Family care strategies in an unpredictable ICU environment. ICU nurses’ and physicians’ interprofessional and individual strategies for critically ill ICU patients’ families – a qualitative study

Background: Critical illness not only disrupts the patient’s life, but also the lives of close family members. The care provided by ICU nurses and physicians can reduce the family members’ burden and improve the patient's outcome. Previous research shows that although ICU families generally report high satisfaction, there are several barriers to family care and areas for improvement. Family members miss emotional support and opportunities to become more involved in patient care. They also report problems with inconsistent information and poor communication with clinicians. This indicates that more knowledge is needed of existing ICU family care practices. Therefore, the overall aim of this study was to explore ICU nurses’ and physicians’ individual and interprofessional strategies for providing care to the families of critically ill ICU patients, in order to enhance knowledge of existing ICU practices and hereby improve patient and family care. Methods: Data were gathered from July 2017 to August 2019, through participant observation, focus groups, dyadic and individual interviews of physicians and nurses from four ICUs in different Norwegian hospitals. In Papers 1 and 2, a constructivist grounded theory approach was used in the data analysis, while thematic narrative analysis was used in Paper 3. Findings: Papers 1, 2 and 3, respectively, describe how handovers, interprofessional care and an individual approach affect family care in the ICU. Together these articles show that family care in the ICU is an interprofessional responsibility, although an individual approach to families by nurses and physicians is crucial, and continuity in family care must be ensured by good information flow between clinicians. The study also indicates that family care in the ICU is largely based on clinicians’ experiences. Conclusion: The study demonstrates that ICU nurses and physicians show care and responsibility towards ICU families, although their family care strategies are mainly experiential and tacit. The study also reveals that despite the inherent unpredictability of ICU, family care can be facilitated by developing a family-friendly culture and environment. The ICU management has a vital role to play in enhancing nurses’ and physicians’ individual and interprofessional family care strategies by developing evidence-based guidelines and encouraging interprofessional dialogue and reflection.Bakgrunn: Akutt og kritisk sykdom påvirker ikke bare pasienten, men også pasientens pårørende. Ivaretakelse og omsorg fra intensivavdelingens sykepleiere og leger kan redusere belastningen på pårørende og forbedre pasientens utfall. Tidligere forskning viser at selv om intensivpasienters pårørende generelt rapporterer om høy tilfredshet, finnes det flere barrierer for ivaretakelse av pårørende og områder for forbedring. Pårørende savner emosjonell støtte og å bli involvert i pasientbehandlingen. De rapporterer også om inkonsekvent informasjon og dårlig kommunikasjon med sykepleiere og leger. Dette indikerer at det er behov for mer kunnskap om eksisterende praksis vedrørende ivaretakelse av intensivpasienters pårørende. Studiens overordnede mål var å utforske sykepleieres og legers individuelle og tverrprofesjonelle strategier overfor pårørende til kritisk syke intensivpasienter, for å øke kunnskapen om eksisterende ICU-praksis og dermed forbedre pasient- og familieomsorgen. Metode: Data ble samlet inn fra juli 2017 til august 2019, gjennom deltakende observasjon, fokusgrupper, dyadiske og individuelle intervjuer av leger og sykepleiere fra fire intensivavdelinger ved ulike norske sykehus. Konstruktivistisk grounded theory ble benyttet i artikkel 1 og 2, mens tematisk narrativ analyse ble benyttet i artikkel 3. Funn: Artikkel 1, 2 og 3 omhandler henholdsvis hvordan informasjonsoverføring, tverrprofesjonell omsorg og en individuell tilnærming påvirker pårørendearbeidet. Sammen viser artiklene at ivaretakelse av pårørende er et tverrprofesjonelt ansvar, samtidig som sykepleiernes og legenes individuelle tilnærming til pårørende er avgjørende og at kontinuitet i pårørendeomsorgen må sikres gjennom god informasjonsflyt mellom klinikerne. Studien indikerer at ivaretakelse av pårørende i stor grad er basert på klinikernes erfaringer. Konklusjon: Studien viser at intensivavdelingens sykepleiere og leger viser omsorg og ansvar for intensivpasienters pårørende. Deres pårørendestrategier er imidlertid hovedsakelig erfaringsbaserte og stilltiende. Studien avslører også at til tross for at arbeidshverdagen i intensivavdelingen er uforutsigbar, kan ivaretakelsen av pårørende forbedres ved å utvikle en familievennlig kultur og et familievennlig miljø. Intensivavdelingens ledelse spiller dessuten en viktig rolle i å styrke sykepleieres og legers individuelle og tverrprofesjonelle pårørendestrategier ved å utvikle evidensbaserte retningslinjer og oppmuntre til tverrprofesjonell dialog og refleksjon

Professionals' narratives of interactions with patients' families in intensive care

Background: ICU patients’ family members are in a new, uncertain, and vulnerable situation due to the patient’s critical illness and complete dependence on the ICU nurses and physicians. Family members’ feeling of being cared for is closely linked to clinicians’ attitudes and behavior. Aim: To explore ICU nurses’ and physicians’ bedside interaction with critically ill ICU patients´ families and discuss this in light of the ethics of care. Research design: A qualitative study using participant observation, focus groups, and thematic narrative analysis. Participants and research context: Data were gathered from July 2017 to August 2019, in four ICUs in Norway through 270 h of fieldwork and seven focus groups with ICU nurses and physicians. Ethical considerations: The Regional Committee for Medical and Health Research Ethics and the Norwegian Centre for Research Data approved the study. Findings: Quality of ICU family care depends on nurses’ and physicians’ attitudes, behavior, and personality traits. Three main themes were identified: being attentive, an active approach, and degree of tolerance. Discussion: The findings are discussed in light of the ethics of care and empirical research from the intensive care environment. Conclusions: This study shows that attentive, active, and tolerant clinicians represent a culture of ethical care that gives families greater freedom of action and active participation in patient care. Clinicians must not bear sole responsibility for this culture; it must have a firm basis in the hospital and ICU and be established through training, interprofessional reflection, and support of clinicians

Description of call handling in emergency medical dispatch centres in Scandinavia: recognition of out-of-hospital cardiac arrests and dispatcher-assisted CPR

Background The European resuscitation council have highlighted emergency medical dispatch centres as an important key player for early recognition of Out-of-Hospital Cardiac Arrest (OHCA) and in providing dispatcher assisted cardiopulmonary resuscitation (CPR) before arrival of emergency medical services. Early recognition is associated with increased bystander CPR and improved survival rates. The aim of this study is to describe OHCA call handling in emergency medical dispatch centres in Copenhagen (Denmark), Stockholm (Sweden) and Oslo (Norway) with focus on sensitivity of recognition of OHCA, provision of dispatcher-assisted CPR and time intervals when CPR is initiated during the emergency call (NO-CPRprior), and to describe OHCA call handling when CPR is initiated prior to the emergency call (CPRprior). Methods Baseline data of consecutive OHCA eligible for inclusion starting January 1st 2016 were collected from respective cardiac arrest registries. A template based on the Cardiac Arrest Registry to Enhance Survival definition catalogue was used to extract data from respective cardiac arrest registries and from corresponding audio files from emergency medical dispatch centres. Cases were divided in two groups: NO-CPRprior and CPRprior and data collection continued until 200 cases were collected in the NO-CPRprior-group. Results NO-CPRprior OHCA was recognised in 71% of the calls in Copenhagen, 83% in Stockholm, and 96% in Oslo. Abnormal breathing was addressed in 34, 7 and 98% of cases and CPR instructions were started in 50, 60, and 80%, respectively. Median time (mm:ss) to first chest compression was 02:35 (Copenhagen), 03:50 (Stockholm) and 02:58 (Oslo). Assessment of CPR quality was performed in 80, 74, and 74% of the cases. CPRprior comprised 71 cases in Copenhagen, 9 in Stockholm, and 38 in Oslo. Dispatchers still started CPR instructions in 41, 22, and 40% of the calls, respectively and provided quality assessment in 71, 100, and 80% in these respective instances. Conclusions We observed variations in OHCA recognition in 71–96% and dispatcher assisted-CPR were provided in 50–80% in NO-CPRprior calls. In cases where CPR was initiated prior to emergency calls, dispatchers were less likely to start CPR instructions but provided quality assessments during instructions.publishedVersio

Breakthrough infections with the omicron and delta variants of SARS-CoV-2 result in similar re-activation of vaccine-induced immunity

Background: Results showing that sera from double vaccinated individuals have minimal neutralizing activity against Omicron have been interpreted as indicating the need for a third vaccine dose for protection. However, there is little information about early immune responses to Omicron infection in double vaccinated individuals. Methods: We measured inflammatory mediators, antibodies to the SARS-CoV-2 spike and nucleocapsid proteins, and spike peptide-induced release of interferon gamma in whole blood in 51 double-vaccinated individuals infected with Omicron, in 14 infected with Delta, and in 18 healthy controls. The median time points for the first and second samples were 7 and 14 days after symptom onset, respectively. Findings: Infection with Omicron or Delta led to a rapid and similar increase in antibodies to the receptor-binding domain (RBD) of Omicron protein and spike peptide-induced interferon gamma in whole blood. Both the Omicron- and the Delta-infected patients had a mild and transient increase in inflammatory parameters. <p<Interpretation: The results suggest that two vaccine doses are sufficient to mount a rapid and potent immune response upon infection in healthy individuals of with the Omicron variant

Priority research questions in atopic dermatitis : an International Eczema Council eDelphi consensus

Recent advances in understanding the complex pathogenesis of atopic dermatitis (AD, also known as eczema or atopic eczema), coupled with the development of new treatments, have led to increased interest from multiple stakeholders. There is a need to prioritize areas for research to inform a coordinated approach to advancing science and patient care

Om at blive student i massemedier på det frie gymnasium

Om at blive student i massemedier på det frie gymnasiu

Knowledge and Awareness of Non-Technical Skills Over the Course of an Educational Program in Nursing - A Repeated Cross-Sectional Study

Background: Non-technical skills (NTS) play an important role in preventing adverse events during hospitalization. Knowledge, awareness and mastery of NTS becomes important key factors in preventing errors. Current status of students and supervisor’s knowledge and awareness of NTS are needed in order to construct an educational plan for improvement. Purpose: To examine knowledge and awareness of NTS over the course of continuing education of nurse anaesthetists, emergency care nurses, critical care nurses, and operating room nurses. Methods: A descriptive, repetitive cross-sectional design with a questionnaire was used to evaluate knowledge and awareness in students and their supervisors about NTS at two different time points during the educational program. Cross tabulations were used in comparisons across specialties and between students and supervisors, frequencies to identify the levels of self-reported knowledge/ importance/focus in clinical practice/ impact on adverse events. Results: The results showed that there was a numeric difference between the reported knowledge/focus in clinical practice on the one hand and importance/ impact on adverse events on the other, and that this gap was reduced after 12 months of education with special focus on NTS. There was no difference across specialties. Supervisors had higher focus on NTS in clinical practice and on the impact on adverse events, than students at both measurements. Conclusion: These data suggest that NTS may have important potential for improvement if included into learning programs both in education and clinical practice. Integration of NTS in various learning activities seems to strengthen students’ competence about NTS.publishedVersio

In vitro effect of dalteparin and argatroban on hemostasis in critically ill sepsis patients with new-onset thrombocytopenia

Thrombocytopenia is common among critically ill sepsis patients, while they also hold an increased risk for thromboembolic events. Thus, the choice of anticoagulant prophylaxis for this patient population is challenging. We investigated the in vitro effect of low-molecular-weight heparin (dalteparin) and direct thrombin inhibitor (argatroban) on the hemostasis in blood from sepsis patients with new-onset thrombocytopenia. Thrombocytopenia was defined as a platelet count drop of ≥30% and/or from >100x109/L to 30-100x109/L within 24 hours prior to inclusion. We included five healthy individuals and ten patients. Analysis of thrombin generation (Calibrated Automated Thrombogram), prothrombin fragment 1+2 (F1+2), thrombin-antithrombin (TAT) complex levels, and thromboelastometry (ROTEM®) were performed. Based on dose-response-relationships investigated in healthy blood, patient samples were spiked with prophylactic (0.25 IU/mL) and therapeutic (0.75 IU/mL) dalteparin and low (0.25 µg/mL) and high (0.50 µg/mL) argatroban concentrations, each with a sample without anticoagulant. In patients, the endogenous thrombin potential was markedly lower in therapeutic dalteparin samples than in samples without anticoagulant [median (range): 29 (0-388) vs. 795 (98-2121) nM×min]. In high argatroban concentration samples, thrombin lag time was longer than in samples without anticoagulant [median (range): 15.5 (10.5-20.2) vs. 5.3 (2.8-7.3) min]. Dalteparin and argatroban both increased clotting time but did not affect maximum clot firmness in the ROTEM INTEM® assay. Six patients had elevated TAT and eight patients had elevated F1+2. In conclusion, dalteparin mainly affected the amount of thrombin generated and argatroban delayed clot initiation in critically ill sepsis patients with new-onset thrombocytopenia. Neither anticoagulant affected clot strength