Hemodynamisk overvåkning er mer enn tall og parametre : Erfarne intensivsykepleieres kliniske beslutningsprosesser ved hemodynamisk overvåkning hvor pulmonalt arteriekateter anvendes i behandling av pasienter med akutt hjertesvikt

Formål: Studiens hensikt var å utforske og beskrive erfarne intensivsykepleieres kliniske beslutningsprosesser ved hemodynamisk overvåkning hvor pulmonalt arteriekateter ble anvendt i behandling av pasienter med akutt hjertesvikt. Teoretisk forankring: Rådende forskningslitteratur i forhold til beslutningsprosesser blant sykepleiere på sykehus og i klinisk praksis, samt forskningslitteratur relatert til anvendelse av pulmonalt arteriekateter ble gjort rede for. I tillegg ble problemstillingen belyst med en gjennomgang av forholdet mellom analytisk og intuitiv kognisjon i beslutningsprosesser, med Hammonds Cognitive Continuum Theory og Benners ekspertmodell for sykepleiere som grunnlag. Metode: Studien hadde et utforskende og beskrivende design og ti erfarne intensivsykepleiere ble intervjuet ved hjelp av semistrukturerte intervju. En kombinasjon av inklusjonskriterier og hensiktsmessig tilfeldig utvalg ble benyttet for å rekruttere intensivsykepleiere. Intervjuer ble utført ved å benytte Kvale og Brinkmanns perspektiver på intervjuforskning og analyse av data ble utført ved å benytte Malteruds systematisk tekstkondensering. Resultater: Erfarne intensivsykepleiere anvendte både kliniske observasjoner og data fra det pulmonale arteriekateteret aktivt. I løpet av et kort tidsrom gjennomførte de tiltak for å stabilisere pasientenes livstruende situasjon, forebygget langsiktige komplikasjoner og ivaretok pårørendes behov. Intensivsykepleierne viste en ansvarspraksis hvor de var fleksible i samarbeidet med legetjenesten og gjorde kontinuerlige vurderinger av pasientens tilstand, samtidig som de videreførte egne vurderinger til andre intensivsykepleiere og kvalitetssikret beslutninger ved å diskutere med erfarne kolleger. Praksiserfaring var den viktigste kilden til kunnskap, men intensivsykepleierne brukte både teoretisk kunnskap og erfaring for å sette ord på kliniske beslutninger ved hemodynamisk overvåkning. Konklusjon: Erfarne intensivsykepleiere anvendte et helhetlig perspektiv på pasientens tilstand ved hemodynamisk overvåkning, men det er nødvendig å synliggjøre hvordan de kombinerte kliniske observasjoner og tallparametre fra det pulmonale arteriekateteret i komplekse pasientsituasjoner på en bedre måte. Det må også kommuniseres hvordan en begrunnet ansvarspraksis så ut til å bidra til en økt kvalitet på overvåkning og behandling av pasienter med akutt hjertesvikt ved hemodynamisk overvåkning. Nøkkelord: klinisk beslutningsprosess, sykepleie, intensivsykepleie, pulmonalt arteriekateter, hemodynamikk, akutt hjertesvik

Professional competence required in advanced practice nursing in critical care: An exploratory qualitative study

Abstract Aim To identify the required competencies of advanced practice nurses (APNs) working with patients in critical care units in Norway. Design An exploratory qualitative design. Methods Four focus group interviews were performed with 18 nurses who worked in critical care units. The data were examined by inductive content analysis following Graneheim and Lundman's approach. Findings Our study found that APNs in critical care require the following professional competencies to meet the needs of patients characterised by greater age, comorbidities and increased complexity: (1) intrapersonal skills as revealed in the subthemes of self‐awareness; motivation and commitment; strong mental health and upholding ethical standards, (2) advanced clinical decision‐making skills as identified in the subthemes of integration of theory and practice; complex practical and technical skills; dealing with increased delegated responsibility and taking the lead in managing increased practice complexity and (3) interpersonal skills, including peer guidance, practising collaboratively and the ability to position oneself

ILC Reference Design Report Volume 1 - Executive Summary

The International Linear Collider (ILC) is a 200-500 GeV center-of-mass high-luminosity linear electron-positron collider, based on 1.3 GHz superconducting radio-frequency (SCRF) accelerating cavities. The ILC has a total footprint of about 31 km and is designed for a peak luminosity of 2x10^34 cm^-2s^-1. This report is the Executive Summary (Volume I) of the four volume Reference Design Report. It gives an overview of the physics at the ILC, the accelerator design and value estimate, the detector concepts, and the next steps towards project realization.The International Linear Collider (ILC) is a 200-500 GeV center-of-mass high-luminosity linear electron-positron collider, based on 1.3 GHz superconducting radio-frequency (SCRF) accelerating cavities. The ILC has a total footprint of about 31 km and is designed for a peak luminosity of 2x10^34 cm^-2s^-1. This report is the Executive Summary (Volume I) of the four volume Reference Design Report. It gives an overview of the physics at the ILC, the accelerator design and value estimate, the detector concepts, and the next steps towards project realization

ILC Reference Design Report Volume 4 - Detectors

This report, Volume IV of the International Linear Collider Reference Design Report, describes the detectors which will record and measure the charged and neutral particles produced in the ILC's high energy e+e- collisions. The physics of the ILC, and the environment of the machine-detector interface, pose new challenges for detector design. Several conceptual designs for the detector promise the needed performance, and ongoing detector R&D is addressing the outstanding technological issues. Two such detectors, operating in push-pull mode, perfectly instrument the ILC interaction region, and access the full potential of ILC physics.This report, Volume IV of the International Linear Collider Reference Design Report, describes the detectors which will record and measure the charged and neutral particles produced in the ILC's high energy e+e- collisions. The physics of the ILC, and the environment of the machine-detector interface, pose new challenges for detector design. Several conceptual designs for the detector promise the needed performance, and ongoing detector R&D is addressing the outstanding technological issues. Two such detectors, operating in push-pull mode, perfectly instrument the ILC interaction region, and access the full potential of ILC physics

ILC Reference Design Report Volume 3 - Accelerator

The International Linear Collider (ILC) is a 200-500 GeV center-of-mass high-luminosity linear electron-positron collider, based on 1.3 GHz superconducting radio-frequency (SCRF) accelerating cavities. The ILC has a total footprint of about 31 km and is designed for a peak luminosity of 2x10^34 cm^-2 s^-1. The complex includes a polarized electron source, an undulator-based positron source, two 6.7 km circumference damping rings, two-stage bunch compressors, two 11 km long main linacs and a 4.5 km long beam delivery system. This report is Volume III (Accelerator) of the four volume Reference Design Report, which describes the design and cost of the ILC.The International Linear Collider (ILC) is a 200-500 GeV center-of-mass high-luminosity linear electron-positron collider, based on 1.3 GHz superconducting radio-frequency (SCRF) accelerating cavities. The ILC has a total footprint of about 31 km and is designed for a peak luminosity of 2x10^34 cm^-2 s^-1. The complex includes a polarized electron source, an undulator-based positron source, two 6.7 km circumference damping rings, two-stage bunch compressors, two 11 km long main linacs and a 4.5 km long beam delivery system. This report is Volume III (Accelerator) of the four volume Reference Design Report, which describes the design and cost of the ILC

International Linear Collider Reference Design Report Volume 2: PHYSICS AT THE ILC

This article reviews the physics case for the ILC. Baseline running at 500 GeV as well as possible upgrades and options are discussed. The opportunities on Standard Model physics, Higgs physics, Supersymmetry and alternative theories beyond the Standard Model are described.This article reviews the physics case for the ILC. Baseline running at 500 GeV as well as possible upgrades and options are discussed. The opportunities on Standard Model physics, Higgs physics, Supersymmetry and alternative theories beyond the Standard Model are described