Tehohoitopotilaan deliriumin ennaltaehkäisy hoitotyön keinoin

Opinnäytetyö kuuluu Helsingin ja Uudenmaan sairaanhoitopiirin, HYKS-sairaanhoitoalueen operatiivisen toimialan ja Laurea-ammattikorkeakoulun väliseen hoitotyön laadunkehittämishankkeeseen, joka toteutetaan vuosina 2007–2012. Opinnäytetyön lähtökohtana on Laurea-ammattikorkeakoulun ja Töölön teho-osaston yhteistyö, jonka tavoitteena on parantaa hoitotyön laatua. Opinnäytetyön aihe on tehohoitopotilaan deliriumin ennaltaehkäisy hoitotyön keinoin. Se on muodostunut Töölön teho-osaston sairaanhoitajan ehdotuksen pohjalta. Teho-osaston henkilökunta kokee tehohoitopotilaan deliriumin ennaltaehkäisyn haastavaksi työssään. Enimmäkseen deliriumia on hoidettu lääkkeellisillä hoitokeinoilla. Opinnäytetyön tekijät lähestyvät ongelmaa näyttöön perustuvan hoitotyön näkökulmasta. Opinnäytetyön aihe on rajattu käsittelemään tehohoidosta johtuvan deliriumin ennaltaehkäisyä. Opinnäytetyön tarkoituksena on kehittää tehohoitopotilaan hoitotyötä deliriumin ennaltaehkäisyn näkökulmasta. Tavoitteena opinnäytetyössä on päivittää teho-osaston henkilökunnan tietoja tuomalla esiin keinoja deliriumin ennaltaehkäisemiseksi. Tavoitteena on myös perustella deliriumin ennaltaehkäisyn tärkeyttä. Deliriumissa olevat potilaat ovat raskashoitoisia, koska he vaativat henkilökunnalta aikaa ja kärsivällisyyttä. Delirium pidentää tehohoitoaikaa ja lisää hoitokustannuksia. Tehohoidon aikana koettu delirium heikentää usein potilaan elämänlaatua vielä hoidon jälkeen. Myös tehohoidon aikainen kuolleisuus lisääntyy. Huomioimalla deliriumille altistavat, myötävaikuttavat ja laukaisevat tekijät voidaan vaikuttaa deliriumia ennaltaehkäisevästi. Hoitajan työkaluina ovat erilaiset hoitotyön auttamismenetelmät, kuten tukeminen, tarkkaileminen ja ohjaaminen. Näitä hoitotyön keinoja käyttämällä ja soveltamalla voidaan ennaltaehkäistä deliriumin kehittymistä. Jokapäiväisessä työssä hoitajat käyttävät näitä keinoja, ja tiedostamattaan he samalla ehkäisevät deliriumin kehittymistä. Tieto deliriumin ennaltaehkäisystä on pilkottuna eri tietolähteisiin. Opinnäytetyössä kootaan tieto yhteen ja tiivistetään se myös innovatiiviseksi julisteeksi. Opinnäytetyön tuloksena on tietopaketti, jota teho-osaston hoitajat voivat hyödyntää työssään. Jatkossa voisi tutkia, miten Töölön teho-osaston henkilökunta käyttää ja soveltaa ennaltaehkäiseviä keinoja. Olisi myös hyvä selvittää, mikä estää ennaltaehkäisyn toteuttamista.Preventing intensive care unit delirium with nursing interventions This thesis is part of the quality development project between the Hospital District of Helsinki and Uusimaa, the department of Surgery of Helsinki University Central Hospital and Laurea University of Applied Sciences during the years 2007- 2012. This thesis was initiated by the cooperation between Laurea UAS and Töölö Hospital Intensive Care Unit. The aim is to im-prove the quality of nursing care. This thesis discusses the prevention of delirium in the intensive care unit with nursing interventions. It is assigned by an ICU nurse at Töölö Hospital. The ICU personnel regard the prevention of an intensive care patient's delirium as challenging. The delirium is for the most part treated with medication. The authors approach the problem from the perspective of evidence-based nursing. The topic of this thesis is outlined to deal with the prevention of delirium due to intensive care. The purpose of this thesis is to develop critical care nursing. It aims to update the knowledge of intensive care unit personnel by enhancing the means to prevent delirium. The aim is also to justify the importance of preventing the delirium. Patients with delirium require staff time and patience. Delirium increases the length of the hospital stay in the intensive care unit as well as the hospital costs. Delirium due to intensive care weakens the patient’s quality of life even after the hospital stay. Delirium leads also to increased mortality. To prevent delirium it is important to observe the factors that expose, contribute to and trigger delirium. The nursing care can consist of different interventions, such as supporting, monitoring and guiding. The use of these nursing interventions can prevent the development of delirium. The nurses use these interventions daily, and unconsciously prevent the development of delirium at the same time. The information about the prevention of delirium is scattered in different sources. In this thesis the information is compiled together and summarised in an innovative poster. The thesis produced a guide that the ICU nurses can use in their work. The future research could aim to investigate how Töölö Hospital ICU personnel use and apply preventive measures. It would also be useful to study the reasons that inhibit the prevention of delirium

Simultaneous determination of indium and nitrogen contents of InGaAsN quantum wells by optical in situ monitoring

In situ monitoring of metal-organic vapor phase epitaxialgrowth of InGaAsN∕GaAs multiquantum wells is studied. The complex refractive index of InGaAsN is determined for several indium and nitrogen contents based on the fits to the reflectance curve. Taking advantage of the different effects caused by the incorporation of indium and nitrogen on the complex refractive index of InGaAsN, the InGaAsN quantum well nitrogen and indium contents are simultaneously determined in situ.Peer reviewe

Cascaded exciton emission of an individual strain-induced quantum dot

Single strain-induced quantum dots are isolated for optical experiments by selective removal of the inducing InP islands from the sample surface. Unpolarized emission of single, bi- and triexciton transitions are identified by power-dependent photoluminescence spectroscopy. Employing time-resolved experiments performed at different excitation powers we find a pronounced shift of the rise and decay times of these different transitions as expected from cascaded emission. Good agreement is found for a rate equation model for a three step cascade

Self-organized InP islands on (100) GaAs by metalorganic vapor phase epitaxy

The effect of growth temperature, deposition rate, and substrate misorientation angle on size, density, and uniformity of InP islands grown on (100) GaAs by metalorganic vapor phase epitaxy is investigated. The density of InP islands is observed to remain constant as a function of growth temperature in the temperature range of 620–680 °C. Below 620 °C the island density increases with decreasing temperature. Above 605 °C a subset of islands having a uniform size is observed. The degree of uniformity depends largely on the deposition rate and the size of the uniform islands on the growth temperature.Peer reviewe

Interference effects in photoreflectance of epitaxial layers grown on semi-insulating substrates

Interferences were observed in the photoreflectance spectra of homoepitaxial layers grown on semi‐insulating GaAs and InP substrates. The modulation mechanism responsible for the interference effect was studied from the frequency and temperature dependence of the interference amplitude and the effect of continuous wave illumination. The results are in agreement with the model that the modulation is due to electrons drifting to the interface from the surface. A simple model was used to fit the interference spectra to the Lorentzian wave forms from the substrate and the epitaxial layer.Peer reviewe

Does It Matter how I Perceive my Nation?: National Symbols, National Identification and Attitudes toward Immigrants

Peer reviewe

Comparison of ammonia plasma and AlN passivation by plasma-enhanced atomic layer deposition

Surface passivation of GaAs by ammonia plasma and AlN fabricated by plasma-enhanced atomic layer deposition are compared. It is shown that the deposition temperature can be reduced to 150 °C and effective passivation is still achieved. Samples passivated by AlN fabricated at 150 °C show four times higher photoluminescence intensity and longer time-resolved photoluminescence lifetime than ammonia plasma passivated samples. The passivation effect is shown to last for months. The dependence of charge carrier lifetime and integrated photoluminescence intensity on AlN layer thickness is studied using an exponential model to describe the tunneling probability from the near-surface quantum well to the GaAssurface.Peer reviewe

Temperature dependence of carrier relaxation in strain-induced quantum dots

We report experimental observation and theoretical interpretation of temperature-dependent, time-resolved luminescence from strain-induced quantum dots. The experimental results are well described by a master equation model for the electrons. The intraband relaxation in the conduction band and the radiative recombination rate are governed by the hole populations resulting in prominent temperature dependence of the relaxation process. Even when only a few electrons and holes are confined in a single quantum dot the Auger-like process provides a rapid intraband relaxation channel for electrons that can replace the phonon scattering as the dominant relaxation mechanism.Peer reviewe

Enhanced Tunnelling in a Hybrid of Single-Walled Carbon Nanotubes and Graphene

Transparent and conductive films (TCFs) are of great technological importance. The high transmittance, electrical conductivity and mechanical strength make single-walled carbon nanotubes (SWCNTs) a good candidate for their raw material. Despite the ballistic transport in individual SWCNTs, however, the electrical conductivity of their networks is limited by low efficiency of charge tunneling between the tube elements. Here, we demonstrate that the nanotube network sheet resistance at high optical transmittance is decreased by more than 50% when fabricated on graphene and thus provides a comparable improvement as widely adopted gold chloride ($\mathrm{AuCl_3}$) doping. However, while Raman spectroscopy reveals substantial changes in spectral features of doped nanotubes, no similar effect is observed in presence of graphene. Instead, temperature dependent transport measurements indicate that graphene substrate reduces the tunneling barrier heights while its parallel conductivity contribution is almost negligible. Finally, we show that combining the graphene substrate and $\mathrm{AuCl_3}$ doping, the SWCNT thin films can exhibit sheet resistance as low as 36 $\Omega$/sq. at 90% transmittance.Comment: 21 pages, 6 figure