''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: Despite the important role of bedside nurses in clinical research in the intensive care unit (ICU), little is known about how ICU nurses feel about research conduct or their contribution to the research process.
Methods: Self-administered, cross-sectional, paper-based survey to characterize nurses’ experiences and beliefs about ICU research in 5 academic ICUs affiliated with the Canadian Critical Care Trials Group. Prior to administration we assessed the survey for face and content validity, discriminability, utility, clarity, and test-retest reliability.
Results: Response rate was 67% (n=297/446). On average, ICUs were engaged in 16 studies and employed 2 full-time research coordinators. Most respondents were female (79%) with over 6 years of ICU experience (70%). Most had an undergraduate nursing degree (56%); 44% had completed an ICU certificate. While the majority reported completing a statistics course (55%), most had minimal to no experiential knowledge of research processes (67%). Few (20%) reported ever participating in research protocol development, data analysis, publication, or research committees. The majority (62%) had cared for a patient requiring study procedures ≥ 6 times but never or infrequently (< 6 times) completed data collection forms (61%). Most (75%) agreed or strongly agreed research facilitates improved care and that eligible ICU patients should be approached for research (61%), but only for minimal risk studies (76%). Most disagreed or strongly disagreed (76%) that ICU patients were too sick to participate in research. Few (22%) agreed or strongly agreed researchers consider practicalities of nursing care when designing studies and 40% agreed or strongly agreed that caring for study patients substantially increased nursing workload.
Conclusion: Nurses support ICU research and are actively involved in the care of research participants. Paradoxically, nurses remain peripheral to important research processes. Greater inclusion of nurses in study conceptualization and design and investigation of research-related nursing workload is warranted.
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: Little data describes the role of emergency department (ED) nurses in caring for ventilated patients yet these patients may remain in ED for prolonged durations due to unavailability of intensive care beds.
Objectives: To examine: exposure of ED nurses to patients requiring invasive ventilation; responsibilities for ventilated patients; and education on ventilation received.
Methods: Cross sectional mailed survey sent to members of the National Emergency Nursing Association in Canada. Domains and items were refined from a survey of ventilation roles and responsibilities in intensive care. Pilot testing comprised ED nurse and respiratory therapist (RT) expert feedback on face and content validity and test-retest reliability.
Results: Response rate was 247/526 (47%); 39% provided care to ≤ 10 ventilated patients every 2 weeks, 32% ≤ 5 patients monthly and 27% ≤ 5 patients every 6 months. A 1:1 nurse: patient ratio for ventilated patients in ED was reported by 38% of respondents; 45% managed 1 or 2 additional patients; 15% ≥ 3 additional patients. Most respondents (54%) reported RTs remained in ED until patients stabilized; 28% RT was available on call, 11% RT remained until patient transfer, and 7% reported no RT available. Few nurses reported being primarily responsible for initial ventilator setting selection (7%), and titration of ventilation (6%); nurse responsibility for these tasks was influenced by RT availability (P<0.001). Primary responsibility for monitoring patient response to ventilation, alarm troubleshooting, and management of oxygenation was reported by 44%, 36%, and 30% respectively. Education was received by 51% of respondents prior to caring for ventilated patients; most (57%) indicated competency in caring for ventilated patients was never assessed. Institutional guidelines for ventilation were reported available by 39% of respondents.
Conclusion: ED nurses have variable exposure to ventilated patients and responsibility for management of ventilation is influenced by RT availability.
health-related quality of life; prolonged mechanical ventilation; weaning; memory
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: Psychological distress of intensive care unit (ICU) survivors is a significant problem and is associated with delusional memories. Psychological morbidity may persist over time impacting health-related quality of life and ability to regain premorbid function including return to work.
Objective: To compare memories and recall of stressful experiences of ICU and a specialized weaning centre (SWC) as described by survivors of prolonged mechanical ventilation (≥ 21 days).
Methods: We recruited participants following hospitalization that included ICU admission and subsequent weaning in a SWC (Toronto, Canada). Using a prospective cross-sectional design, we determined memories and recall of stressful experiences of ICU and SWC stay using the ICU Memory Tool and ICU Experience Questionnaire administered via mail or in-person.
Results: Of the 45 eligible participants, 13 did not respond to recruitment strategies, 6 refused, 1 was incompetent, and 1 didn’t return questionnaires (24 participants). Mean time since SWC discharge was 1.9±1.2 years, age 67±16.8; 50% were female. 17% (ICU) and 8% (SWC) of participants had no recall of admission; 29% (ICU) and 75% (SWC) remembered all of their stay. Participants had similar mean numbers of factual (6.6 vs 6.6) and feeling (3.5 vs 3.1) memories of ICU and SWC. More delusional memories were reported for ICU than SWC (1.6 vs 0.6, P<0.001). Thirst (67%), no control (67%), noise (63%), and inability to sleep (58%) were events recalled most frequently from ICU: procedures (75%), night awakening (67%), inability to sleep (67%), and no control (63%) from SWC. Thirst and trouble speaking were rated most distressing. Since discharge, unexplained feelings of panic were experienced by 50% and intrusive memories by 46% of participants.
Conclusion: Despite moderate prevalence of psychological disturbance, few delusional memories were recalled. Difficulty sleeping, thirst, and lack of control were common experiences suggesting interventions focused in these areas are needed.
caregivers, chronically- ill, community, family support, caregiving
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
This qualitative case series aimed to determine the preparedness of caregivers with chronically-ill patients in the community of Tacloban City, Leyte. There were 3 caregivers, aliased Buttercup, Bubbles and Blossom. Buttercup is a 50-year old housewife to a 64-year old post below knee amputation (BKA) patient. Buttercup’s husband is a retired government employee. Bubbles is a 34-year old housewife taking care of her 75 year old father diagnosed with osteoarthritis. Aside from taking care of her father, husband and children, Bubbles runs a small store just outside their house. Blossom, on the other hand, is an 18 year old nursing student. She takes care of a grandfather who just had his second stroke attack. Blossom’s grandfather is a retired barangay captain.
The qualitative data showed that the caregivers address the physical and emotional needs of their ailing family member. They also prepare for any complications and emergencies that are brought about by the condition of their patient. Enabling and disabling factors contributing to the caregiving preparedness were determined. Knowledge and anticipation and family support were enabling factors; while caregiver role strain, other responsibilities and economic changes were identified as disabling factors.
Caregivers are prepared when it comes to the physical needs of their patients. They are somewhat prepared for the emotional challenges that come with caregiving, and a little prepared when it comes to emergencies. Caregivers were enabled and disabled by a variety of factors.
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Introductions: Light or no sedation has been more common while receiving mechanical ventilation treatment and it is preferable from a medical perspective. Patients who are mechanical ventilated treatment are unable to speak verbally. To communicate was perceived as difficult and evoked feelings of helplessness. When patients are conscious communication becomes a major problem compared to the situation when patients are deeply sedated. Not being able to communicate created feelings of losing power and control.
Aims: The aim was to describe patients’ communication during a video - recorded interview while undergoing mechanical ventilation treatment.
Methods: Fourteen patients treated with no or light sedation while receiving ventilator treatment was interviewed and video recorded. A quantitative content analysis was used focusing on how the patients communicated. Each type of communicative strategy the patients used during the recording was registered and counted.
Results: The patients developed individual styles of communication while on the ventilator, but there were common characteristics. All the patients nodded and shook their head; except two who blinked.
Most of the patients used aids such as pen and paper, although some were unable to write due to injuries caused by trauma, disease or shaky hands. The patients gesticulated and used facial expressions to varying extent. Some frowned and raised their eyebrows but some had the same facial expression during the interview. Only one of the four patients with oral endotracheal tube mouthed and three nasally intubated mouthed their answers during the interview.
Conclusions: Patients developed their own individual communication patterns which takes time to establish and understood by carer and relatives. Some techniques could easily be taught so that communication can be facilitated. As ability to communicate seems vital for patients’ feelings of security it is important to establish a continuing caring and well- functioning relationship between patients and their carers.
endotracheal suction , normal saline , ventilated pateint
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Endotracheal suction is a corner procedure in the management of secretions in mechanically ventilated patients. Normal saline instillation is used by nurses during treatment of intubated patients within the intensive care unit, usually to enhance sputum yield. Its use is controversial; detrimental effects have been documented and evidence of any benefit is limited. Some studies have suggested routine use be discontinued. This study investigates the effect of endotracheal suction with and without instillation of normal saline on oxygen saturation, heart rate, blood pressure and arterial blood gases in mechanically ventilated patients. An experimental cross over design was adopted. The study was carried out at medical and surgical Intensive Care Units of King Fahad University Hospital. The study sample consists of 25 adult male and female patients. They were randomly assigned to two techniques of suction (with and without instillation of normal saline) participants are randomly assigned to different orderings of treatment. An Observational checklist was developed by the researcher to collect the needed data that covers patients’ demographic data, heart rate, blood pressure, SPO2, and arterial blood gases before & after suction for 5 minutes. The study reveals that there was statistical significant difference between mean heart rate, PCo2, PaO2 and PaO2/FiO2 over time after suction with instillation of normal saline while there was no significant difference between mean heart rate, blood pressure and arterial blood gases among the two techniques of suction. The researcher strongly recommended that saline instillation should not be used as a routine clinical practice and the nurses should consider other interventions to promote secretion clearance include providing adequate systemic hydration, humidification, chest percussion and vibration.
