scholarly journals Nursing Care of the Chronically Critically ill: An Exploratory Descriptive Study

2021 ◽  
Author(s):  
◽  
Anne Rosamond Butt
Keyword(s):  
Compassion Fatigue ◽  
Critically Ill ◽  
Patient Group ◽  
Working Environment ◽  
Cultural Issues ◽  
Icu Patients ◽  
Work Related ◽  
Nursing Experience ◽  
Changing Practice ◽  
Chronically Critically Ill

<p>Background:There is an emerging group of intensive care unit (ICU) patients known as the chronically critically ill (CCI). This patient group is steadily increasing worldwide (Nelson et al., 2004).No published literature was located that focused on the nursing experience of caring for CCI patients, however studies alluded to CCI patients as frustrating to look after.This is pertinent because these patients are costly to care for and considered burdensome to nurses and physicians. (Daly, Rudy, Thompson & Happ, 1991). In a working environment where turnover and shortage of nursing staff is evident and predicted to worsen, this is cause for real concern about future resourcing for this patient group (Carasa & Nespoli, 2002). Research Aims: The aim of this study was to explore and describe nurses' experiences of caring for CCI patients. ICU nurses are the key providers of bedside care to all ICU patients. They have valuable contributions concerning the planning and implementation of patient-focused care, including that of long-stay and CCI patients. Method: A qualitative approach was used with an exploratory descriptive design. Semistructured interviews were conducted which generated in-depth description of participant experiences. Findings: Six key themes are identified: 1. Nursing autonomy and control 2. Work-related stress, compassion fatigue and staff allocation 3. The CCI patient in the ICU environment 4. Teamwork, nursing practice and continuity of care 5. The culture of ICU 6. Withdrawal of care and palliation. Summary: Six nurses from two tertiary level ICUs within New Zealand were interviewed using a semi-structured approach. Participants were encouraged to comment on several issues including access to training and resources, cultural issues within ICU and any suggestions for how CCI patient care might be improved.The interviews were transcribed to allow a thorough content analysis. These topics were explored and generated recommendations for changing practice.</p>

scholarly journals Nursing Care of the Chronically Critically ill: An Exploratory Descriptive Study

2021 ◽  
Author(s):  
◽  
Anne Rosamond Butt
Keyword(s):  
Compassion Fatigue ◽  
Critically Ill ◽  
Patient Group ◽  
Working Environment ◽  
Cultural Issues ◽  
Icu Patients ◽  
Work Related ◽  
Nursing Experience ◽  
Changing Practice ◽  
Chronically Critically Ill

<p>Background:There is an emerging group of intensive care unit (ICU) patients known as the chronically critically ill (CCI). This patient group is steadily increasing worldwide (Nelson et al., 2004).No published literature was located that focused on the nursing experience of caring for CCI patients, however studies alluded to CCI patients as frustrating to look after.This is pertinent because these patients are costly to care for and considered burdensome to nurses and physicians. (Daly, Rudy, Thompson & Happ, 1991). In a working environment where turnover and shortage of nursing staff is evident and predicted to worsen, this is cause for real concern about future resourcing for this patient group (Carasa & Nespoli, 2002). Research Aims: The aim of this study was to explore and describe nurses' experiences of caring for CCI patients. ICU nurses are the key providers of bedside care to all ICU patients. They have valuable contributions concerning the planning and implementation of patient-focused care, including that of long-stay and CCI patients. Method: A qualitative approach was used with an exploratory descriptive design. Semistructured interviews were conducted which generated in-depth description of participant experiences. Findings: Six key themes are identified: 1. Nursing autonomy and control 2. Work-related stress, compassion fatigue and staff allocation 3. The CCI patient in the ICU environment 4. Teamwork, nursing practice and continuity of care 5. The culture of ICU 6. Withdrawal of care and palliation. Summary: Six nurses from two tertiary level ICUs within New Zealand were interviewed using a semi-structured approach. Participants were encouraged to comment on several issues including access to training and resources, cultural issues within ICU and any suggestions for how CCI patient care might be improved.The interviews were transcribed to allow a thorough content analysis. These topics were explored and generated recommendations for changing practice.</p>

scholarly journals UK consultants’ experiences of the decision-making process around referral to intensive care: an interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044752
Author(s):  
Kaja Heidenreich ◽  
Anne-Marie Slowther ◽  
Frances Griffiths ◽  
Anders Bremer ◽  
Mia Svantesson
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Moral Responsibility ◽  
Critically Ill ◽  
Interpersonal Relationships ◽  
Qualitative Interviews ◽  
Working Environment ◽  
Critically Ill Patient ◽  
Decision Making Process ◽  
Moral Duties

ObjectiveThe decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these issues in practice. The aim of this study was to describe and understand consultants’ experiences of the decision-making process around referral to intensive care.DesignQualitative interviews were analysed according to a phenomenological hermeneutical method.Setting and participantsConsultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.ResultsIn the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient’s situation, and responding to mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.ConclusionThe findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. For this reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.

scholarly journals Psychosocial, emotional and professional challenges faced by female healthcare professionals during the COVID-19 outbreak in Lahore, Pakistan: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sumbal Shahbaz ◽  
Muhammad Zeshan Ashraf ◽  
Rubeena Zakar ◽  
Florian Fischer
Keyword(s):  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Working Environment ◽  
Cultural Issues ◽  
Self Reflection ◽  
Professional Challenges ◽  
Proper Training ◽  
Phenomenological Methodology ◽  
Novel Coronavirus ◽  
And Coping

Abstract Background The novel coronavirus disease (COVID-19) is spreading rapidly, increasing the stress and challenges for healthcare professionals around the world. This study aims to discover the psychosocial, emotional and professional challenges faced by female healthcare professionals (HCPs) treating COVID-19 patients in Pakistan. Methods Using an empirical phenomenological methodology, semi-structured telephone-based qualitative interviews were conducted with 22 female HCPs who were providing their expertise for COVID-19 patients in tertiary-level hospitals in Lahore, Pakistan. Purposive sampling was used for recruitment. The interviews were conducted between 20 July and 20 August 2020. The interviews were analysed using thematic analysis. Results This study explored the psychosocial, emotional and professional challenges faced by female HCPs serving COVID-19 patients. Five themes were observed in the interviews: apprehension while treating COVID-19 patients; feelings towards COVID-19 patients; challenges as female HCPs and coping strategies; confidence in government, administration and self-reflection; and finally, future concerns and recommendations. Many of these themes have also been linked with cultural issues, making the results specific to Pakistan. Conclusions During the COVID-19 pandemic, female frontline HCPs have faced immense psychosocial pressure, ranging from unsupportive family norms to an unwelcoming working environment and insensitive hospital administrations. Moreover, rumours among the general public, lack of proper training, missing incentives and improper system surveillance have increased the anxiety and stress among HCPs. Hence, legislators are advised to take appropriate actions countrywide in order to alleviate the still ongoing challenges and support female HCPs in their working environment.

How Long Does (S)He Have? Retrospective Analysis of Outcomes After Palliative Extubation in Elderly, Chronically Critically Ill Patients

2016 ◽  
Vol 44 (6) ◽  
pp. 1138-1144 ◽  
Author(s):  
Cynthia X. Pan ◽  
Dimitris Platis ◽  
Min Min Maw ◽  
Jane Morris ◽  
Simcha Pollack ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Chronically Critically Ill

scholarly journals The impact of viremia on organ failure, biomarkers and mortality in a Swedish cohort of critically ill COVID-19 patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Josef D. Järhult ◽  
Michael Hultström ◽  
Anders Bergqvist ◽  
Robert Frithiof ◽  
Miklos Lipcsey
Keyword(s):  
Organ Failure ◽  
Critically Ill ◽  
Independent Predictor ◽  
Corticosteroid Treatment ◽  
Blood Stream ◽  
Common Finding ◽  
Icu Patients ◽  
Extra Pulmonary ◽  
The Impact ◽  
Swedish Cohort

AbstractThe spread of virus via the blood stream has been suggested to contribute to extra-pulmonary organ failure in Coronavirus disease 2019 (COVID-19). We assessed SARS-CoV-2 RNAemia (RNAemia) and the association between RNAemia and inflammation, organ failure and mortality in critically ill COVID-19 patients. We included all patients with PCR verified COVID-19 and consent admitted to ICU. SARS-CoV-2 RNA copies above 1000/ml measured by PCR in plasma was defined as RNAemia and used as surrogate for viremia. In this cohort of 92 patients 59 (64%) were invasively ventilated. RNAemia was found in 31 patients (34%). Hypertension and corticosteroid treatment was more common in patients with RNAemia. Extra-pulmonary organ failure biomarkers and the extent of organ failure were similar in patients with and without RNAemia, but the former group had more renal replacement therapy and higher mortality (26 vs 16%; 35 vs 16%, respectively, p = 0.04). RNAemia was not an independent predictor of death at 30 days after adjustment for age. SARS-CoV2 RNA copies in plasma is a common finding in ICU patients with COVID-19. Although viremia was not associated with extra pulmonary organ failure it was more common in patients who did not survive to 30 days after ICU admission.Trial registration: ClinicalTrials NCT04316884.

Een slechte start en dan?

2017 ◽  
Vol 33 (3) ◽  
Author(s):  
Henk-Jan Dirven ◽  
Wouter van der Torre ◽  
Seth van den Bossche
Keyword(s):  
Analysis Data ◽  
Working Environment ◽  
Work Situation ◽  
Financial Situation ◽  
Work Related ◽  
Self Employment ◽  
Level Of Satisfaction ◽  
Set Up ◽  
Employment Quality

A bad start and what then? The work situation of self-employed entrepreneurs with negative and positive start motives This article assesses the extent to which the quality of labor varies between solo self-employed who set up a business for negative reasons and those who started for positive reasons. A negative reason is, for example, not being able to find a suitable job as an employee; an example of a positive reason is wanting to be self-employed from the very beginning. Quality of labor is measured according to the person's financial situation, security of employment, quality of the working environment and work satisfaction. In the analysis, data are used from the Self-employment Survey conducted by Statistics Netherlands and TNO. Compared to self-employed persons with a positive motivation, those who were negatively motivated show lower performance in terms of their business's financial situation, income position, work-related mental fatigue (burn-out), self-perceived health status, concern about the business's future and the level of satisfaction. However, in absolute terms, the vast majority appear to be satisfied with their work situation, enthusiastic and not intending to quit self-employment.

Prevalence and Risk Factors of work Related Musculo Skeletal Disorders (wrmsd’s) Among Doctors - A Cross Sectional Study

2021 ◽  
pp. 1-4
Author(s):  
Biju Azariah ◽  
◽  
Geethu Babu ◽  
Keyword(s):  
Risk Factors ◽  
Service Sector ◽  
Care Delivery ◽  
Tertiary Care ◽  
Health Sector ◽  
High Volume ◽  
Cross Sectional Study ◽  
Working Environment ◽  
Cross Sectional ◽  
Work Related

Work related musculoskeletal disorders (WRMSDs) have not only shown to impact the physical and pschycological comfort of the employee but also deteriorate the prospects of any production or service sector. The prevalence of WRMSDs, though studied extensively in various sectors, has been understudied in health sector, especially among doctors. This study which evaluated the prevalence and risk factors of these disorders among fifty cancer treating Radiation Oncologist at a Tertiary Care Cancer Centre in India had exposed out an alarming 68% prevalence of these disorders in the study population, with neck pain being the commonest site of these Muscloskeletal Disorders (MSDs). Several factors which could impact the development of MSDs were analysed. This higher incidence of MSDs is presumed to be because of extreme physical and mental stress of working in a high volume cancer care centre, persistent unhealthy postures during work, inadequate micropauses between works and uncomfortable working atmosphere. Adequate physician patient ratio, restricting the patient load, providing good physician friendly working environment and adequate mandatory breaks might significantly reduce the incidence of these disorders and can prevent the sagging of health care delivery.

scholarly journals Integrating human factors aspects into performance optimization models of a serial assembly system

2021 ◽  
Author(s):  
Ahmad Sobhani
Keyword(s):  
Markov Chain ◽  
Performance Optimization ◽  
Employee Health ◽  
Working Environment ◽  
Optimization Models ◽  
Assembly System ◽  
Health State ◽  
Total Cost ◽  
Work Related ◽  
Analytical Phase

This dissertation investigates the effects of human factors (HF) of the working environment on the performance of an operation system. Poor HF design of the workplace interrupts the balance of the working environment and reduces employees' overall work performance creating a substantial economic burden on organizations. This thesis focuses on integrating HF aspects into performance optimization models of the serial system. For this reason, a modeling framework has been developed for hierarchical consideration of HF consequences at the individual, workstation and system levels. The developed framework provides a road map for the three analytical phases of this PhD research. In the first analytical phase, a two-state Markov chain is developed to quantify the connection between Work-related Ill Health (WIH) risk factors (ergonomic conditions in the workplace) and employee health-state in a probabilistic way. Subsequently, an optimization model is developed to minimize the total cost of the assembly system with regard to employee health-related productivity loss. Numerical results indicate that there is between 0.5% and 8% difference in the optimal cost of the system with and without including HF effects. In the second analytical phase, a three health-state Markov chain models the connection between HF aspects of the workplace and the employees' work-related productivity and quality variations. Results show between 0.02% and 32% increase for the optimal total cost when both employee productivity and quality losses due to poor HF design of the workplace are integrated into the optimization model. In the third analytical phase, the uncertainty involved in customer demand is considered by developing a two-regime switching model, using a pentanomial lattice. The developed modeling approach investigates the effects of both work-related employee performance variation and demand behavior on the optimal cost of the serial assembly system. Results show that a prediction of the demand distribution throughout the product life cycle is necessary to reduce the over/under cost estimation of the system, due to the stochastic behavior of the demand. This research opens a new window for considering HF intervention not only as occupational health and safety but also as operation improvement method leading to design safer and more efficient systems.

scholarly journals Time-Limited Trials Among Critically Ill Patients With Advanced Medical Illnesses to Reduce Nonbeneficial Intensive Care Unit Treatments: Protocol for a Multicenter Quality Improvement Study (Preprint)

2019 ◽  
Author(s):  
Dong Chang ◽  
Jennifer Parrish ◽  
Nader Kamangar ◽  
Janice Liebler ◽  
May Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Decision Makers ◽  
Care Planning ◽  
Improvement Strategy ◽  
Icu Patients ◽  
Family Meetings ◽  
Planning Approach ◽  
Icu Physicians

BACKGROUND Invasive intensive care unit (ICU) treatments for patients with advanced medical illnesses and poor prognoses may prolong suffering with minimal benefit. Unfortunately, the quality of care planning and communication between clinicians and critically ill patients and their families in these situations are highly variable, frequently leading to overutilization of invasive ICU treatments. Time-limited trials (TLTs) are agreements between the clinicians and the patients and decision makers to use certain medical therapies over defined periods of time and to evaluate whether patients improve or worsen according to predetermined clinical parameters. For patients with advanced medical illnesses receiving aggressive ICU treatments, TLTs can promote effective dialogue, develop consensus in decision making, and set rational boundaries to treatments based on patients’ goals of care. OBJECTIVE The aim of this study will be to examine whether a multicomponent quality-improvement strategy that uses protocoled TLTs as the default ICU care-planning approach for critically ill patients with advanced medical illnesses will decrease duration and intensity of nonbeneficial ICU care without changing hospital mortality. METHODS This study will be conducted in medical ICUs of three public teaching hospitals in Los Angeles County. In Aim 1, we will conduct focus groups and semistructured interviews with key stakeholders to identify facilitators and barriers to implementing TLTs among ICU patients with advanced medical illnesses. In Aim 2, we will train clinicians to use protocol-enhanced TLTs as the default communication and care-planning approach in patients with advanced medical illnesses who receive invasive ICU treatments. Eligible patients will be those who the treating ICU physicians consider to be at high risk for nonbeneficial treatments according to guidelines from the Society of Critical Care Medicine. ICU physicians will be trained to use the TLT protocol through a curriculum of didactic lectures, case discussions, and simulations utilizing actors as family members in role-playing scenarios. Family meetings will be scheduled by trained care managers. The improvement strategy will be implemented sequentially in the three participating hospitals, and outcomes will be evaluated using a before-and-after study design. Key process outcomes will include frequency, timing, and content of family meetings. The primary clinical outcome will be ICU length of stay. Secondary outcomes will include hospital length of stay, days receiving life-sustaining treatments (eg, mechanical ventilation, vasopressors, and renal replacement therapy), number of attempts at cardiopulmonary resuscitation, frequency of invasive ICU procedures, and disposition from hospitalization. RESULTS The study began in August 2017. The implementation of interventions and data collection were completed at two of the three hospitals. As of September 2019, the study was at the postintervention stage at the third hospital. We have completed focus groups with physicians at each medical center (N=29) and interviews of family members and surrogate decision makers (N=18). The study is expected to be completed in the first quarter of 2020, and results are expected to be available in mid-2020. CONCLUSIONS The successful completion of the aims in this proposal may identify a systematic approach to improve communication and shared decision making and to reduce nonbeneficial invasive treatments for ICU patients with advanced medical illnesses. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16301

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