Nursing care at the intensive care unit (ICU): going beyond objectivity

Nowadays, nursing is sustained by different paradigms, among which we highlight those related to totality and simultaneity, since these embody the main conceptual models and specific theories for nursing practice. This study aims to provide elements that will lead to reflections about the possibility of founding health practices at ICUs on the Humanistic Theory of Paterson and Zderad, which is part of the simultaneity paradigm. This theory supports dialogue-based care, which is translated as the genuine encounter between and among caregivers, patients and their families. Thus, ICU care will go beyond the I-that relation, to achieve the I-you relation, that is, the subjectiveness of human beings.     

Infections,accidents and nursing overtime in a neonatal intensive care unit

The European Journal of Health Economics - The paper investigates the effects of nursing overtime on nosocomial infections and medical accidents in a neonatal intensive care unit (NICU). The...     

Quality of nursing care provided in a neonatal intensive care unit. Structure assessment

Structure is considered one of the three major approaches to the evaluation of quality the other two being process and outcome. Appraisal of structure involves the attributes of the settings in which care is delivered that includes the material resources, the human resources, and the organizational structure. The aim of the study was to assess the quality of nursing care provided at tne neonatal intensive care unit (NICU) at Princess Badia Teaching Hospital, Jordan, as regards the various components of structure domain within the context of quality. A checklist for structure assessment was developed which included criteria classified under three main areas namely, material resources, human resources, and organizational structure. Results revealed certain deviations from the recommended compliance scores for each area. Recommendations were proposed to stress the importance of the NICU being specifically built to reflect practice, environment, and cultural needs, as well as continuous education activities of NICU staff. Documented policy and procedure manuals were also recommended for assuring maintained quality care at the NICU.     

ICU术前访视制度在专科监护室中的应用价值探讨

目的 探讨ICU术前访视制度在专科监护室中的应用价值.方法 将肝胆外科手术患者95例随机分为访视组55例和非访视组40例,访视组患者术前给予介绍ICU环境、设备、制度等,并给予心理疏导,非访视组则不予介绍.自行设计问卷,在两组患者搬出ICU时对其进行调查.了解其心理状况.结果 访视组的心理压力明显小于非访视组;访视组对护理工作满意度高于非访视组,(P<0.05).结论 术前访视制度的建立有效减轻了患者入住ICU期间的心理压力,提高了患者的满意率及护士的工作效率,减少了医患之间的矛盾.     

The need for nursing care in intensive care units: daily patient assessment according to the nursing activities score (NAS)

This study aimed to characterize patients admitted to ICU according to their bio-social factors and admissions and verify the daily needs for nursing care according to NAS. The sample was composed by 50 adult patients who were consecutively admitted to the ICU of a University Hospital in S?o Paulo city. It was concluded that most patients were older than 60 with an average of 3.5-day stay in the ICU; they came from the Emergency Room and were referred to the Semi-Intensive Care Unit. NAS average was 66.5% (+/- 9.1) with a score higher than 50.0% during their stay in the ICU.     

Validation of a ratio scale for family needs at an intensive care unit

The hospitalization of a close relative due to unexpected critical illness may trigger an unbalance in the patient's family structure. The family plays an important role in the patient's recovery and, often, its needs are unknown by nurses and little emphasis is given to attention to the family's needs. This study aimed to validate a ratio-level scale of family needs at an intensive care unit (ICU). The sample consisted of 52 family members who visited their relatives during ICU hospitalization. Psychophysical methods of magnitude estimation (ME) and cross modality matching (line length) were used, calculating the geometric mean of each need by both methods. The results showed a high agreement on needs among the participants, with a Pearson coefficient of r= 0.97 (p<0.0001). The relationship between these methods can be described as a power function, confirming that this scale of family needs is valid, stable and consistent.     

An exploratory study using data envelopment analysis to assess neurotrauma patients in the intensive care unit

Patients with severe head trauma were studied retrospectively to determine if Data Envelopment Analysis (DEA) could successfully model patients early in their stay in an intensive care unit. Variables examined were cerebral perfusion pressure, body temperature, mean arterial pressure, serum osmolarity and pCO₂. Unlike regression-based models that focus on mean values for the group, DEA evaluates each patient individually calculating an efficiency score based on a patient's ability to maximize output for a given set of physiologic inputs. Patients with high efficiency scores were found to have a better chance of making a full recovery than similarly injured patients that were inefficient. This approach needs further study but may offer physicians the opportunity to improve patient outcome subject to the manipulation of individual variables from the results of a DEA model rather than aiming for normal or average physiologic values.     

Tap water colonization with Pseudomonas aeruginosa in a surgical intensive care unit (ICU) and relation to Pseudomonas infections of ICU patients.

Water faucets on a surgical intensive care ward were examined prospectively as a source of Pseudomonas aeruginosa infections. All water outlets harbored distinct genotypes of P aeruginosa over prolonged time periods. Over a period of 7 months, 5 (29%) of 17 patients were infected with P aeruginosa genotypes also detectable in tap water.     

NICU医院感染监测及护理对策

目的 了解新生儿重症监护病房医院感染的特点,为实施科学有效的干预措施提供依据.方法 2009年7月-2010年6月入住新生儿重症监护病房＞48 h的全部住院患儿1480例,进行医院感染前瞻性监测,对转出患儿随访48 h.结果 医院感染发生率为3.51％,其中主要感染为呼吸道感染占44.23％,其次为胃肠道感染占38.46％;呼吸机的利用率1.66％,呼吸机使用日的感染率为0.13‰.结论 加强新生儿医院感染的监测,严格执行感染控制措施,降低医院感染率.     

Enterobacter cloacae epidemic on a neonatal intensive care unit due to the use of contaminated thermometers

From December 1999 to March 2000 a nosocomial outbreak of multiresistant Enterobacter cloacae occurred in the neonatal intensive care unit (NICU) at the VU Medical Center, Amsterdam, the Netherlands. Twenty-six patients were infected or colonized with this strain resistant to third generation cephalosporins and with decreased sensitivity for aminoglycosides. Three neonates experienced sepsis with E. cloacae with serious clinical symptoms and two of them died. Comparison of the Enterobacter isolates by amplified-fragment length polymorphism indicated that this outbreak was caused by the spread of a single strain. Infection control precautions were initiated in order to stop further spread; barrier precautions, enforcement of hand disinfection and cohorting of colonized patients. A multidisciplinary crisis team coordinated these infection control precautions and informed all persons involved. Analysis of antibiotic usage in 1999 showed an increase in the use of third generation cephalosporins from November onwards. Due to the resistance pattern of the epidemic strain the use of third generation cephalosporins was discontinued in February 2000. At the end of February the NICU was temporarily closed. The epidemic strain of E. cloacae was isolated from one digital rectal thermometer. Patient use of thermometers and disposable coverings for rectal thermometers were introduced to eliminate this possible means of spread. No spread of multiresistant E. cloacae was found following the introduction of these interventions. Once all the neonates had been transferred, the NICU was disinfected and reopened in March.     

Alcohol-based hand disinfection: a more robust hand-hygiene method in an intensive care unit

This study involved observation of hand-hygiene behaviour and evaluation of the effect of alcohol-based hand disinfection and handwashing with plain liquid soap on microbial flora. The study was performed in a combined medical and surgical intensive care unit. We demonstrated a crude compliance of hand hygiene of 50.4%, which was only performed adequately in 20.8% of cases. Of this group, handwashing and hand-disinfection procedures were performed properly 34.0% and 71.6% of the time, respectively. Hand samples for bacteriological examinations with the glove juice method demonstrated that whilst handwashing was sensitive to the way in which hand hygiene was performed, alcohol-based hand disinfection was less sensitive to such performance. Our study demonstrated that alcohol-based hand disinfection is a robust hand-hygiene method with many advantages in a practical setting. It is very feasible for use in hospital wards.     

Use of multistate models to assess prolongation of intensive care unit stay due to nosocomial infection.

BACKGROUND: Reliable data on the costs attributable to nosocomial infection (NI) are crucial to demonstrating the real cost-effectiveness of infection control measures. Several studies investigating this issue with regard to intensive care unit (ICU) patients have probably overestimated, as a result of inappropriate study methods, the part played by NIs in prolonging the length of stay. METHODS: Data from a prospective study of the incidence of NI in 5 ICUs over a period of 18 months formed the basis of this analysis. For describing the temporal dynamics of the data, a multistate model was used. Thus, ICU patients were counted as case patients as soon as an NI was ascertained on any particular day. All patients were then regarded as control subjects as long as they remained free of NI (time-to-event data analysis technique). RESULTS: Admitted patients (n=1,876) were observed for the development of NI over a period of 28,498 patient-days. In total, 431 NIs were ascertained during the study period (incidence density, 15.1 NIs per 1,000 patient-days). The influence of NI as a time-dependent covariate in a proportional hazards model was highly significant (P< .0001, Wald test). NI significantly reduced the discharge hazard (hazard ratio, 0.72 [95% confidence interval, 0.63-0.82])--that is, it prolonged the ICU stay. The mean prolongation of ICU length of stay due to NI (+/- standard error) was estimated to be 5.3+/-1.6 days. CONCLUSIONS: Further studies are required to enable comparison of data on prolongation of ICU length of stay with the results of various study methods.     

Project of introduction of nursing records at the pediatric intensive care unit

The project, performed at the Infantile General Hospital ITU, in Curitiba, Paraná, enabled to experience nursing practices in caring for seriously ill in hospital children and, also in concrete day by day situations. At beginning we have notice the absence of nursing care records of any kind, through many situations, that sometimes, put children's treatment in risk for nursing information records precariously and for the Tailorized way of nursing care. From nursing records process diagnosis, was discussed the project build, we have elaborated a record form and two manuals (Nursing records and Pharmacology Notions) for professionals training and follow-up. The project introduction has provided a better interaction between patient and nursing assistance and has encouraged, through the systematized way of information records, a interdisciplinary work, besides organization of nursing assistance, resulting in a better assistance quality and credibility.     

手卫生干预对降低重症监护室医院感染率的影响

目的对某院重症监护室（ICU）医务人员手卫生进行干预,了解其对医院感染率的影响。方法对某院ICU医务人员手卫生进行干预,并建立有效的监督管理机制,比较干预前（2012年1-12月）和干预后（干预后第1阶段：2013年1-6月;干预后第2阶段：2013年7-12月）医务人员手卫生依从率和医院感染率。结果共调查4 066例患者,干预前医务人员手卫生依从率为50.03%,干预后第1、2阶段手卫生依从率分别为61.80%和64.57%,上升趋势具有统计学意义（rs=1.00, P<0.001）。干预前,ICU医院感染率为5.48%,干预后第1、2阶段分别为3.86%和3.30%,医院感染率的下降趋势具有统计学意义（rs=-1.00,P<0.001）。ICU导管相关血流感染率、导尿管相关尿路感染率和呼吸机相关性肺炎感染率下降趋势均具有统计学意义（rs=-1.00,均P<0.001）。手卫生依从率与ICU医院感染率、导管相关血流感染率、导尿管相关尿路感染率、呼吸机相关性肺炎感染率间存在负相关（均P<0.05）。结论提高手卫生依从性,可有效降低ICU病房医院感染发生率。     

舒适护理在重症监护病房气管切开患者护理中的效果观察

目的 观察舒适护理对ICU病房内气管切开患者的护理效果。方法 选取了自2015年6月—2016年11月在本院ICU病房住院并接受气管切开术治疗的77名患者,根据患者住院时间的不同,将患者分为2组。2015年6月—2016年2月住院的患者纳入对照组接受常规护理干预;而2016年3月及以后住院的患者纳入实验组,予以舒适护理。比较2组患者住院期间气管切开术并发症的发生情况。采用焦虑自评量表和忧郁自评量表对患者住院期间的焦虑及忧郁情绪进行打分,比较两组间的差异。另外,患者出院后采用自制的问卷对住院期间护理的满意度和舒适度进行评定。结果 实验组患者术后并发症的发生率低于对照组。其中脱管、皮下气肿和气道出血的发生率两组差异无统计学意义(P>0.05),肺部感染的发生率差异有统计学意义(P<0.05)。实验组患者焦虑自评量表评分和忧郁自评量表评分均显著低于对照组,差异有统计学意义(P<0.05)。实验组患者对住院期间护理工作的舒适度评分和满意度评分均明显高于对照组,差异有统计学意义(P<0.05)。结论 舒适护理能在一定程度上降低ICU病房气管切开患者的术后并发症发生率,缓解患者住院期间焦虑、抑郁等不良情绪,提高护理满意度和舒适度,值得进一步推广和应用。