ABSTRACT
OBJECTIVE: To explore and describe the experiences of Norwegian intensive care unit nurses providing nurse-led follow-up to patients and their families. DESIGN AND METHODS: The study had a qualitative design with a phenomenological approach. Three focus-group interviews were conducted with nurses on three intensive care units. Giorgi's phenomenological method guided the analysis. FINDINGS: The creation of meaning emerged as a general structure describing intensive care nurses' experiences of nurse-led follow-up. When caring for critically ill patients, nurses described becoming emotionally moved, which motivated them to perform nurse-led follow-up procedures, such as writing in patient diaries. A general wish to give context to the patients' time spent in intensive care emerged. When conducting nurse-led follow-up, the nurses made personal contributions, which could be emotionally challenging for them. Overall, nurse-led follow-up was found to increase nurses' insight into and motivation for their own practice. CONCLUSION: The performance of nurse-led follow-up appears to be grounded in care for and engagement in individual patients and families. The nurses studied wanted to help patients and families to be able to handle their experiences during an intensive care stay. In addition, nurse-led follow-up gave meaning to the intensive care nurses' own practice.
Subject(s)
Aftercare/standards , Nurses/psychology , Adult , Aftercare/methods , Aftercare/statistics & numerical data , Critical Care Nursing/methods , Critical Care Nursing/standards , Critical Illness/nursing , Female , Focus Groups/methods , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Norway , Nurse-Patient Relations , Nurses/statistics & numerical data , Qualitative ResearchSubject(s)
Intensive Care Units/standards , Positive-Pressure Respiration/standards , Respiration, Artificial/standards , Ventilator Weaning , Adult , Humans , Hypnotics and Sedatives/administration & dosage , Intensive Care Units/statistics & numerical data , Length of Stay , Monitoring, Physiologic , Motor Activity , Positive-Pressure Respiration/adverse effects , Positive-Pressure Respiration/statistics & numerical data , Quality Assurance, Health Care , Respiration, Artificial/adverse effects , Respiration, Artificial/statistics & numerical data , Ventilator Weaning/standards , Ventilator Weaning/statistics & numerical dataABSTRACT
PROBLEM: Need for improved sedation strategy for adults receiving ventilator support. DESIGN: Observational study of effect of introduction of guidelines to improve the doctors' and nurses' performance. The project was a prospective improvement and was part of a national quality improvement collaborative. BACKGROUND AND SETTING: A general mixed surgical intensive care unit in a university hospital; all doctors and nurses in the unit; all adult patients (>18 years) treated by intermittent positive pressure ventilation for more than 24 hours. KEY MEASURES FOR IMPROVEMENT: Reduction in patients' mean time on a ventilator and length of stay in intensive care over a period of 11 months; anonymous reporting of critical incidents; staff perceptions of ease and of consequences of changes. STRATEGIES FOR CHANGE: Multiple measures (protocol development, educational presentations, written guidelines, posters, flyers, emails, personal discussions, and continuous feedback) were tested, rapidly assessed, and adopted if beneficial. EFFECTS OF CHANGE: Mean ventilator time decreased by 2.1 days (95% confidence interval 0.7 to 3.6 days) from 7.4 days before intervention to 5.3 days after. Mean stay decreased by 1.0 day (-0.9 to 2.9 days) from 9.3 days to 8.3 days. No accidental extubations or other incidents were identified. LESSONS LEARNT: Relatively simple changes in sedation practice had significant effects on length of ventilator support. The change process was well received by the staff and increased their interest in identifying other areas for improvement.
