the catheter\", \"insertion of the catheter\" and \"post-insertion of the catheter\". The sample consisted of the non-participant observation of 101 PICC passages in the PNICU. The average was calculated by multiplying the time (measured) spent by nurses and nursing technicians by the unit cost of direct labor (dl), adding up to the cost of materials and solutions. The Brazilian Real currency (R $), originally used in the calculations, was converted to the US dollar currency (US $). Results: The ADC of the PICC procedure ( )) corresponded to US $ 226.60 (SD = 82.84), ranging from US $ 99.03 to US $ 530.71, with a median of US $ 313.21. ADC regarding material was US $ 138.81 (SD = 75.48), and ADC regarding nurse dl was US $ 78.80 (SD = 30.75) which were the most significant values for the ( ) composition. The catheter kits corresponded to the items with the highest impact in the composition of the ADC regarding material and with a higher unit cost, with emphasis on epicutaneous catheter + introducer, kit - 2FR / two tracks (US $ 208.82 / unit); Epicutaneous catheter + introducer, \"kit\" - 2FR (US $ 74.09 / unit) and epicutaneous catheter + introducer, \"kit\" - 3FR (US $ 70.37 / unit). The ADC regarding dl of the nursing team was higher in Phase 2: \"insertion of the catheter\" (US $ 43.26 - SD = 21.41) and in Phase 1 \"pre-insertion of the catheter\" (US $ 37.96 - SD = 14.89). There was a predominance of the ADC regarding nurse dl, especially due to the leading role of the nurse practitioners, US $ 40.40 (SD = 20.58) and US $ 34.05 (SD = 15.03), respectively. Conclusion: This case study, besides providing the measurement of the PICC passage, allowed visibility to the inputs consumed from the perspective of contributing to its rational use. It also favored the proposition of strategies aimed at increasing the prolonged IVT through PICC and, consequently, to contain / minimize costs and reduce intangible costs to patients.

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Garcia, Julia Helena. "Incompatibilidade de medicamentos intravenosos e fatores de risco em pacientes críticos: coorte histórica". Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-14102015-111302/.

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Introdução: A incompatibilidade de medicamento resulta de um fenômeno físico-químico causado pela combinação de dois ou mais medicamentos na mesma solução ou misturados em um mesmo recipiente. Pode ser considerado um erro de medicação pelo potencial de comprometer negativamente o tratamento. Objetivo: Estimar a incidência de incompatibilidades potenciais de medicamentos administrados por via intravenosa e fatores associados em pacientes críticos. Método: Coorte retrospectiva conduzida com pacientes internados nas Unidades de Terapia Intensiva e Semi-intensiva do Hospital Universitário da Universidade de São Paulo. A amostra foi composta por 110 indivíduos adultos hospitalizados, por pelo menos 72 horas, nessas unidades e submetidos à terapia intravenosa. A incompatibilidade potencial de medicamento foi analisada em duplas de medicamentos, utilizando-se a ferramenta Trissel´s TM 2 Compatibility IV, através da base de dados Micromedex 2.0®. A variável dependente foi a ocorrência de incompatibilidade. As variáveis independentes foram idade, sexo, procedência, tipo de internação, tempo de permanência, SAPSII, índice de Charlson, carga de trabalho de enfermagem, condição de alta, modo de infusão, número de medicamentos prescritos e de prescritores. Na análise dos dados utilizaram-se os testes qui-quadrado de Pearson, Exato de Fisher, Kruskal-Wallis, modelo de análise de variância ANOVA e regressão logística, com significância de p 0,05. Resultados: A incidência de incompatibilidade potencial de medicamentos foi de 2,7%. Foram prescritos 72 tipos diferentes de medicamentos que formaram 565 duplas, destas, 44,9%, foram compatíveis e 8,8%, incompatíveis. O aparecimento de precipitação (50,0%) foi a alteração físico-química mais identificada, após as combinações via dispositivo em Y. Na frequência de aparecimento, as duplas de medicamentos incompatíveis formadas por fenitoína (32,0%), diazepam (14,0%), midazolam (10,0%) e dobutamina (8,0%) foram as mais identificadas. Cerca de 70% dos pacientes receberam medicamentos prescritos a critério médico, principalmente durante o período noturno. Os fatores de riscos associados à incompatibilidade foram procedência (RC: 1,506; IC: 0,327 - 6,934); tempo de permanência prolongado nas unidades (RC: 1,175; IC: 1,058 - 1,306); maior número de medicamentos prescritos (RC: 1,395; IC: 1,091 -1,784) e carga elevada de trabalho de enfermagem (RC: 1,060; IC: 1,010 -1,113). Conclusão: O número de medicamentos prescritos aos pacientes críticos, em decorrência da gravidade clínica, aumenta exponencialmente a ocorrência de incompatibilidade e, os expõe a graves consequências. Embora haja outros estudos que identifiquem as incompatibilidades potenciais, observa-se, no cotidiano das unidades críticas, a repetição de rotinas que comprometem a segurança do paciente. A incompatibilidade poderá ser teoricamente diminuída, quando houver ênfase nas medidas preventivas e na contínua educação da equipe multidisciplinar.
Introduction: Drug incompatibility results from a physicochemical phenomenon caused by the combination of two or more drugs in the same solution or mixed in a single container. It can be considered a medication error due to its potential to compromise the treatment. Objective: To estimate the incidence of potential incompatibilities of drugs administered intravenously and associated factors in critically ill patients. Methods: Retrospective cohort study conducted with patients in Intensive and Semi-intensive Care Units at the University Hospital of the University of São Paulo. The sample consisted of 110 adults hospitalized for, at least 72 hours, in these units and submitted to intravenous therapy. The potential drug incompatibility was analyzed in pairs of drugs, using the TM Trissel\'s 2 Compatibility IV tool through Micromedex 2.0® database. The dependent variable was the occurrence of incompatibility. The independent variables were age, gender, origin, type of admission, length of stay, SAPSII, Charlson index, nursing workload (NAS), discharge condition, infusion mode, number of prescription drugs and prescribers. To analyze the data we used the chi-squared Pearson tests, Fisher Exact test, Kruskal-Wallis, ANOVA model and logistic regression, with significance p 0.05. Results: The incidence of potential incompatibility of drugs was 2.7%. Seventy-two 72 different types of drugs were prescribed forming 565 pairs of which 44.9% were compatible and 8.8%, incompatible. The precipitation onset (50.0%) was most identified physical-chemical change after the combinations via device Y. In frequency of appearance, the pairs of drugs formed by phenytoin (32.0%), diazepam (14.0%), midazolam (10.0%) and dobutamine (8.0%) were the most identified. About 70% of the patients received prescription drugs to medical criteria, especially during the night. Risk factors associated with the incompatibility were origin (OR: 1.506; CI: 0.327 to 6.934); prolonged length of stay in the units (OR: 1.175; CI: 1.058 to 1.306); greater number of prescribed medications (OR: 1.395; CI: 1.091 -1.784) and high nursing workload (OR: 1.060; CI: 1.010 -1.113). Conclusion: The number of prescription drugs to critically ill patients, due to the clinical severity, exponentially increases the occurrence of incompatibility and exposes them to serious consequences. Although there are other studies that identify the potential incompatibilities, we observe, in the daily life of critical units, repeating routines that compromise patient safety. Incompatibility can be theoretically reduced when there is emphasis on preventive measures and continuous education of the multidisciplinary team

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Giannini, Fábio Poianas. "Abordagem do erro em unidades de terapia intensiva paulistanas". Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5169/tde-23102018-114122/.

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A prática da medicina vem mudando rapidamente. Nos últimos 20 anos os profissionais de saúde tem se preocupado cada vez mais com os erros que ocorrem durante o processo de cuidado dos pacientes enquanto trabalham duramente para preveni-los e mitigá-los. Tão importante quanto o erro em si é a maneira como o evento adverso é discutido e a maneira como os profissionais envolvidos no erro são abordados. O objetivo da pesquisa foi aplicar um questionário sobre erro e abordagem do erro. O instrumento foi originalmente publicado em língua inglesa e validado em português pelo método de Brislin. Responderam ao questionário 161 profissionais de saúde (enfermeiros, técnicos de enfermagem, médicos e fisioterapeutas) provenientes de 19 diferentes unidades de terapia intensiva adulto públicas e privadas da cidade de São Paulo (Estado de São Paulo - Brasil).Os resultados revelaram que profissionais do sexo masculino são mais propensos a reconhecer que cometem erros em relação a profissionais do sexo feminino com uma razão de chances de 0,21 (0,07-0,65); que profissionais oriundos de unidades públicas reportam com mais frequência que ameaça de processos {RC 0,23 (0,11 - 0,48)}, ameaça à estabilidade no emprego {RC 0,49 (0,24 - 0,99)} e personalidade de outros membros da equipe {RC 0,22 (0,09 - 0,51)} são motivos para que os erros não sejam discutidos tampouco abordados adequadamente. Estas informações levantam possíveis oportunidades para aprofundar a discussão e o tratamento de eventos adversos em unidades de terapia intensiva
The practice of medicine is changing quickly. In the last 20 years, health professionals have increasingly worried about errors that occur during the process of patient care while working hard for its prevention and mitigation.As important as the error itself is the way each adverse event is discussed as well as each professional involved in an error is approached .The goal of the research was applying a survey about error and its approach. The tool was originally published in english and afterwards validated in portuguese by the Brislin method. The survey was answered by 161 health professionals (nurses, nurse technicians, intensive care physicians and physiotherapists) coming from 19 different adult intensive care units both public and private in the city of São Paulo (São Paulo - Brazil). The results revealed that male professionals are more likely to recognize having made an error than female professionals with a odds ratio of 0.21 (0.07-0.65). It also showed that professionals coming from public units report more often that the threat of litigation {RC 0.23 (0.11 - 0.48)}, threat of unemployment {RC 0,49 (0,24 - 0,99) } and other team members personality {RC 0.22} (0.09 - 0.51) are reasons for problems not being discussed or addressed. The informations collected on this survey raise opportunities to improve the study and treatment of adverse events in intensive care units

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Susin, Ângela Carissimi. "Estratégias de humanização em uma unidade de terapia intensiva de um hospital privado do município de Caxias do Sul – RS". Universidade do Vale do Rio dos Sinos, 2016. http://www.repositorio.jesuita.org.br/handle/UNISINOS/5812.

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A humanização em Unidade de Terapia Intensiva (UTI) é um assunto amplamente debatido e as experiências vivenciadas neste espaço evidenciam a falta de preparo por parte da equipe multidisciplinar ao tratar o familiar como uma unidade de cuidado e a escassez de práticas humanizadoras na assistência. Elaborar estratégias de humanização e revelar pela ótica dos familiares e da equipe multidisciplinar o conceito de humanização. Estudo observacional, descritivo e exploratório, com abordagem mista. As entrevistas foram realizadas em uma UTI adulto de um hospital privado da cidade de Caxias do Sul-RS, no período de janeiro a junho de 2016, partindo das seguintes questões norteadoras: “considerando a experiência vivenciada, o que significa humanizar em uma UTI?” e “quais são suas sugestões para tornar a UTI mais humanizada?”. As análises dos dados obtidos através destes questionamentos apontam para aspectos fundamentais na assistência ao paciente crítico. Considerando a concepção de humanização, ambos grupos relacionaram a empatia, acolhimento e respeito a individualidade do paciente como fundamentais para uma assistência humanizada. Quanto às sugestões, a equipe multidisciplinar elencou a comunicação, capacitação da equipe, condições de trabalho e o estreitamento da relação equipe/paciente/família. Destas sugestões duas foram citadas também pelos familiares dos pacientes internados: comunicação e capacitação da equipe para uniformidade dos processos. Algumas estratégias foram elaboradas por meio dos dados obtidos: a reorganização da sistemática de atendimento ao familiar na visita, a flexibilização e visita estendida após avaliação da equipe multidisciplinar, a hora da informação, implantação de um grupo de trabalho hospitalar e rodas de conversa para os funcionários. A humanização é algo intrínseco, dada a nossa condição de humanos, mas atualmente, os processos de trabalho das instituições de saúde ainda são focados somente para procedimentos, protocolos e centrados no modelo biomédico o que acarreta lacunas entre a humanização e a prática.
The humanization in Intensive Care Unit (ICU) is a widely debated issue and the experiences lived in this unit show the lack of preparation by the multidisciplinary team to treat the family as a unit of care and the shortage of humanizing practices in the assistance. To develop humanization strategies and reveal the perspective of the family and the multidisciplinary team the concept of humanization. Observational, descriptive and exploratory study, with mixed approach. The interviews were conducted in an adult ICU of a private hospital in the city of Caxias do Sul-RS, in the period of January to June 2016, based on the following guiding questions: "considering the lived experience, what does it mean humanize in an ICU?"and " what are your suggestions to make the ICU more humanized?". The analysis of the data obtained through these questions pointed to fundamental aspects of assistance for the critical patient. Considering the conception of humanization, both groups related the empathy, reception and respect to the individuality of the patient as essential for a humanized assistance. As for suggestions, the multidisciplinary team outlined the communication, team training, working conditions and the strengthening of the staff / patient / family relationship. From these suggestions, two were also mentioned by family members of the hospitalized patients: communication and staff training for uniformity of processes. Some strategies were prepared over the data obtained: the reorganization of the systematic of attendance to the relative in the visit, the flexibility and extended visit after evaluation of the multidisciplinary team, the time of the information, the implementation of a hospital working group and conversation circles for employees. The humanization is something intrinsic, given our condition as humans, but currently, the work processes of healthcare institutions are still focused only to procedures, protocols and focused on the biomedical model which causes gaps between the humanization and the practice.

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47

Jones, Mari. "Modelling activities in a Critical Care Unit". Thesis, Cardiff University, 2008. http://orca.cf.ac.uk/54919/.

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The Critical Care Unit (CCU) is the sector of the hospital where, as the name suggests, critically ill patients receive treatment. The main aim of this research is to identify and apply suitable Operational Research techniques to model patient flow in the CCU at the University Hospital of Wales, Cardiff. The Operational Research techniques employed in this thesis include queueing theory and simulation. These methods have been utilised previously in the field of healthcare with much success. The thesis begins by considering two aspects of queueing theory, namely batch service queueing theory and batch arrival queueing theory. The latter of these is utilised to model patient flow within the CCU. Although queueing theory may be used as a good approximation to activities in the Unit, it does not incorporate all aspects of real-life. Thus discrete-event simulation is suggested as an alternative approach. Two types of statistical analysis, CART and Regression, are applied to both length of stay and mortality variables. The results from these statistical tests are compiled and investigated in more depth. Finally, a discrete event simulation model is built in Visual Basic for Applications, for Microsoft Excel. This simulation model incorporates many of the complexities of a CCU, such as patient priority and cancellation of scheduled patients if all beds on the Unit are occupied. The model is then used to test various "what-if type" scenarios, including the possibility of funding additional beds, the concept of ring-fencing of beds for different levels of care, and the likely effect of reducing the impact of bed-blocking.

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Melo, Talita de Oliveira. "Custo de procedimentos realizados por profissionais de enfermagem ao paciente grande queimado em Unidade de Terapia Intensiva". Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/7/7140/tde-11012016-130825/.

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Introdução: A assistência hospitalar a pacientes portadores de queimaduras é altamente dispendiosa devido aos recursos humanos, materiais e estruturais necessários à sua viabilização. O conhecimento financeiro relativo a essa temática ainda é escasso, especialmente no que tange aos custos dos procedimentos executados por profissionais de enfermagem a pacientes, grandes queimados, em condições críticas. Objetivo: Identificar o custo direto médio (CDM) dos procedimentos realizados, com maior frequência, por profissionais de enfermagem, a pacientes grandes queimados internados em uma Unidade de Terapia Intensiva de Queimaduras (UTIQ). Método: Esta pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único, foi conduzida na UTIQ da Unidade de Queimaduras do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. O CDM foi calculado multiplicando-se o tempo (cronometrado) despendido por profissionais de enfermagem na execução dos procedimentos, objeto de estudo, pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais e soluções/medicamentos. Para a realização dos cálculos utilizou-se a moeda brasileira (R$). Resultados: A partir de 1354 observações, relativas a 12 procedimentos frequentemente realizados na UTIQ, obteve-se o CDM de R$ 1,88 (DP=1,04) para controle dos sinais vitais; R$ 28,78 (DP=69,74) para administração de medicamentos via intravenosa; R$ 16,97 (DP=7,92) para mensuração de diurese; R$ 2,68 (DP=1,20) para verificação de glicemia capilar; R$ 6,71(DP=2,20) para administração de medicamentos via sonda nasoenteral; R$ 50,07 (DP=11,89) para higiene íntima no leito; R$ 3,64 (DP=2,01) para auxílio alimentação; R$ 55,88 (DP=18,98) para banho no leito/arrumação da cama; R$ 287,11 (DP=372,87) para curativo; R$ 6,65 (DP=2,09) para higiene oral; R$ 3,13 (DP=1,08) para administração de medicamentos via oral e R$ 8,51 (DP=1,79) para administração de medicamentos via subcutânea. Conclusão: A apuração dos custos dos recursos consumidos nos procedimentos requeridos pelos pacientes, grandes queimados, em UTI, pode fundamentar as tomadas de decisão gerenciais subsidiando a sua eficiência alocativa, evitando a ocorrência de desperdícios e, quando possível, indicando estratégias de contenção/minimização de custos sem prejuízos à qualidade da assistência de enfermagem.
Introduction: Hospital care for critical burn patients is highly costly due to human, material and structural resources required for its viability. The financial knowledge concerning this subject is still scarce, especially in regard to the cost of procedures performed by nurses in critical burn patients. Objective: To identify the average direct cost (ADC) of the nursing procedures carried out with greater frequency for burn patients admitted into the burn intensive care unit (BICU). Methodology: This quantitative exploratory and descriptive single case study was conducted in BICU at the Burn Unit of the Hospital das Clinicas of the Faculty of Medicine, Universidade de Sao Paulo. The ADC was calculated by multiplying the time (chronometering) spent by nursing professionals in procedures, object of this study, by the unit cost of direct labor adding to the cost of materials and solutions/drugs. For the purposes of the calculation, the Brazilian currency (R$) was used. Results: Based on 1354 observations related to 12 procedures often performed in BICU, it was obtained the ADC of R$ 1.88 (SD=1.04) for \"control the vital signs\"; R$ 28.78 (SD=69.74) for \"administering medication intravenously\"; R$ 16.97 (SD=7.92) for \"measurement of diuresis\"; R$ 2.68 (SD=1.20) to \"check Capillary Blood Glucose\"; R$ 6.71 (SD=2.20) for \"drug administration via nasogastric tube\"; R$ 50.07 (SD=11.89) for \"patient intimate hygiene; R$ 3.64 (SD=2.01) for \"food aid\"; R$ 55.88 (SD=18.98) for \"bed bathing/make the bed\"; R$ 287.11 (SD=372.87) for \"dressing\"; R$ 6.65 (SD=2.09) for \"oral hygiene\"; R$ 3.13 (SD=1.08) for \"oral drug administration\" and R$ 8.51 (SD=1.79) for \"drug administration subcutaneously\". Conclusion: The calculation of the resource costs spent in the procedures required by critical burn patients, in ICU, justify the decision making of subsidizing its allocative efficiency, avoiding the occurrence of waste and, when possible, indicating control strategies/minimizing strategy costs without impairing the quality of nursing care

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Majó, Roviras Carme. "Anàlisi dels problemes ètics de la limitació de l'esforç terapèutic a la Unitat de Cures Intensives". Doctoral thesis, Universitat de Barcelona, 2016. http://hdl.handle.net/10803/394008.

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La funció de les Unitats de Cures Intensives consisteix en donar suport a la insuficiència dels òrgans de pacients greument malalts. En la gran majoria de pacients, s'aconsegueix revertir la situació de risc vital, però en contrapartida també estem parlant d'un dels serveis hospitalaris que té més mortalitat estadísticament i que ha de limitar les tècniques en una part important dels casos. Atenent el principi de beneficència, un dels principis de la ètica mèdica, la limitació es pot produir abans d'aplicar aquestes tècniques ja que d'entrada es determina que no es podrà oferir cap benefici terapèutic al malalt, però un cop ja s'han aplicat aquestes tècniques també s'han de limitar ja que deixen de ser beneficients més endavant. Aquestes possibilitats han evidenciat cada vegada més aspectes relacionats amb tractaments desproporcionats. S'ha constatat que els professionals solen tenir dos dubtes ètics relacionats amb la limitació de l'esforç terapèutic: 1. Un té a veure en determinar com i en quin moment l'assistència als malalts ha d'agafar una altra dimensió i passar de la vessant terapèutica a la vessant pal•liativa i de confort evitant que els tractaments resultin fútils o desproporcionats. 2. l l'altre, amb el grau d'adequació dels tractaments i de cures al final de la vida. Per poder fer una aportació respecte al debat actual sobre aquest tema, en aquesta tesi s'analitzen tots els casos de LET detectats a la Unitat de Cures Intensives de L'Hospital Universitari Dr. Josep Trueta de Girona, a partir de la sessió clínica de cada dia on es recull, en un registre, l'evolució de tots els pacients distingint els que s'aplicà la Limitació de L'Esforç Terapèutic. Es tracta d'un estudi retrospectiu a través de la revisió de les Històries Clíniques dels pacients a qui es va aplicar una LET. L'estudi té l'objectiu d'actualitzar el debat des de l'estadística i la casuística i per aquesta raó, la tesi parteix d' un marc empíric A la primera part, es donen les dades estadístiques generals sobre la LET a la UCI des del dia 1 d'octubre de 2010 i el dia 30 setembre de 2011, un any en total. A la segona part, es realitza una anàlisi qualitativa dels 77 casos de LET detectats. Finalment, es fa una síntesi dels resultats obtinguts amb una valoració des del principis de la bioètica i s’indiquen unes propostes de millora.
In order to make a contribution with respect to the present debate on the subject of Limitation of life-sustaining treatments, the evolvement of patients is analyzed from daily clinical session registries, distinguishing those where limitation of life-sustaining was applied in the Intensive Care Unit (ICU) of the University Hospital Dr. Josep Trueta of Girona. One is a retrospective study through the revision of the medical histories of patients where limitation of life-sustaining treatments was applied. The objective of this study is to bring up to date the debate from the statistical and casuistry, and therefore, the thesis is part of an empirical standpoint. In the first part, the general statistical data on limitation of life-sustaining treatments in the ICU is from October 1, 2010 to September 30, 2011, one year altogether. In the second part, a qualitative analysis of the 77 cases where limitation of life-sustaining treatments was applied is realized. Finally, a summary of the results obtained along with an evaluation of bioethical principles and some propositions for improvement are indicated. The objective of the doctoral thesis apart from a bioethical standpoint is to find the tools in intensive medicine to adequately combine the therapeutical with support, care and comfort: 1. - How the decisions of limitation of life-sustaining treatments are carried out day to day in the ICU of the Trueta Hospital of Girona and what are the ethical problems that arise. 2. - Determination of what type or what profile of a patient with limitation of life-sustaining treatments in the ICU has. On one hand, how is this patient, what characteristic defines them; age, sex, pathology or reason for admission, origin, number of entered days, complications. On the other hand, questions regarding the principle of autonomy, competency, will and expectations, representatives of the patients, professional opinions, family members and social-economic quality of life, factors, the personal antecedents of interest. 3. - Detect strong and weak points, taking into account, as a last objective, to contribute to the qualitative improvement of care and attention.

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Komenda, Izabela. "Modelling critical care unit activities through queueing theory". Thesis, Cardiff University, 2013. http://orca.cf.ac.uk/47686/.

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Critical Care Units (CCUs) are one of the most complex and expensive of all medical resources and hospital managers are challenged to meet the demand for critical care services with adequate capacity. The pressure on critical care beds is continuously increasing as new medical equipment provides the opportunity to save more patients lives. It is therefore crucial that beds are managed well and used efficiently. This thesis describes two major projects, the first undertaken in conjunction with the CCU at the University Hospital of Wales in Cardiff (UHW); and the second with two CCUs from the Aneurin Bevan Health Board. In the first project data has been analysed to determine the flow of patients through the Unit. Admissions to CCUs were categorised under two headings: emergency, and elective. The length of stay in the CCU is heavily dependent on the admission category. In this thesis, both computer simulation and theoretical queueing models have been considered, which show how improvements in bed management may be achieved by considering these two categories of patients separately. The vast majority of previous literature in this field is concerned only with steady-state conditions, whereas in reality the processes are time-dependent. This thesis goes some way to addressing this deficiency. The second project relates to work undertaken with managers from the Royal Gwent Hospital in Newport and at the Nevill Hall Hospital in Abergavenny. Data from both hospitals have been analysed to define arrival and service processes. A state-dependent theoretical queueing model has been considered which has been used to investigate the significance of combining the two units. The model has been also utilised to advise on the number of beds the new combined unit should have in order to satisfy targets quoted by the hospital managers. In the final part of the thesis, consideration has been given to the impact of collaboration, or lack thereof, between hospitals using a game theoretical approach. The effect of patient diversion has been studied. To formally investigate the impact of patients transfers, a Markov chain model of the two CCUs has been set-up, each admitting two arrival streams: namely, their own patients and transfers from other hospital. Four different models were considered and for each model the effect of targets, demand and capacity were studied. The efficiency of a system which degrades due to selfish behaviour of its agents has been measured in terms of Price of Anarchy.

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