Artículos de revistas sobre el tema "Intensive care nurse´s"
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Khorasani, Elahe, MohammadHossein Yarmohammadian, Golrokh Atighechian y MarzieJafarian Jazi. "Risk assessment in the intensive care unit; nurse′s perspectives". International Journal of Health System and Disaster Management 2, n.º 3 (2014): 147. http://dx.doi.org/10.4103/2347-9019.142196.
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Kodjebacheva, Gergana Damianova, Constance Creech, Loretta Walker, Mary Linton, Susumu Inoue, Joseph Alnarshi y Ranjan Monga. "Health Communication in Neonatal Intensive Care". Californian Journal of Health Promotion 15, n.º 3 (1 de diciembre de 2017): 48–58. http://dx.doi.org/10.32398/cjhp.v15i3.1908.
Resumen
Background and Purpose: Health communication interventions to successfully promote satisfaction with care among parents in the Neonatal Intensive Care Unit (NICU) are limited. This study investigated strategies for effective health communication in the NICU through focus groups with parents and nurses, and individual interviews with neonatologists. Methods: Eight parents, seventeen nurses, and three neonatologists from one NICU in Genesee County, Michigan participated. Results: Parents expressed a preference for daily, face-to-face communication with the physician. They recommended the use of visual aids to help with understanding infants� conditions. One such aid would be a baby diary to serve as the infant�s daily progress report for the parent to review during the visit. A communication strategy used by nurses was providing parents with the most up-to-date information in an approachable, reassuring manner. Physicians suggested interactive communication practice sessions as strategies to increase effective communication between physicians and parents. Physician-to-nurse strategies consisted of building trustworthy relationships by holding scientific forums, discussing health care disagreements, and accepting differing opinions. Conclusion: Future research may assess the influence of strategies recommended in this study on parental satisfaction with care and adherence to treatment recommendations as well as on health care provider self-efficacy.
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Bloemendaal, Alexander L. A., Ad C. Fluit, Wouter M. T. Jansen, Menno R. Vriens, Tristan Ferry, Laurent Argaud, Jose M. Amorim et al. "Acquisition and Cross-Transmission of Staphylococcus aureus in European Intensive Care Units". Infection Control & Hospital Epidemiology 30, n.º 2 (febrero de 2009): 117–24. http://dx.doi.org/10.1086/593126.
Resumen
Objective.To study the acquisition and cross-transmission of Staphylococcus aureus in different intensive care units (ICUs).Methods.We performed a multicenter cohort study. Six ICUs in 6 countries participated. During a 3-month period at each ICU, all patients had nasal and perineal swab specimens obtained at ICU admission and during their stay. All S. aureus isolates that were collected were genotyped by spa typing and multilocus variable-number tandem-repeat analysis typing for cross-transmission analysis. A total of 629 patients were admitted to ICUs, and 224 of these patients were found to be colonized with S. aureus at least once during ICU stay (22% were found to be colonized with methicillin-resistant S. aureus [MRSA]). A total of 316 patients who had test results negative for S. aureus at ICU admission and had at least 1 follow-up swab sample obtained for culture were eligible for acquisition analysis.Results.A total of 45 patients acquired S. aureus during ICU stay (31 acquired methicillin-susceptible S. aureus [MSSA], and 14 acquired MRSA). Several factors that were believed to affect the rate of acquisition of S. aureus were analyzed in univariate and multivariate analyses, including the amount of hand disinfectant used, colonization pressure, number of beds per nurse, antibiotic use, length of stay, and ICU setting (private room versus open ICU treatment). Greater colonization pressure and a greater number of beds per nurse correlated with a higher rate of acquisition for both MSSA and MRSA. The type of ICU setting was related to MRSA acquisition only, and the amount of hand disinfectant used was related to MSSA acquisition only. In 18 (40%) of the cases of S. aureus acquisition, cross-transmission from another patient was possible.Conclusions.Colonization pressure, the number of beds per nurse, and the treatment of all patients in private rooms correlated with the number of S. aureus acquisitions on an ICU. The amount of hand disinfectant used was correlated with the number of cases of MSSA acquisition but not with the number of cases of MRSA acquisition. The number of cases of patient-to-patient cross-transmission was comparable for MSSA and MRSA.
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Nagle, Claire W. y Deborah F. Perlmutter. "THE EVOLUTION OF THE NURSE PRACTITIONER ROLE IN THE NEONATAL INTENSIVE CARE UNIT". American Journal of Perinatology Volume 17, Number 05 (2000): 225–28. http://dx.doi.org/10.1055/s-2000-9991.
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Li, Yihong, Yang Kim, Carol Prendergast, Roslyn Mayers, Moi Louie y Karen Hendricks-Muñoz. "Maternal and Neonatal Nurse Perceived Value of Kangaroo Mother Care and Maternal Care Partnership in the Neonatal Intensive Care Unit". American Journal of Perinatology 30, n.º 10 (28 de enero de 2013): 875–80. http://dx.doi.org/10.1055/s-0033-1333675.
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Hoonakker, Peter L. T., Rebecca J. Rankin, Jennifer C. Passini, Jenny A. Bunton, Bradley D. Ehlenfeldt, Shannon M. Dean, Anne S. Thurber y Michelle M. Kelly. "Nurses' Expectations of an Inpatient Portal for Hospitalized Patients and Caregivers". Applied Clinical Informatics 10, n.º 04 (agosto de 2019): 625–33. http://dx.doi.org/10.1055/s-0039-1694750.
Resumen
Background Patient portals are intended to engage patients and enhance patient-centered care. Recent studies suggest that the information within portals could provide benefits to patients and their caregivers during hospitalization; however, few studies have examined nurse and staff expectations of portals when used in the hospital setting. Objective This article examines inpatient nurse and support staff expectations of a commercially available inpatient portal prior to its hospital-wide implementation. Methods In this cross-sectional study, nurses and support staff were surveyed 1 month prior to the implementation of an inpatient portal for patients. Items included respondent characteristics, satisfaction with online inpatient portal training, expectations of the effects of portal use on patients, caregivers, and staff, overall acceptance, and barriers to its implementation. Results Of 881 respondents, 73.0% were staff nurses, 18.4% nurse assistants, 4.3% unit coordinators, and 1.2% nurse managers. Respondents were generally satisfied with the portal information they received from online training. A majority liked the portal to some extent prior to its use (66.7%); however, they noted multiple implementation barriers, including: tablets would get lost/damaged (66.2% of respondents), patients and/or caregivers would have too many questions (48.5%), and staff would have problems integrating it into their workflow (44.7%). Respondents working on medical units had higher expectations (p < 0.001) and acceptance (p < 0.01) of the portal than those on surgical and intensive care units. Nurse managers were more positive than respondents with other job roles were (all p < 0.001). Conclusion Overall, nurse and support staff had high expectations of the effects of inpatient portal use prior to its hospital-wide implementation. They thought it would benefit patients and/or their caregivers; however, they also perceived several barriers to its implementation. These results will be used in conjunction with patient and caregiver perspectives to inform future efforts to evaluate and improve upon inpatient portal implementation and dissemination across health systems.
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Heidari, Haydeh y Marjan Mardani-Hamooleh. "Nurses' Perception of Family-Centered Care in Neonatal Intensive Care Units". Journal of Pediatric Intensive Care 09, n.º 01 (30 de agosto de 2019): 016–20. http://dx.doi.org/10.1055/s-0039-1695060.
Resumen
AbstractFamily-centered care (FCC) is one of the important elements of care in neonatal intensive care units (NICUs). The aim of this study was to understand the nurses' perception of FCC in NICUs. This qualitative study was performed using conventional content analysis. Participants in this study included 18 nurses who were selected by a purposeful method. Semistructured, in-depth and face-to-face interviews were conducted with the participants. All interviews were written down, reviewed, and analyzed. Two categories were identified after the data analysis: (1) prerequisite for providing FCC and (2) parents' participation. Prerequisite for providing FCC consisted of two subcategories namely suitable facilities and adequate personnel. Parents' participation included subcategories of parents: neonate's attachment and parents' training. Nurses' perception of FCC in NICUs can facilitate an appropriate condition for the participation of family members in the care of neonates.
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Sowan, Azizeh K., Nancy Staggers, Andrea Berndt, Tommye Austin, Charles C. Reed, Ashwin Malshe, Max Kilger, Elma Fonseca, Ana Vera y Qian Chen. "Improving the Safety, Effectiveness, and Efficiency of Clinical Alarm Systems: Simulation-Based Usability Testing of Physiologic Monitors". JMIR Nursing 4, n.º 1 (3 de febrero de 2021): e20584. http://dx.doi.org/10.2196/20584.
Resumen
Background Clinical alarm system safety is a national patient safety goal in the United States. Physiologic monitors are associated with the highest number of device alarms and alarm-related deaths. However, research involving nurses’ use of physiologic monitors is rare. Hence, the identification of critical usability issues for monitors, especially those related to patient safety, is a nursing imperative. Objective This study examined nurses’ usability of physiologic monitors in intensive care units with respect to the effectiveness and efficiency of monitor use. Methods In total, 30 nurses from 4 adult intensive care units completed 40 tasks in a simulation environment. The tasks were common monitoring tasks that were crucial for appropriate monitoring and safe alarm management across four categories of competencies: admitting, transferring, and discharging patients using the monitors (7 tasks); managing measurements and monitor settings (23 tasks); performing electrocardiogram (ECG) analysis (7 tasks); and troubleshooting alarm conditions (3 tasks). The nurse-monitor interaction was video-recorded. The principal investigator and two expert intensive care units nurse educators identified, classified, and validated task success (effectiveness) and the time of task completion (efficiency). Results Among the 40 tasks, only 2 (5%) were successfully completed by all the nurses. At least 1-27 (3%-90%) nurses abandoned or did not correctly perform 38 tasks. The task with the shortest completion time was “take monitor out of standby” (mean 0:02, SD 0:01 min:s), whereas the task “record a 25 mm/s ECG strip of any of the ECG leads” had the longest completion time (mean 1:14, SD 0:32 min:s). The total time to complete 37 navigation-related tasks ranged from a minimum of 3 min 57 s to a maximum of 32 min 42 s. Regression analysis showed that it took 6 s per click or step to successfully complete a task. To understand the nurses’ thought processes during monitor navigation, the authors analyzed the paths of the 2 tasks with the lowest successful completion rates, where only 13% (4/30) of the nurses correctly completed these 2 tasks. Although 30% (9/30) of the nurses accessed the correct screen first for task 1 and task 2, they could not find their way easily from there to successfully complete the 2 tasks. Conclusions Usability testing of physiologic monitors revealed major ineffectiveness and inefficiencies in the current nurse-monitor interactions. The results indicate the potential for safety and productivity issues in completing routine tasks. Training on monitor use should include critical monitoring functions that are necessary for safe, effective, efficient, and appropriate monitoring to include knowledge of the shortest navigation path. It is imperative that vendors’ future monitor designs mimic clinicians’ thought processes for successful, safe, and efficient monitor navigation.
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Reynolds, Tera L., Patricia R. DeLucia, Karen A. Esquibel, Todd Gage, Noah J. Wheeler, J. Adam Randell, James G. Stevenson y Kai Zheng. "Evaluating a handheld decision support device in pediatric intensive care settings". JAMIA Open 2, n.º 1 (4 de enero de 2019): 49–61. http://dx.doi.org/10.1093/jamiaopen/ooy055.
Resumen
Abstract Objective To evaluate end-user acceptance and the effect of a commercial handheld decision support device in pediatric intensive care settings. The technology, pac2, was designed to assist nurses in calculating medication dose volumes and infusion rates at the bedside. Materials and Methods The devices, manufactured by InformMed Inc., were deployed in the pediatric and neonatal intensive care units in 2 health systems. This mixed methods study assessed end-user acceptance, as well as pac2’s effect on the cognitive load associated with bedside dose calculations and the rate of administration errors. Towards this end, data were collected in both pre- and postimplementation phases, including through ethnographic observations, semistructured interviews, and surveys. Results Although participants desired a handheld decision support tool such as pac2, their use of pac2 was limited. The nature of the critical care environment, nurses’ risk perceptions, and the usability of the technology emerged as major barriers to use. Data did not reveal significant differences in cognitive load or administration errors after pac2 was deployed. Discussion and Conclusion Despite its potential for reducing adverse medication events, the commercial standalone device evaluated in the study was not used by the nursing participants and thus had very limited effect. Our results have implications for the development and deployment of similar mobile decision support technologies. For example, they suggest that integrating the technology into hospitals’ existing IT infrastructure and employing targeted implementation strategies may facilitate nurse acceptance. Ultimately, the usability of the design will be essential to reaping any potential benefits.
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Gupte, Pranati y Narasimman Swaminathan. "Nurse′s perceptions of physiotherapists in critical care team: Report of a qualitative study". Indian Journal of Critical Care Medicine 20, n.º 3 (2016): 141–45. http://dx.doi.org/10.4103/0972-5229.178176.
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Blais, Régis, Guy Lacroix, Michèle Cabot, Bruno Piedboeuf y Marc Beltempo. "Association of Nursing Overtime, Nurse Staffing, and Unit Occupancy with Health Care–Associated Infections in the NICU". American Journal of Perinatology 34, n.º 10 (4 de abril de 2017): 0996–1002. http://dx.doi.org/10.1055/s-0037-1601459.
Resumen
Objective This study aims to assess the association of nursing overtime, nurse staffing, and unit occupancy with health care–associated infections (HCAIs) in the neonatal intensive care unit (NICU). Study Design A 2-year retrospective cohort study was conducted for 2,236 infants admitted in a Canadian tertiary care, 51-bed NICU. Daily administrative data were obtained from the database “Logibec” and combined to the patient outcomes database. Median values for the nursing overtime hours/total hours worked ratio, the available to recommended nurse staffing ratio, and the unit occupancy rate over 3-day periods before HCAI were compared with days that did not precede infections. Adjusted odds ratios (aOR) that control for the latter factors and unit risk factors were also computed. Results A total of 122 (5%) infants developed a HCAI. The odds of having HCAI were higher on days that were preceded by a high nursing overtime ratio (aOR, 1.70; 95% confidence interval [95% CI], 1.05–2.75, quartile [Q]4 vs. Q1). High unit occupancy rates were not associated with increased odds of infection (aOR, 0.85; 95% CI, 0.47–1.51, Q4 vs. Q1) nor were higher available/recommended nurse ratios (aOR, 1.16; 95% CI, 0.67–1.99, Q4 vs. Q1). Conclusion Nursing overtime is associated with higher odds of HCAI in the NICU.
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Kaur, Sukhpal, Karobi Das y Ruchi Saini. "Stress, Stress Reactions, Job Stressors and Coping among Nurses Working in Intensive Care Units and General Wards of a Tertiary Care Hospital: A Comparative Study". Journal of Postgraduate Medicine, Education and Research 50, n.º 1 (2016): 9–17. http://dx.doi.org/10.5005/jp-journals-10028-1184.
Resumen
ABSTRACT Literature has presented nursing as a stressful profession. The present study was conducted to compare stress level and job stressors operating in two different units, i.e. intensive care units (ICU) and general wards of a tertiary care hospital of North India. This is a cross-sectional study involving 285 nurses (general wards = 176; ICU = 109). The nurses were selected conveniently. Demographic profile sheet, modified workplace stress scale (WSS), workplace stress symptom scale (WSSS) and coping checklist (CCL) of Rao, Subbakrishna and Prabhu (1989) was used in the study. Findings of the study revealed moderate to high stress level among general wards and ICU nurses with young female nurses experiencing more stress. Further, workload, role ambiguity and lesser social support accounted for significant amount stress among nurses working on both the units while external factors, such as physical environment and resources hardly contributed to stress. It was also found that the ICU nurses experienced stress more in the form of exhaustion (11.9%); irritation (11.9%) and reduced self-confidence (0.9%) that those working in general wards. However, the nurses on both the units use distraction, positive coping, problem-solving and religious strategies to manage and handle their stress. The findings of the study give insight into stress and stressors related to job which can be buffered using various stress management strategies by the nurse managers. How to cite this article Saini R, Kaur S, Das K. Stress, Stress Reactions, Job Stressors and Coping among Nurses Working in Intensive Care Units and General Wards of a Tertiary Care Hospital: A Comparative Study. J Postgrad Med Edu Res 2016; 50(1):9-17.
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Heydari, Abbas, Ali Vafaee-Najar y Mahmoud Bakhshi. "Intensive Care Nurses' Belief Systems Regarding the Health Economics: A Focused Ethnography". Global Journal of Health Science 8, n.º 9 (21 de enero de 2016): 172. http://dx.doi.org/10.5539/gjhs.v8n9p172.
Resumen
<p><strong>BACKGROUND: </strong>Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses' beliefs and their effect on nurse<strong>'s</strong> practices and behavior patterns regarding the health economics.</p><p><strong>METHODS:</strong> In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994).</p><p><strong>FINDINGS:</strong> Eight beliefs were found that gave meaning to ICU nurse's practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2.Monitoring and auditing improve consumption; 3.There is a fear of possible shortage in the future; 4.Supply and replacement of equipment is difficult; 5.Higher prices lead to more accurate consumption; 6.The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8.Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics.</p><p><strong>CONCLUSIONS:</strong> ICU nurses’ belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the reforms in various aspects, such as the hospital's strategic plan and supply chain management system.</p>
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Kitzmiller, Rebecca, Ashley Vaughan, Angela Skeeles-Worley, Jessica Keim-Malpass, Tracey Yap, Curt Lindberg, Susan Kennerly et al. "Diffusing an Innovation: Clinician Perceptions of Continuous Predictive Analytics Monitoring in Intensive Care". Applied Clinical Informatics 10, n.º 02 (marzo de 2019): 295–306. http://dx.doi.org/10.1055/s-0039-1688478.
Resumen
Background The purpose of this article is to describe neonatal intensive care unit clinician perceptions of a continuous predictive analytics technology and how those perceptions influenced clinician adoption. Adopting and integrating new technology into care is notoriously slow and difficult; realizing expected gains remain a challenge. Methods Semistructured interviews from a cross-section of neonatal physicians (n = 14) and nurses (n = 8) from a single U.S. medical center were collected 18 months following the conclusion of the predictive monitoring technology randomized control trial. Following qualitative descriptive analysis, innovation attributes from Diffusion of Innovation Theory-guided thematic development. Results Results suggest that the combination of physical location as well as lack of integration into work flow or methods of using data in care decisionmaking may have delayed clinicians from routinely paying attention to the data. Once data were routinely collected, documented, and reported during patient rounds and patient handoffs, clinicians came to view data as another vital sign. Through clinicians' observation of senior physicians and nurses, and ongoing dialogue about data trends and patient status, clinicians learned how to integrate these data in care decision making (e.g., differential diagnosis) and came to value the technology as beneficial to care delivery. Discussion The use of newly created predictive technologies that provide early warning of illness may require implementation strategies that acknowledge the risk–benefit of treatment clinicians must balance and take advantage of existing clinician training methods.
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Prabhu, Savitha, Sushmitha Shetty, Veena Prabhu, Maria Pais y Basil Kuriakose. "EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PREVENTION OF ICU DELIRIUM AMONG NURSES". Journal of Health and Allied Sciences NU 05, n.º 02 (junio de 2015): 028–30. http://dx.doi.org/10.1055/s-0040-1703885.
Resumen
AbstractDelirium is extremely common in intensive care unit (ICU) patient due to comorbidity, critical illness and iatroogenesis. This complication of hospital stay is extremely hazardous in older persons and is associated with prolonged hospital stays. yet ICU nurses and physicians are usually unaware of the presence of hypoactive delirium and only recognize this disturbance in agitated patients (hyperactive delirium).The aim of the study was to assess the existing knowledge of ICU staff nurses regarding ICU delirium and to assess the effectiveness of structured teaching programme on the knowledge of ICU staff nurses regarding ICU delirium. An evaluative approach with one group Pretest Posttest design was used for the study. Fourty samples were selected by using non-probability purposive sampling method, in selected hospitals of Udupi District. The collected data were analyzed using descriptive and inferential statistics. A significant difference between Pretest and Posttest knowledge was found (t=23.95, p=<0.0001). The study findings showed that there significant increase in posttest knowledge of ICU staff nurses regarding ICU delirium. The nurse can identify the delirium early and prevent the complication by treating well in advance.
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Naidoo, Vasanthrie y Maureen Nokuthula Sibiya. "Critical Care Nurses’ Experiences With Death and Dying: A South African Perspective". Global Journal of Health Science 11, n.º 9 (10 de julio de 2019): 69. http://dx.doi.org/10.5539/gjhs.v11n9p69.
Resumen
The aim of this study was to explore experiences of South African critical care nurses regarding grief, death and dying in a critical care environment. Data was collected using semi-structured interviews and was analyzed using Giorgi’s thematic data analysis method. Available literature suggests that critical care nurses have varied experiences in relation to their experiences in relation to end-of -life patient care. However, few studies have examined the involvement of South African intensive care nurses’ in caring for the dying patient, their grief, their reactions to death in the workplace and the extent to which their nursing practice is based on shared beliefs, experiences and attitudes. Findings from this study revealed many predisposing factors and circumstantial occurrences shaping both, the nature of care of the dying and subsequent grief that, affected the nurse. Repeated exposure to grief, leads to occupational stress and burn out, causing emotional disengagement from caring for the dying, which ultimately affect the quality of care rendered for both the dying patient and their family. Issues, such as communication, multicultural diversity, education and coping mechanisms are essential in nursing education and practice and nurses caring for the critically ill or dying patient, need to have support networks and strategies put in place, not only to assist in providing care, but also for their own emotional support and well-being.
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Mandetta, M., M. M. Balieiro y T. Boyamian. "P0489 / #1689: FACTORS THAT CONTRIBUTE FOR BETTER NURSE´S ATTITUDES WITH FAMILY AT THE NEONATAL INTENSIVE CARE UNIT". Pediatric Critical Care Medicine 22, Supplement 1 3S (marzo de 2021): 247. http://dx.doi.org/10.1097/01.pcc.0000740292.61359.2b.
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Hawkins, Carrie L. "Virtual Rapid Response". AACN Advanced Critical Care 23, n.º 3 (1 de julio de 2012): 337–40. http://dx.doi.org/10.4037/nci.0b013e31825dff69.
Resumen
The first of its kind in the Veterans Affairs (VA) system, the Denver VA Medical Center’s tele–intensive care unit (ICU) program is unique because it is entirely nurse driven. A nontraditional tele-ICU model, the program was tailored to meet the needs of rural veterans by using critical care nursing expertise in Denver, Colorado. An experienced CCRN-certified nurse manages the system 24 hours a day, 7 days a week, from Eastern Colorado Health Care System. The virtual ICU provides rapid response interventions through virtual technology. This tele-ICU technology allows for a “virtual handshake” by nursing staff at the start of the shift and a report on potential patient issues. Clinical relationships have been strengthened between all 5 VA facilities in the Rocky Mountain Region, increasing the likelihood of early consultation at the onset of clinical decline of a patient. In addition, the tele-ICU nurse is available for immediate nursing consultation and support, coordinates point-to-point virtual consultation between physicians at the rural sites and specialists in Denver, and assists in expediting critical care transfers. The primary objectives for the tele-ICU program include improving quality and access of care to critical care services in rural sites, reducing community fee basis costs and frequency of transfers, and increasing collaboration and collegiality among nursing and medical staff in all Region 19’s medical centers.
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Lee, Jennifer, Annie Voskertchian, Danielle Koontz, Karen Carroll, Tracy Howard, Elizabeth Colantuoni y Aaron Michael Milstone. "Neonatal Exposure to Staphylococcus aureus in the Neonatal Intensive Care Unit: Identifying Reservoirs Among Colonized Healthcare Workers and Parents". Infection Control & Hospital Epidemiology 41, S1 (octubre de 2020): s490—s491. http://dx.doi.org/10.1017/ice.2020.1166.
Resumen
Background:Staphylococcus aureus (S. aureus) is the second most common cause of healthcare-acquired infections in neonates. S. aureus colonization is a known risk factor for invasive disease. Aside from healthcare workers (HCWs), recent data suggest that parents are important reservoirs of S. aureus in the neonatal intensive care unit (NICU). S. aureus typically colonizes the nares, but it can also colonize other anatomic locations such as the throat. Objective: Our objectives were to identify and compare S. aureus colonization among HCWs and parents and to identify and compare different sites of S. aureus colonization. Methods: Between April 2015 and July 2016, we performed 4 point-prevalence surveys and collected nares and throat swabs from HCWs (nurses, respiratory therapists, nurse practitioners, and physicians) at a quaternary-care NICU. During an overlapping period, we screened parents of neonates in the NICU for S. aureus colonization using nares, throat, groin, and perianal cultures as a part of an ongoing randomized control trial. Cultures from both studies were collected using standardized methods. ESwabs were used to collect samples, which were inoculated into broth for enrichment and subsequently cultured onto chromogenic agar to differentiate between MSSA and MRSA. Results: The prevalence of methicillin susceptible S. aureus (MSSA) colonization was 46% (105/226) in HCWs and 28% (239/842) in parents. The prevalence of methicillin resistant S. aureus (MRSA) colonization was 2.2% (5/226) in HCWs and 2.2% (19/842) in parents. Of those who were colonized with S. aureus, 35% (79/226) of HCWs and 46.5% (160/344) of parents had nares and throat colonization while 11.5% (26/226) of HCWs and 12.2% (42/344) of parents had only throat colonization but not nares colonization. Of those who were MRSA colonized, 1.3% (3/226) of HCWs and 1.8% (15/842) of parents had a positive nares and throat culture as compared to 0.9% (2/226) of HCWs and 0.2% (2/842) of parents had only positive throat cultures. Additionally, 68% (175/257) were colonized with S. aureus at any swabbed site including nares, throat, groin, or perinanal areas. However, only 30% (77/257) of parents had only nares colonization as compared to 58.8% (151/257) had throat and nares colonization, 38.1% (98/257) had nares and groin colonization, and 37.4% (96/257) had nares and perianal colonization. Conclusions: HCWs had greater prevalence of S. aureus colonization compared to parents. As expected, the nares was the most common site of MSSA and MRSA, but a large proportion of S. aureus colonized HCWs and parents had only throat colonization. Given the prevalence of S. aureus in non-nares sites of HCWs and parents in the NICU, further studies should examine the role of non-nares carriers in the transmission of S. aureus in this population.Funding: NoneDisclosures: Aaron Milstone reports consultancy with Becton Dickinson.
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Markewitz, Andreas, Jana Lewandowski, Georg Trummer y Andreas Beckmann. "Status of Cardiac Surgical Intensive Care Medicine in Germany in 2018: A Report on Behalf of the German Society for Thoracic and Cardiovascular Surgery". Thoracic and Cardiovascular Surgeon 68, n.º 05 (12 de julio de 2019): 377–83. http://dx.doi.org/10.1055/s-0039-1693028.
Resumen
Background This report summarizes the results of a voluntary survey designed to assess the current situation of cardiac surgical intensive care medicine in Germany in 2018. Methods A standardized questionnaire concerning detailed information about structural characteristics of cardiac surgical intensive care units (ICUs) was sent to all German departments performing cardiac surgery. Results Response rate was 93% (n = 75/81). Compared with previous surveys since 1998, the median number of intensive care beds for patients after cardiac surgery increased from 15 in 2013 to 16 in 2018. The proportion of cardiac surgical ICUs decreased to 51% with a simultaneous increase of interdisciplinary ICUs. The proportion of cardiac surgeons acting as director of an ICU increased to 43%. The physicians' teams were mostly interdisciplinary (57%). More than half of the directors were board-certified intensivists (62%) with a peak of 100% in ICUs run by cardiac surgeons. Human resources development in the ICU showed similar trends with an increase of physicians and nurses. More than half of all ICUs (61%) and the vast majority of cardiac surgical ICUs (82%) offer an accredited training program for intensive care medicine. Conclusion The results of this survey corroborate once again that intensive care medicine represents a substantial and important part of cardiac surgery. However, efforts are necessary to keep this attitude alive for the future.
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Colman, Nora, Janet Figueroa, Courtney McCracken y Kiran Hebbar. "Simulation-Based Team Training Improves Team Performance among Pediatric Intensive Care Unit Staff". Journal of Pediatric Intensive Care 08, n.º 02 (14 de diciembre de 2018): 083–91. http://dx.doi.org/10.1055/s-0038-1676469.
Resumen
AbstractSimulation training fosters collaborative learning and improves communication among interdisciplinary teams. In this prospective observational cohort study, we evaluated the impact of interdisciplinary simulation-based team training (SBTT) on immediate learning of team performance behaviors. In a 3-month period, 30 simulation sessions were conducted and 165 staff members, including physicians, nurses, and respiratory therapists, were trained. Regression analysis showed a statistically significant improvement in team performance (p < 0.0001). Study results demonstrate that SBTT is effective in immediate acquisition of optimal team performance behaviors by multidisciplinary pediatric intensive care unit staff, including physicians with higher level subspecialty training in the simulation environment.
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King-Morrieson, Tamara, Anna Stachel, Michael Phillips, Maria E. Aguero-Rosenfeld, Kenneth Inglima y Sarah Hochman. "565. Implementation of a Staphylococcus aureus Screening and Decolonization Program in a Multisite Urban Healthcare System". Open Forum Infectious Diseases 6, Supplement_2 (octubre de 2019): S267—S268. http://dx.doi.org/10.1093/ofid/ofz360.634.
Resumen
Abstract Background Staphylococcus aureus infection confers high mortality. S. aureus-colonized hospitalized patients are more likely to develop invasive infection and can transmit S. aureus to other patients in the absence of symptoms. Our health system has a baseline S. aureus colonization rate of 21% (MSSA and MRSA combined). To reduce risk of invasive S. aureus infection in our patients, we implemented an inpatient S. aureus screening and decolonization program. Methods Interventions include universal S. aureus screening and targeted decolonization for all patients on the Medicine and Pediatrics inpatient services. Adult patients are screened at admission and change in the level of care; pediatric patients are screened weekly. S. aureus screening began incrementally by unit between 2016 and 2017, and extended to transplant units in 2018. All cultures are processed in the hospital microbiology lab for identification of MRSA and MSSA. S. aureus decolonization (mupirocin ointment in nares twice daily, chlorhexidine 2% wipes below the chin daily for 5 days) began in 2017 for patients with a central venous catheter, in intensive care unit or multibedded room. Decolonization was extended to all S. aureus-colonized patients beginning in June 2018, with involvement of a dedicated clinical nurse specialist. We compared compliance with screening and decolonization and the secondary outcome of MRSA bacteremia in the 6 month period before and after the addition of the clinical nurse specialist. Results 21.5% of screened patients were colonized with S. aureus (82.4% MSSA, 17.6% MRSA). Screening compliance improved from 39.4% of eligible patients (N = 1805) to 52.1% (N = 2024) and decolonization increased from 18.6% of colonized patients to 41.2% comparing January-June 2018 with July-December 2018. The MRSA bacteremia rate fell from 0.2/1,000 patient-days in the first half of 2018 to 0.1/1,000 patient-days in the second half of 2018. Conclusion A system-wide program that includes S. aureus screening and decolonization of hospitalized patients found that 21% of patients had S. aureus colonization. Screening and decolonization compliance increased with the introduction of a dedicated clinical nurse specialist, and the MRSA bloodstream infection rate fell. Disclosures All authors: No reported disclosures.
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Lauren, Williams y McIntosh Trudi. "SP5 A study exploring the opinions and attitudes of medical staff towards pharmacist independent prescribing in a neonatal intensive care unit". Archives of Disease in Childhood 103, n.º 2 (19 de enero de 2018): e1.45-e1. http://dx.doi.org/10.1136/archdischild-2017-314584.5.
Resumen
AimExisting published literature supports the implementation of pharmacist independent prescribing (PIP). A positive impact on patient care1 has been reported, with an encouraging response from patients2 and other healthcare professionals when asked about their views. There have also been reported patient safety benefits from PIP in secondary care.3 There is a gap in the literature regarding the utilisation of PIP in neonatal practice. The views of neonatal pharmacists across the UK towards PIP have been considered4 but to date there has been no research published on the opinions of medical staff about PIP in Neonatal Intensive Care Units (NICU). This study aimed to explore the opinions and attitudes of medical staff towards PIP in NICU, identifying any barriers and facilitators to the current service.MethodSemi-structured interviews were conducted with a purposively selected sample of senior registrars and consultants working within NICU. An interview schedule was developed, assessed for content validity and then piloted with two initial interviews (total interviews=10). Interviews were digitally recorded then transcribed verbatim. Framework Analysis principles were applied to data analysis. Ethics approval was granted by Robert Gordon University.ResultsParticipants displayed a positive attitude towards PIP, stating that it has been beneficial to the overall service provided in NICU. Improved patient safety, shared workload for medical staff and increased efficiency in prescribing were cited as important benefits. Collaborative working as a multi-disciplinary team when making prescribing decisions for the patient was noted to be essential, as was ensuring junior medical staff still receive the prescribing experience required for them to be competent prescribers. Although medical staff reported no concerns with PIP, lack of a service at weekends and PIP being limited by multiple concomitant ward rounds were identified barriers. The interpersonal skills and knowledge displayed by neonatal pharmacist prescribers, acceptance by the medical team and positivity towards new developments shown by all staff were highlighted as important facilitators.ConclusionAll participants were fully supportive of the PIP service provided in NICU. Utilising the knowledge and skills of pharmacist prescribers has improved the efficiency and quality of prescribing in the unit and has had a positive impact on patient care.ReferencesLatter S, Blekinsopp A, Smith A, et al. Evaluation of nurse and pharmacist independent prescribing 2010. London: University of Southampton. http://eprints.soton.ac.uk/184777/2/ENPIPexecsummary.pdf [accessed: 2016 August 17].Tinelli M, Blekinsopp A, Later S, et al. Survey of patients‘ experiences and perceptions of care provided by nurse and pharmacist independent prescribers in primary care. Health Expectations 2013;18:1241–1255.Baqir W, Crehan O, Murray R, et al. Pharmacist prescribing within a UK NHS hospital trust: Nature and extent of prescribing, and prevalence of errors. Eur J Hosp Pharm 2015;22:79–82.Mulholland PJ. Pharmacists as non-medical prescribers; what role can they play? The evidence in a neonatal intensive care unit. E J Hosp Pharm 2014;21:335–338.
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Santos, Alaneir, Humberto Alves, Thaís Queiroz, Nara Silva y Maria Melo. "Telemonitoring of Neonatal Intensive Care Units: Preliminary Experience in the State of Minas Gerais, Brazil". American Journal of Perinatology 36, n.º 04 (21 de agosto de 2018): 393–98. http://dx.doi.org/10.1055/s-0038-1668558.
Resumen
Objective This article describes the implementation and functioning of a telemonitoring center of neonatal intensive care units (NICUs) organized by the Telehealth Center of the Medical School of the Federal University of Minas Gerais who signed an agreement with the Minas Gerais State Department of Health (SES/MG, in Portuguese), Brazil. Study Design This is a descriptive retrospective study from December 2012 to June 2014 of a NICU telemonitoring project. Results Twelve Web conferences have been performed. Six thousand, eight hundred and thirty nine (6,839) online teleconsultations of pediatricians and nurses with experience in neonatology and intensive care have been performed, of which 174 were with subspecialists, with an average response time of 6 hours. Discussion The project has demonstrated to be satisfactory, with fast response in relation to the demands of subspecialists, promoting care, and management support to the NICU. The qualification via Web conferences prevents the displacement of the professionals to big centers for continuous medical education. Conclusion The telemonitoring of NICU can contribute in the process of management, regulation of beds, reduction of displacements and transferences, adhesion to best practices, care support, and qualification of the involved professionals.
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Seitz, Guido, Andreas Schmidt, Hanna Renk, Matthias Kumpf, Frank Fideler, Martin Esslinger, Ines Gerbig, Jörg Fuchs, Michael Hofbeck y Felix Neunhoeffer. "Analgesia and Sedation Protocol for Mechanically Ventilated Postsurgical Children Reduces Benzodiazepines and Withdrawal Symptoms—But Not in All Patients". European Journal of Pediatric Surgery 27, n.º 03 (25 de julio de 2016): 255–62. http://dx.doi.org/10.1055/s-0036-1586202.
Resumen
Background We demonstrated recently that the implementation of a nurse-driven analgesia and sedation protocol (pediatric analgesia and sedation protocol [pASP]) for mechanically ventilated nonpostsurgical patients reduces the total dose of benzodiazepines and the withdrawal symptoms significantly. It has not been investigated if these results can also be expected in the group of patients undergoing surgery. Objectives To evaluate the effects of the pASP in mechanically ventilated postsurgical children regarding drug dosage, duration of mechanical ventilation, length of stay, and rate of withdrawal symptoms. Methods This is a two-phase prospective observational control study. The preimplementation group was managed by the physician's order and the postimplementation group was managed with the pASP including COMFORT-B, nurse interpretation of sedation, and Sophia observation withdrawal symptoms scale scoring. Measurements and Main Results One hundred and sixteen patients were included before and one hundred and ten patients after implementation. The pASP had no effect on length of pediatric intensive care unit stay or duration of mechanical ventilation. The protocol reduced total (5.0 mg/kg [0.5–58.0] vs 4.0 mg/kg [0.0–47.0]; p = 0.021) and daily doses (4.4 mg/kg/d [1.1–33.9] vs 2.9 mg/kg/d [0.0–9.9]; p < 0.001) of benzodiazepines significantly. No difference was observed in total and daily doses of opioids (5.0 mg/kg [0.1–67.0] vs 3.0 mg/kg [0.1–71.0]; p = 0.81) and (0.7 mg/kg/d [0.0–7.0] vs. 0.8 mg/kg/d [0.0–3.7]; p = 0.35), respectively. Rate of withdrawal symptoms was significantly lower after implementation (35.3 vs 20.0%; p = 0.01), but not in patients after solid organ transplantation or oncological patients. Conclusion The nurse-driven analgesia and sedation protocol is an effective procedure to reduce the total doses of benzodiazepines and occurrence of withdrawal symptoms in postsurgical children, which are naïve to opioids or benzodiazepines.
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Mudumbai, Seshadri C., Troy Tanaka y Edward R. Mariano. "Development and Deployment of an Intraoperative Clinical Summary Document: A Veterans Health Care Affairs Perspective". ACI Open 04, n.º 01 (enero de 2020): e30-e34. http://dx.doi.org/10.1055/s-0040-1701192.
Resumen
Abstract Background Clinical summary documents that abstract details of episodes of care are essential to Advancing Care Information requirements for electronic health records. Few examples exist for intraoperative clinical summary documents (ICSD). Methods We describe the development and deployment of an ICSD at a tertiary hospital within the United States. Development included identification of needs of key stakeholders, evaluation of current clinical and data workflows, iterative development of prototypes with primary stakeholders, i.e., anesthesiologists and evaluation of prototypes with test patients. We deployed the ICSD over 6-months with tracking of (1) usage (number and types of end users and surgery types) and (2) written and oral feedback. Results Current workflows involved accessing a 10 to 40 page document presenting all surgery details with review described as burdensome. The ICSD prototype was a separate one-page summary optimized for viewing on a monitor or paper. The document had four sections: (1) administrative data, allergies, and precautions; (2) medications, infusions, and fluid intake and output; (3) airway assessments and a graphical presentation of hemodynamic trends (blood pressure), and (4) standardized text for events (hypotension) occurring intraoperatively. During the 6-month deployment, postanesthesia care unit and intensive care unit nurses were most prominent users followed by anesthesiologists. While overall well received, our pilot users reported challenges for readability, font size, and the lack of customization. Conclusion While the ICSD was designed for anesthesiologists, postanesthesia care unit and intensive care unit nurses were the most frequent users. Future development will involve customization for different stakeholders.
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Pallas, Jeremy David, John Paul Smiles y Michael Zhang. "Cardiac Arrest Nurse Leadership (CANLEAD) trial: a simulation-based randomised controlled trial implementation of a new cardiac arrest role to facilitate cognitive offload for medical team leaders". Emergency Medicine Journal 38, n.º 8 (26 de enero de 2021): 572–78. http://dx.doi.org/10.1136/emermed-2019-209298.
Resumen
BackgroundMedical team leaders in cardiac arrest teams are routinely subjected to disproportionately high levels of cognitive burden. This simulation-based study explored whether the introduction of a dedicated ‘nursing team leader’ is an effective way of cognitively offloading medical team leaders of cardiac arrest teams. It was hypothesised that reduced cognitive load may allow medical team leaders to focus on high-level tasks resulting in improved team performance.MethodsThis randomised controlled trial used a series of in situ simulations performed in two Australian emergency departments in 2018–2019. Teams balanced on experience were randomised to either control (traditional roles) or intervention (designated nursing team leader) groups. No crossover between groups occurred with each participant taking part in a single simulation. Debriefing data were collected for thematic analysis and quantitative evaluation of self-reported cognitive load and task efficiency was evaluated using the NASA Task Load Index (NTLX) and a ‘task time checklist’ which was developed for this trial.ResultsTwenty adult cardiac arrest simulations (120 participants) were evaluated. Intervention group medical team leaders had significantly lower NTLX scores (238.4, 95% CI 192.0 to 284.7) than those in control groups (306.3, 95% CI 254.9 to 357.6; p=0.02). Intervention group medical team leaders working alongside a designated nursing leader role had significantly lower cognitive loads than their control group counterparts (206.4 vs 270.5, p=0.02). Teams with a designated nurse leader role had improved time to defibrillator application (23.5 s vs 59 s, p=0.004), faster correction of ineffective compressions (7.5 s vs 14 s, p=0.04), improved compression fraction (91.3 vs 89.9, p=0.048), and shorter time to address reversible causes (107.1 s vs 209.5 s, p=0.002).ConclusionDedicated nursing team leadership in simulation based cardiac arrest teams resulted in cognitive offload for medical leaders and improved team performance.
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Lalova, Valentina, Gergana Petrova y Elena Merdzhanova. "Assessment of various aspects of using protocols in intensive care units in Plovdiv, Bulgaria." Medical Science Pulse 13, n.º 2 (18 de abril de 2019): 3–5. http://dx.doi.org/10.5604/01.3001.0013.1586.
Resumen
Background: Since 1950 intensive care has become a separate and independent specialty. Significant technological advances have allowed the Intensive Care Unit (ICU)s to be monitored through the centralized work of a multidisciplinary team of specialists. ICUs provide cares at different levels of support. To provide patient access to this highly specialized cares, the “Critical care without walls” or “Intensive Care without Borders” theories have emerged, involving reanimation nurses offering highly specialized care and support. Protocols for nurses have been developed, with the aim of facilitating their day-to-day activities, improving outcomes and safety of patients and all staff. Utilizing this concept, the role of intensive care has rapidly expanded over the past 20 years. Aim of the study: To understand the effectiveness and benefits derived from organisation of the working process. Material and methods: We used documentary and survey methods and analysed the data using the software package SPSS v. 21.0. Graphics were prepared using Microsoft Excel 2013. Numbers from 1 to 5 refer to the answers “no”, “not really”, “cannot judge”, “closer to yes” and “yes”, respectively. Results: Nurses’ performance, as an integral part of multidisciplinary ICU teams, is evidence that mortality and morbidity can be improved thanks to the early recognition of patient deterioration and rapid resuscitation. The better healing process is accomplished by optimising the content and evaluation of the desired results, in association with good doctor practices. Respondents’ opinions about outcomes of protocol use differed significantly between professions in regard to making their job easier, improving patient outcomes, providing consistency in care, and preventing patient harm. Conclusions: A more flexible and standard framework for nurses should be developed to improve quality of care. The rapidly growing lack of ICU nurses in Bulgaria is concerning.
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Arthur, Joseph Anthony, Akhila Sunkepally Reddy, Uniqua Smith, David Hui, Diane D. Liu, Minjeong Park y Eduardo Bruera. "Nurses’ beliefs and practices regarding intravenous opioid use for breakthrough cancer pain." Journal of Clinical Oncology 36, n.º 34_suppl (1 de diciembre de 2018): 222. http://dx.doi.org/10.1200/jco.2018.36.34_suppl.222.
Resumen
222 Background: Faster intravenous (IV) opioid administration speed is associated with increased adverse effects and subsequent increased opioid intake. Infusion rates ≥ 2 minutes are recommended. Data on nurse practices regarding IV opioid administration are limited. We assessed the frequency of nurse-reported speeds of IV opioid bolus infusion in the inpatient oncology units, and nurses’ beliefs and perceptions about opioids in cancer pain management. Methods: A cross-sectional survey among inpatient nurses working in the medical, surgical, intensive care unit (ICU), and emergency department (ED) work areas was conduceted. We defined fast IV opioid bolus infusion speed as < 120 seconds(s). Results: The participant response rate was 60% (731/1234).57%, 55%, and 58% of all nurses administered morphine, hydromorphone, and fentanyl in < 120s.Overall median (IQR) infusion speed of IV morphine, hydromorphone, and fentanyl were 60s (40-120), 90s (45-120), and 60s (30-120) respectively. Correlation between morphine, hydromorphone, and fentanyl infusion speeds were 0.93, 0.90, and 0.90 respectively (p <0 .0001). Median infusion speed of morphine was 55s for ICU nurses, 60s for both surgical unit and emergency department nurses, and 85s for medical unit nurses (p=0.0002). The odds ratio for fast IV opioid infusion was 2.22 for ED nurses (p= 0.027), 2.67 for ICU nurses (p= 0.001), 0.27 and 0.18 for frequent (p=0.003) and very frequent(p=0.001) use a timing device respectively, and 0.86 for hydromorphone infusion compared with morphine (< 0.0001). Fast infusion was also independently associated with perception that suboptimal pain control as the reason for increased patient opioid requests(p=0.009), clinician reluctance to prescribe opioids(p=0.008), lack of psychosocial support services (p= 0.03), and patient’s reluctance to take opiates (p=0.015). Conclusions: More than half the nurses working in the inpatient setting reported administering IV opioids at a faster speed than recommended. Nurses who frequently use a timing device are more likely to infuse at a more optimal speed. Further research is needed to standardize and improve safe intermittent infusion of parenteral opioids.
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de Groot, Marcel G., Marjorie de Neef, Marieke H. Otten, Job B. M. van Woensel y Reinout A. Bem. "Interobserver Agreement on Clinical Judgment of Work of Breathing in Spontaneously Breathing Children in the Pediatric Intensive Care Unit". Journal of Pediatric Intensive Care 09, n.º 01 (7 de octubre de 2019): 034–39. http://dx.doi.org/10.1055/s-0039-1697679.
Resumen
AbstractClinical assessment of the work of breathing (WOB) remains a cornerstone in respiratory support decision-making in the pediatric intensive care unit (PICU). In this study, we determined the interobserver agreement of 30 observers (PICU physicians and nurses) on WOB and multiple signs of effort of breathing in 10 spontaneously breathing children admitted to the PICU. By reliability analysis, the agreement on overall WOB was poor to moderate, and only three separate signs of effort of breathing (breathing rate, stridor, and grunting) showed moderate-to-good interobserver reliability. We conclude that the interobserver agreement on the clinical WOB judgment among PICU physicians and nurses is low.
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Caldwell, Claire, Victoria MacBean, Katie Hunt y Anne Greenough. "Parental views on attending neonatal intensive care ward rounds". BMJ Paediatrics Open 3, n.º 1 (abril de 2019): e000449. http://dx.doi.org/10.1136/bmjpo-2019-000449.
Resumen
ObjectivesTo ascertain parental views regarding taking part in neonatal unit ward rounds.DesignA service evaluation project.SettingTertiary neonatal intensive care unit.PatientsParent(s) of infants receiving care on the neonatal unit.InterventionsStructured interviews conducted at the cot side.Main outcome measuresParents were asked if they knew when ward rounds occurred, whether they had attended ward rounds and if they had not what were the factors inhibiting them from doing so, their experience of attending ward rounds and whether they were concerned about issues of confidentiality.Results23 of 24 consecutive parents agreed to be interviewed. The median age of their infants was 14 (range 3 – 123) days when they were interviewed. Eighty-five per cent were able to identify when a nursing handover or doctor’s ward round occurred. Seventy-five per cent of parents had attended at least one ward round and the median score in terms of usefulness was 5 out of 5. Reasons for not attending included time and cost to travel to the unit, their partners were working and having other children. Parents volunteered that the nurses proactively updated them as soon as they arrived, hence making regular attendance less important. Regarding confidentiality, 85% were not concerned if other people overheard information about their baby, unless the news was bad.ConclusionsParents recognised the value of attending ward rounds and generally found it a positive experience, but emphasised limitations on their ability to attend.
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Chauhan, Rajeev, Summit Dev Bloria y Ankur Luthra. "Management of Postoperative Neurosurgical Patients". Indian Journal of Neurosurgery 08, n.º 03 (24 de septiembre de 2019): 179–84. http://dx.doi.org/10.1055/s-0039-1698001.
Resumen
AbstractThe patient profile undergoing neurosurgery varies from neonates to elderly, and from patients undergoing elective surgery to patients undergoing emergency surgeries. The goals of postoperative management include prevention of secondary brain injury and taking care of the major organ systems till the time patient recovers from the primary insult. Postsurgery, patients may be shifted to a neurosurgical intensive care unit or managed in a neurosurgical ward. As a general rule, all patients should be nursed 30-degree head up. We will be discussing the basic principles of postoperative management of neurosurgical patients.
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Breeman, Wim, Mark G. Van Vledder, Michael H. J. Verhofstad, Albert Visser y Esther M. M. Van Lieshout. "First attempt success of video versus direct laryngoscopy for endotracheal intubation by ambulance nurses: a prospective observational study". European Journal of Trauma and Emergency Surgery 46, n.º 5 (19 de febrero de 2020): 1039–45. http://dx.doi.org/10.1007/s00068-020-01326-z.
Resumen
Abstract Purpose The aim of this study was to compare the rate of first attempt success of endotracheal intubation performed by ambulance nurses in patients with a Glasgow Coma Scale (GCS) of 3 using video laryngoscopy versus direct laryngoscopy. Methods A prospective cohort study was conducted in a single, independent ambulance service. Twenty of a total of 65 nurse-staffed ambulances were equipped with a video laryngoscope; a classic direct laryngoscope (Macintosh) was available on all 65 ambulances. The primary outcome was first attempt success of the intubation. Secondary outcomes were overall success, time needed for intubation, adverse events, technical or environmental issues encountered, and return of spontaneous circulation (ROSC). Ambulance nurses were asked if the intubation device had affected the outcome of the intubation. Results The first attempt success rate in the video laryngoscopy group [53 of 93 attempts (57%)] did not differ from that in the direct laryngoscopy group [61 of 126 (48%); p = 0.221]. However, the second attempt success rate was higher in the video laryngoscopy group [77/93 (83%) versus 80/126 (63%), p = 0.002]. The median time needed for the intubation (53 versus 56 s) was similar in both groups. Ambulance nurses more often expected a positive effect when performing endotracheal intubation with a video laryngoscope (n = 72, 81%) compared with a direct laryngoscope (n = 49, 52%; p < 0.001). Conclusion Although no significant effect on the first attempt success was found, video laryngoscopy did increase the overall success rate. Ambulance nurses had a more positive valuation of the video laryngoscope with respect to success chances.
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Cottrell, J. J., J. Murakami, M. E. Mackesy, B. Fetzer, A. S. Elstein y C. Christensen. "Forecasting Survival in the Medical Intensive Care Unit: A Comparison of Clinical Prognoses With Formal Estimates". Methods of Information in Medicine 32, n.º 04 (1993): 302–8. http://dx.doi.org/10.1055/s-0038-1634937.
Resumen
AbstractPhysicians often need to make prognostic judgments. In the present study, the accuracy was explored of survival estimates for patients in the Medical Intensive Care Unit (MICU). Estimates were made by physicians and nurses several times during each patient’s stay in the MICU and were compared to those of the APACHE II scale, a widely used quantitative index for critically ill patients. ROC curve and calibration curve analyses were performed to assess the accuracy of these estimates. Results revealed that MICU personnel were fairly accurate discriminators of patients who survived vs. who died, although there was a consistent tendency to underestimate survival. In addition, there was some relationship between the level of physician training and forecasting accuracy, but only within the patient’s first 24 hours in the MICU. Finally, the estimates of physicians did not differ significantly from those of the APACHE II scale. Physicians tended to be better calibrated in their predictions, while the APACHE II scale was slightly superior in terms of discrimination.
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Mulligan, Joanna L. "Neonatal Nonketotic Hyperglycinemia: A Case Study and Review of Management for the Advanced Practice Nurse". Neonatal Network 32, n.º 2 (2013): 95–103. http://dx.doi.org/10.1891/0730-0832.32.2.95.
Resumen
Nonketotic hyperglycinemia (NKH) is an autosomal recessive inborn error of glycine metabolism. In this article, I will present the case of baby girl S. who presented to the emergency room on Day 4 of life with severe lethargy, seizures, and respiratory depression requiring mechanical ventilation. A diagnosis of NKH was made secondary to elevated plasma and cerebrospinal fluid glycine concentrations. I will review the pathophysiology of NKH, methods of diagnosis, and the differential diagnosis. There are a variety of different pharmacologic and alternative therapies for NKH. Despite these treatments, the prognosis for infants with NKH is poor, with severe neurologic impairment, intractable seizures, and death common before 5 years of age. I will address the role of the advanced practice nurse in caring for an infant with NKH including clinical, educational, and research implications.
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Allen, Ruth y Janine Wiles. "Essay: A type of lady's corset? Support for older people". Journal of Primary Health Care 1, n.º 2 (2009): 156. http://dx.doi.org/10.1071/hc09156.
Resumen
Sub-threshold anxiety and depression are common presentations in primary care. They carry a significant disability burden along with the risk of developing a frank disorder. Intervention options are limited, although there is some evidence that ultra brief interventions may be effective with this patient group. We argue that there is a need for a systematic but ultra brief, minimal contact intervention, that can be delivered by GPs or practice nurses. Such an intervention would be a form of facilitated self-management, a step up from self-help, from which people could be referred on to more intensive treatment or medication if required. MeSH KEYWORDS: Primary health care, mental health, psychotherapy, mental disorders
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van den Hoogen, A. "A STUDY INTO THE NURSE???S ROLE AND RESPONSIBILITY IN THE DECISION-MAKING PROCESS ON LIFE-TERMINATING MEASURES IN NEW-BORN INFANTS". Pediatric Critical Care Medicine 6, n.º 2 (marzo de 2005): 238. http://dx.doi.org/10.1097/00130478-200503000-00049.
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Patricia Sanchez Espinoza, Evelyn, Lauro Viera Perdigão Neto, Sania Alves dos Santos, Camila Risek, Maria Renata Gomes Franco, Roberta C. R. Martins, Gaspar C. O. Pereira, Bsc et al. "1211. Microbiologic Evaluation of Mobile Phones and Hands of Healthcare Professionals in Two Intensive Care Units in a Brazilian University Hospital". Open Forum Infectious Diseases 6, Supplement_2 (octubre de 2019): S435. http://dx.doi.org/10.1093/ofid/ofz360.1074.
Resumen
Abstract Background Healthcare-associated infections (HAIs) are a worldwide concern because of their high morbidity, mortality, and associated costs. Mobile phones (MP) are an important work tool in the healthcare setting, but they can be a reservoir of nosocomial pathogens if not carefully cleaned and cause re-contamination of the healthcare professional’s (HCP) hands. We aimed to evaluate bacterial colonization of HCP’s hands and their respective MPs. Methods A cross-sectional study was performed in two Intensive Care Units (ICUs), an internal medicine and a burn unit, of a Brazilian tertiary university hospital. These units were chosen because of their different hand hygiene (HH) compliance. We assessed HH and MP handling practices by an electronic inquiry and collected samples from the dominant hand (DH) by the sterile bag technique and of MPs by moistened sterile swab. MALDI-TOF was used for bacterial identification and Dilution Agar (DA) was used to screen Gram-negative bacteria (GNB) susceptibility to carbapenems and colistin. Results Forty-seven HCPs were evaluated; of whom, 30% were medical residents, 19% nurses, 17% nurse-technicians, 17% physiotherapists, 13% cleaning staff, and 4% radiology technicians.Overall, 85% of HCPs reported use of MP at work, 26% had never cleaned it, and 34% reported optimal HH compliance practices. All of them believed that MPs can have HAIs agents. DH culture showed 94% of colonization and the most common Gram-positive bacteria (GPB) and GNB were S. epidermidis (n = 17∕44) and A. baumannii complex (n = 11∕44), respectively. MP were colonized in 89% of the cases and the most common GPB and GNB were S. epidermidis (n = 16∕42) and Pseudomonas spp (n = 9∕42), respectively. Overall, in the screening 38% of GNB were resistant to meropenem and 22% to colistin. A. baumannii was the most common meropenem (n = 4) and colistin (n = 2) resistant GNB. In the two units, 32% of HCPs had the same microorganism species isolated in the MP and in the DH (Table 1). Conclusion There was a high rate of bacterial colonization on the MP and DH of HCPs and some of these bacteria were carbapenem or colistin resistant. A policy for MP handling in the healthcare setting should be implemented in order to avoid cross-contamination between the MP and the hand of HCPs. Disclosures All authors: No reported disclosures.
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Elie-Turenne, Marie-Carmelle, Helen Fernandes, José R. Mediavilla, Marnie Rosenthal, Barun Mathema, Ashima Singh, Tiffany R. Cohen et al. "Prevalence and Characteristics of Staphylococcus aureus Colonization among Healthcare Professionals in an Urban Teaching Hospital". Infection Control & Hospital Epidemiology 31, n.º 6 (junio de 2010): 574–80. http://dx.doi.org/10.1086/652525.
Resumen
Objective.To determine the prevalence of asymptomatic carriage of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) among healthcare professionals (HCPs) who experience varying degrees of exposure to ambulatory patients and to genetically characterize isolates.Methods.This single-center, cross-sectional study enrolled 256 staff from the intensive care units, emergency department, and prehospital services of an urban tertiary care university hospital in 2008. Occupational histories and nasal samples for S. aureus cultures were obtained. S. aureus isolates were genetically characterized with the use of spa typing and screened for mecA. MRSA isolates underwent further characterization.Results.S. aureus was isolated from 112 of 256 (43.8%) HCPs, including 30 of 52 (57.7%) paramedics, 51 of 124 (41.1%) nurses, 11 of 28 (39.3%) clerical workers, and 20 of 52 (38.5%) physicians. MRSA was isolated from 17 (6.6%) HCPs, including 1 (1.9%) paramedic, 13 (10.5%) nurses, 1 (3.6%) clerical worker, and 2 (3.8%) physicians. Among S. aureus isolates, 15.2% were MRSA. MRSA prevalence was 9.6% (12/125) in emergency department workers, 5.1% (4/79) in intensive care unit workers, and 1.9% (1/52) in emergency medical services workers. Compared with paramedics, who had the lowest prevalence of methicillin resistance among S. aureus isolates (1 of 30 [3.3%] isolates), nurses, who had the highest prevalence (13 of 51 [25.4%] isolates), had an odds ratio of 9.92 (95% confidence interval, 1.32-435.86; P = .02) for methicillin resistance. Analysis of 15 MRSA isolates revealed 7 USA100 strains, 6 USA300 strains, 1 USA800 strain, and 1 EMRSA-15 strain. All USA300 strains were isolated from emergency department personnel.Conclusions.The observed prevalence of S. aureus and MRSA colonization among HCPs exceeds previously reported prevalences in the general population. The proportion of community-associated MRSA among all MRSA in this colonized HCP cohort reflects the distribution of the USA300 community-associated strain observed increasingly among US hospitalized patients.
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Glancova, Alzbeta, Quan T. Do, Devang K. Sanghavi, Pablo Moreno Franco, Neethu Gopal, Lindsey M. Lehman, Yue Dong, Brian W. Pickering y Vitaly Herasevich. "Are We Ready for Video Recognition and Computer Vision in the Intensive Care Unit? A Survey". Applied Clinical Informatics 12, n.º 01 (enero de 2021): 120–32. http://dx.doi.org/10.1055/s-0040-1722614.
Resumen
Abstract Objective Video recording and video recognition (VR) with computer vision have become widely used in many aspects of modern life. Hospitals have employed VR technology for security purposes, however, despite the growing number of studies showing the feasibility of VR software for physiologic monitoring or detection of patient movement, its use in the intensive care unit (ICU) in real-time is sparse and the perception of this novel technology is unknown. The objective of this study is to understand the attitudes of providers, patients, and patient's families toward using VR in the ICU. Design A 10-question survey instrument was used and distributed into two groups of participants: clinicians (MDs, advance practice providers, registered nurses), patients and families (adult patients and patients' relatives). Questions were specifically worded and section for free text-comments created to elicit respondents' thoughts and attitudes on potential issues and barriers toward implementation of VR in the ICU. Setting The survey was conducted at Mayo Clinic in Minnesota and Florida. Results A total of 233 clinicians' and 50 patients' surveys were collected. Both cohorts favored VR under specific circumstances (e.g., invasive intervention and diagnostic manipulation). Acceptable reasons for VR usage according to clinicians were anticipated positive impact on patient safety (70%), and diagnostic suggestions and decision support (51%). A minority of providers was concerned that artificial intelligence (AI) would replace their job (14%) or erode professional skills (28%). The potential use of VR in lawsuits (81% clinicians) and privacy breaches (59% patients) were major areas of concern. Further identified barriers were lack of trust for AI, deterioration of the patient–clinician rapport. Patients agreed with VR unless it does not reduce nursing care or record sensitive scenarios. Conclusion The survey provides valuable information on the acceptance of VR cameras in the critical care setting including an overview of real concerns and attitudes toward the use of VR technology in the ICU.
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Raza, Syed M., Mohamed M. Sheta, Suzan S. Gad, Nermine Elmaraghy, Ahmed S. Hussein, Shaimaa Sahmoud y Abeer I. Al-Khalafawi. "Effect of Educational Intervention on Implementation of Neonatal Safety Standards". Journal of Child Science 10, n.º 01 (enero de 2020): e93-e96. http://dx.doi.org/10.1055/s-0040-1716376.
Resumen
Abstract Background and Aim Patient safety in the neonatal intensive care unit (NICU) is one of the highest priority issues on the health care quality agenda worldwide. Efforts are needed to improve neonatal safety in NICU. The present study evaluated the effect of educational intervention on neonatal safety. Materials and Methods Quasi-experimental study was conducted in three major hospitals, including the health care workers in their NICU during the period of study from May 2016 to May 2018. Neonatal safety standards were evaluated using an observational checklist after its validation by a pilot study. An intervention educational program was conducted in the three hospitals, followed by a reevaluation of the standards. All staff members (58 physicians and 69 nurses) participated in the three stages of the study. Results The interventional program resulted in significant improvement of the health care workers implementation of the general (90.6 ± 15.1 vs. 127.6 ± 7.02, p = 0.016) and specific (50.6 ± 17.1 vs. 96.1 ± 13.2, p = 0.04) Egyptian Neonatal Safety Standards. Conclusion Training and increasing the awareness of health care workers of the neonatal safety standards can significantly increase the fulfilment of these standards in both secondary and tertiary care neonatal units.
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Cortez, Elaine Antunes, Glaucimara Riguete, Ilda Cecília Moreira da Silva, Selma Petra Chaves Sá, Thalita Gomes do Carmo y Thiago Gomes do Carmo. "Aspectos éticos e implicações jurídicas do enfermeiro frente ao preparo e administração de soros e antibióticos". Revista de Enfermagem UFPE on line 3, n.º 3 (3 de julio de 2009): 715. http://dx.doi.org/10.5205/reuol.149-181-1-rv.0303200937.
Resumen
ABSTRACT Objectives: to identify the procedures applicable to the nurse about the preparation and administration of serums and antibiotics linking them with the ethical and professional responsibilities for the professional practice of nurses. Methodology: exploratory research and descriptive, qualitative approach to literature, held in Medline, Lilacs, SciELO and BDENF. We conducted a thematic analysis of the categories that emerged: Procedures performed by nurses for the preparation and administration of intravenous antibiotics and serum, ethics and professional responsibility of nurses, and the Judiciary in front of the administrative decisions of the disciplinary COFEN/COREN's. Results: the field of ethical issues is crucial to the nurse is able to reflect and take decisions aimed at the promotion of human dignity and quality of life. Conclusion: concluded that knowledge of ethics is essential to the profession of nursing, because the subsidies and provides a theoretical basis to make effective results in order to protect the human being. Descriptors: ethics; nursing; medication errors; intensive care units; hydration.RESUMO Objetivo: identificar os procedimentos cabíveis ao enfermeiro quanto ao preparo e administração de soros e antibióticos relacionando-os com as responsabilidades éticas e profissionais referentes ao exercício profissional do enfermeiro. Metodologia: pesquisa exploratória e descritiva, bibliográfica com abordagem qualitativa, realizada na BVS (Medline,Lilacs, Scielo e Bdenf). Realizamos uma análise temática dos quais emergiram as categorias: Procedimentos realizados pelo enfermeiro para o preparo e administração venosa de soroterapias e antibiótico; Responsabilidade ética e profissional do enfermeiro; e O Poder Judiciário frente às decisões administrativas disciplinares do COFEN/COREN´s. Resultados: o domínio das questões éticas é crucial para que o enfermeiro seja capaz de refletir e tomar decisões que visem à promoção da dignidade humana e da qualidade de vida. Conclusão: concluímos que o conhecimento da ética é essencial para a profissão da enfermagem, porque subsidia o embasamento teórico e propicia um fazer com resultados efetivos de forma a proteger o ser humano. Descritores: ética; enfermagem; erros de medicação; unidades de terapia intensiva; hidratação.RESUMEN Objetivos: identificar los procedimientos cabíveis al enfermero cuanto a lo preparo y administración de sueros y antibióticos relacionándolos con las responsabilidades éticas y profesionales referentes al ejercicio profesional del enfermero. Metodologia: Investigación exploratória y descriptiva, bibliográfica con abordaje cualitativo, realizada en Medline, Lilacs, Scielo y Bdenf. Realizamos un análisis temático de los cuáles emergieron las categorías: Procedimientos realizados por el enfermero para lo preparo y administración venosa de soroterapias y antibiótico; Responsabilidad ética y profesional del enfermero; y El Poder Judicial frente a las decisiones administrativas que disciplines del COFEN/COREN?s. Resultados: el dominio de las cuestiones éticas es crucial para que el enfermero sea capaz de reflejar y tomar decisiones que visen a la promoción de la dignidad humana y de la calidad de vida. Conclusión: concluimos que el conocimiento de la ética es esencial para la profesión de la enfermería, porque subsidia el embasamiento teórico y propicia un hacer con resultados efectivos de forma a proteger el ser humano. Descriptores: ética; enfermería; errores de medicación; unidades de terapia intensiva; hidratación.
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Cavalcanti, Daniel, Paulo Mata y Paulo Niemeyer Filho. "The First Two Years of Instituto Estadual do Cérebro Paulo Niemeyer: Initial Results of a Brazilian Public Hospital Dedicated to Neurosurgery". Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 37, n.º 03 (26 de abril de 2016): 182–89. http://dx.doi.org/10.1055/s-0036-1583315.
Resumen
AbstractThe dissemination of specialty hospitals throughout the urban centers has revolutionized the full spectrum of care for cardiology, oncology and orthopedics during the last decades. To centralize care, from translational and basic research to clinicians and surgeons, in the same dedicated institution leads to a decrease in complications rates, mortality and possible reductions in the length of hospital stays. Moreover, there has been a significant impact on hospital costs and on the quality of care. The Insituto Estadual do Cérebro Paulo Niemeyer (IECPN, in the Portuguese acronym) was opened in June 2013 in Rio de Janeiro, Brazil. It is the very first high-volume neurosurgical institution in the country. The core foundation of this institution is that the anesthesiologists, intensive care practitioners, nurses, pathologists, radiologists and rehabilitation staffs are trained and live the full management of neurosurgical lesions at the same facility on a daily basis. The present paper seeks to analyze the circumstances in which the institution was planned and opened as well as its complexity, infrastructure and initial results following its first 24 months of operation.
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Abraham, Joanna, Christopher R. King y Alicia Meng. "Ascertaining Design Requirements for Postoperative Care Transition Interventions". Applied Clinical Informatics 12, n.º 01 (enero de 2021): 107–15. http://dx.doi.org/10.1055/s-0040-1721780.
Resumen
Abstract Background Handoffs or care transitions from the operating room (OR) to intensive care unit (ICU) are fragmented and vulnerable to communication errors. Although protocols and checklists for standardization help reduce errors, such interventions suffer from limited sustainability. An unexplored aspect is the potential role of developing personalized postoperative transition interventions using artificial intelligence (AI)-generated risks. Objectives This study was aimed to (1) identify factors affecting sustainability of handoff standardization, (2) utilize a human-centered approach to develop design ideas and prototyping requirements for a sustainable handoff intervention, and (3) explore the potential role for AI risk assessment during handoffs. Methods We conducted four design workshops with 24 participants representing OR and ICU teams at a large medical academic center. Data collection phases were (1) open-ended questions, (2) closed card sorting of handoff information elements, and (3) scenario-based design ideation and prototyping for a handoff intervention. Data were analyzed using thematic analysis. Card sorts were further tallied to characterize handoff information elements as core, flexible, or unnecessary. Results Limited protocol awareness among clinicians and lack of an interdisciplinary electronic health record (EHR)-integrated handoff intervention prevented long-term sustainability of handoff standardization. Clinicians argued for a handoff intervention comprised of core elements (included for all patients) and flexible elements (tailored by patient condition and risks). They also identified unnecessary elements that could be omitted during handoffs. Similarities and differences in handoff intervention requirements among physicians and nurses were noted; in particular, clinicians expressed divergent views on the role of AI-generated postoperative risks. Conclusion Current postoperative handoff interventions focus largely on standardization of information transfer and handoff processes. Our design approach allowed us to visualize accurate models of user expectations for effective interdisciplinary communication. Insights from this study point toward EHR-integrated, “flexibly standardized” care transition interventions that can automatically generate a patient-centered summary and risk-based report.
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Michalsen, Andrej, Andreas Hillert, Andreas Schießl y Dominik Hinzmann. "Burnout in der Intensivmedizin". DMW - Deutsche Medizinische Wochenschrift 143, n.º 01 (enero de 2018): 21–26. http://dx.doi.org/10.1055/s-0043-109258.
Resumen
AbstractBoth acute crises and chronically incriminating circumstances in people’s lives may lead to their being afflicted by psychological and somatic ailments. “Burnout” has been coined and established as the term for chronic occupational strain. Many professions claim to be extraordinarily affected by burnout, amongst others physicians and nurses, especially those working in anaesthesiology and critical care. Usually assessed with the Maslach Burnout Inventary, the prevalence of moderate or severe burnout in these areas is estimated at about 30 % amongst nurses and about 40 % to 50 % amongst physicians. Both individual characteristics of those afflicted and occupational factors – as well as their interactions – are made responsible for causing burnout. The complexity of potentially stressful impingements, though, particularly within anaesthesiology and critical care, cannot be covered by the traditional burnout-paradigm. The plethora of recommendations found in popular science may be helpful in individual cases. However, there are no evidence-based preventive or therapeutic measures yet, that would endurably mitigate the sequelae of chronic occupational strain. On the one hand, occupationally burdensome factors needed to be registered more elaborately, for instance using the “Stress-Monitor” instrument. On the other hand, an in-hospital “peer-support system” has been developed and implemented in a Munich hospital recently. Anaesthetists and intensive care physicians have formed a network that supports health care workers surmounting acute occupational strain and thus helps to prevent its chronification. Ultimately, the goal of health care workers needed to consist of establishing individual work-related strategies to adequately cope with the manifold occupational stressors in a lifelong learning process.
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Gershengorn, Hayley y Allan Garland. "Who Should Be at the Bedside 24/7: Doctors, Families, Nurses?" Seminars in Respiratory and Critical Care Medicine 37, n.º 01 (28 de enero de 2016): 107–18. http://dx.doi.org/10.1055/s-0035-1570350.
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Melo, Elizabeth Mesquita, Stelânia Sales Silva, Aline Mota Marques, Isabel Cristina Veras Aguiar, Jéssyca Larissa Almeida Silva y Lucilene Barbosa Gomes Aguiar. "Knowledge of intensive care unit nurses about the procedure of endotracheal suctioning/Conhecimento do enfermeiro de unidade de terapia intensiva sobre o procedimento de aspiração endotraqueal/Conocimiento del enfermero de unidad de cuidados intensivos so". Revista de Enfermagem da UFPI 3, n.º 3 (5 de noviembre de 2014): 58. http://dx.doi.org/10.26694/reufpi.v3i3.1987.
Resumen
ABSTRACT Objective: to evaluate nurses' knowledge about the procedure of endotracheal suctioning performed in the Intensive Care Unit (ICU). Method: descriptive exploratory study with a quantitative approach, carried out in the Intensive Care Unit of a public hospital in Fortaleza-CE, with 39 nurses. Data collected from April to May 2012, from a questionnaire and organized into an Excel and subjected to statistical analysis. Study approved by the Ethics Committee of Hospital with number 090207/11. Results: regarding the procedure of endotracheal suction, draws attention not to perform the lung auscultation for 69.23%. Other points that deserve attention include the non-suspension of enteral feeding (51.29%) and non-use of Personal Protective Equipment (51.28%) during the procedure; 94.27% said to use saline solution at 0.9% to thin the secretions. Conclusion: it´s need to intensify the educational activities regarding the importance of care during the procedure, in order to minimize risks to patients. Keywords: Respiratory aspiration. Intensive care unit. Nursing care. RESUMO Objetivo: verificar o conhecimento dos enfermeiros acerca do procedimento de aspiração endotraqueal realizado na unidade de terapia intensiva (UTI). Metodologia: estudo exploratório descritivo, com abordagem quantitativa, realizado nas Unidades de Terapia Intensiva de um hospital público, em Fortaleza-CE, com uma amostra de 39 enfermeiros. Dados coletados de abril a maio de 2012, com um questionário, organizados no Excel e submetidos à análise estatística. Estudo aprovado pelo Comitê de Ética da instituição com parecer no. 090207/11. Resultados: quanto ao procedimento de aspiração endotraqueal, chama a atenção a não realização da ausculta pulmonar por 69,23%. Outros pontos merecem destaque como a não suspensão da dieta enteral (51,29%) e a não utilização dos Equipamentos de Proteção Individual (51,28%) durante o procedimento; 94,27% utilizam soro fisiológico 0,9% para fluidificar as secreções. Conclusão: há necessidade de intensificar as atividades educativas quanto à importância dos cuidados durante o procedimento, na tentativa de minimizar os riscos para os pacientes. Palavras-chave: Aspiração respiratória. Unidade de terapia intensiva. Cuidados de enfermagem. RESUMEN Objetivo: evaluar el conocimiento de los enfermeros sobre el procedimiento de aspiración endotraqueal realizado en la Unidad de Cuidados Intensivos (UCI). Método: estudio exploratorio descriptivo, con abordaje cuantitativo, realizado en las Unidades de Cuidados Intensivos de un hospital público, en Fortaleza-CE, con 39 enfermeros. Datos recolectados en el periodo de abril a mayo de 2012, con un cuestionario y organizados en el Excel, siendo sometidos a análisis estadístico. Estudio aprobado por el comité de ética, con el parecer no. 090207/11. Resultados: en cuanto al procedimiento de aspiración endotraqueal, llama la atención la no realización de la ausculta pulmonar por 69,23% de los participantes. Otros puntos merecen destacarse como la no suspensión de la dieta enteral (51,29%) y la no utilización de los Equipos de Protección Individual (51,28%) durante el procedimiento; 94,27% utiliza suero fisiológico 0,9% para fluidificar las secreciones. Conclusión: hay necesidad de intensificar las actividades educativas en relación a la importancia de los cuidados durante el procedimiento, intentando minimizar los riesgos para los pacientes. Palabras clave: Aspiración respiratoria. Unidad de cuidados intensivos. Atención de enfermería.
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Souza, Elaine Roberta Leite de, José Henrique de Araújo Cruz, Nílvia Maria Lima Gomes, Júlia Tavares Palmeira, Heloisa Mara Batista Fernandes de Oliveira, Gymenna Maria Tenório Guênes, Maria Angélica Sátyro Gomes Alves y Abrahão Alves de Oliveira Filho. "Fisiopatologia da pneumonia nosocomial: uma breve revisão". ARCHIVES OF HEALTH INVESTIGATION 9, n.º 5 (20 de abril de 2020): 485–92. http://dx.doi.org/10.21270/archi.v9i5.4728.
Resumen
Introdução: A pneumonia nosocomial é definida como infecção do parênquima pulmonar que ocorre depois de aproximadamente 48 horas de internação e os principais microrganismos envolvidos nessa infecção são bastonetes Gram-negativos, é a complicação mais comum que ocorre entre os pacientes internados em UTIs, e os microrganismos que podem gerar essas infecções respiratórias estão predispostos à colonizar do biofilme bucal. Objetivo: Realizar uma revisão de literatura acerca da Pneumonia Nosocomial relacionada à odontologia, a fim de compreender fatores como aspectos gerais, tipos de bactérias mais frequentes, fisiopatologia, epidemiologia e o tratamento. Metodologia: As buscas foram realizadas no período de 10 de Janeiro a 10 de Maio de 2019, foram utilizados artigos científicos retirados das bases de dados: SCIELO, MEDLINE, LILACS, e monografias que atendiam aos requisitos. Os artigos utilizados como referências bibliográficas foram do período entre 2008 a 2018, com exceção de artigos clássicos. A pesquisa foi realizada tanto na língua portuguesa, como em inglês e espanhol. Foram utilizados como descritores para a busca: "Pneumonia Nosocomial", "Pneumoia Hospitalar”, “Pneumonia Hospitalar e Odontologia”, “Odontologia Hospitalar”, “Pneumonia associada à ventilação mecânica”,e com um resultado de 43 artigos utilizados. Conclusão: Portanto, a Pneumonia nosocomial pode ter relação com a cavidade bucal, deste modo é necessário a implantação do cirurgião dentista no âmbito hospitalar e na Unidade Terapia Intensiva (UTI) para o melhor controle dos microrganismos que colonizam a boca na forma de biofilme bucal e que se proliferam rapidamente quando não é feita higiene adequada e/ou fazem uso de medicações que geram hipossalivação.
Descritores: Pneumonia Nosocomial; Unidade Terapia Intensiva; Odontologia.
Referências
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Belteki, Gusztav y Colin J. Morley. "Frequency, duration and cause of ventilator alarms on a neonatal intensive care unit". Archives of Disease in Childhood - Fetal and Neonatal Edition 103, n.º 4 (27 de octubre de 2017): F307—F311. http://dx.doi.org/10.1136/archdischild-2017-313493.
Resumen
ObjectiveTo investigate the frequency and cause of neonatal ventilator alarms. Neonatal ventilators frequently alarm and also disturb babies, parents and nurses. If frequent they may cause alarm fatigue and be ignored. The number, frequency and details of neonatal ventilator alarms are unreported.MethodsWe developed programs for retrieving and analysing ventilator data each second on alarms and ventilation parameters from 46 babies ventilated with Dräger Babylog VN500 ventilators using various modes.ResultsA mean of 60 hours was recorded per baby. Over 116 days, 27 751 alarms occurred. On average, that was 603 per baby and 10 per hour. Median (IQR) alarm duration was 10 (4–21) s. Type, frequency and duration varied between infants. Some babies had >10% of their time with alarms. Eight alarm types caused ~99% of all alarms. Three alarms, ‘MV <low limit’, ‘MV >high limit’ and ‘respiratory rate >high limit’, caused 46.6%, often due to inappropriate settings. 49.9% were due to a low expired tidal volume during volume guarantee ventilation, often due to the maximum pressure being set too low. 26 106 (94.1%) of all alarms lasted <1 min. However, 86 alarms lasted >10 min and 16 alarms >1 hour. Similar alarms were frequently clustered, sometimes >100/hour.ConclusionsFrequent ventilator alarms are caused by physiological variability in the respiratory rate or minute volume, inappropriate alarm limits or too low maximum peak inflating pressure during volume-targeted ventilation. While most alarms were very short, sometimes alarms were ignored by neonatal intensive care unit staff for long periods.
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Lukmanulhakim, Lukmanulhakim y Delly Arfa Syukrowardi. "THE EFFECTS OF SPIRITUAL COUNSELING ON THE ANXIETY LEVEL OF PATIENT’S FAMILY AT THE INTENSIVE CARE UNIT (ICU) OF dr. DRADJAT PRAWIRANEGARA HOSPITAL IN SERANG, BANTEN PROVINCE, INDONESIA". Belitung Nursing Journal 4, n.º 4 (29 de junio de 2018): 403–10. http://dx.doi.org/10.33546/bnj.404.
Resumen
Background: Critical nursing is a specific service in giving a holistic nursing service to fulfill human response to a life-threatening problem. A critical nurse can give a social support to patient’s family through assessment, counseling, and supporting group. Counseling is combination between high technology physical caring and emotional caring, which is needed by patients and the family. Spiritual counseling is a complementary medication preferred by the family of patient who is in acute and critical care.Objective: The study intends to identify the effects of spiritual counseling on the anxiety level of patient’s family at the ICU of dr. Dradjat Prawiranegara Hospital in Serang, Banten Province.Methods: The study is a pre-experimental research with one group pre-test and post-test design. The samples are 25 respondents who were selected by using consecutive sampling technique during one month (May to June 2016). The data of anxiety level were collected by using HAR-S (Hamilton Rating Scale for Anxiety) questionnaire. Then the data was analyzed by using parametrical t-test paired sample for the variable of anxiety before and after giving spiritual counseling. Meanwhile, the variable of respondent characteristics to anxiety was analyzed by using independent sample test.Results: The study finds that the mean of respondents’ anxiety level before spiritual counseling is 33.44 and the standard deviation is 5.213. Meanwhile, after conducting spiritual counseling, the mean is 18.60 and the standard deviation (SD) is 2.582. Bivariate analysis result shows a significant difference between anxiety level of patient’s family in ICU (Intensive Care Unit) before and after conducting spiritual counseling in which p value is 0.000, the mean is 14.840, and SD is 5.437.Conclusion: Nurses should be more capable in implementing the intervention of spiritual counseling to patient’s family. Spiritual counseling can give a positive alteration to the family emotional situation. It impacts on the decrease of patient’s family anxiety level. By the decrease of family anxiety level, the possibility of doing mistake in decision-making is expected to be avoided.