Inter- und intraprofessionelle Zusammenarbeit in Krisensituationen auf der Intensivstation am Beispiel von COVID-19.

Interprofessional and intraprofessional collaboration in crises situations in the intensive care unit regarding COVID-19 - a qualitative, retrospective analysis Abstract. Background: Interprofessional collaboration is elementary in the intensive care unit, a success factor in difficult patient situations and complex therapies. The COVID-19-pandemic challenged newly composed treatment teams, however, experience does not exist. Aim: We analyzed personal experiences and views on inter- and intraprofessional collaboration in intensive care units during the COVID-19-pandemic and identified influencing factors. Methods: We used a qualitative, retrospective study design, collected data from physicians, nurses in intensive care, anesthesia and surgery and physiotherapists during group discussions using the story / dialogue method. We analyzed the data according to Mayring's Qualitative content analysis. Results: We identified two main categories, each with three sub-categories: 1. Mastering a exceptional situation actively (Recognizing a common goal; Acting in solidarity; Getting to know each other in inter- / intraprofessional collaboration), 2. Having overcome the exceptional situation in retrospect (Maintaining personal contacts; Gaining new knowledge and perspectives; Taking what has been learned into the future). The participants rated the interprofessional and intraprofessional collaboration as good to very good. Conclusions: Factors promoting collaboration and positive experiences are to be incorporated into everyday work. The intraprofessional management team thereby defines common goals and values for the best possible patient care.

Comparison of the Zurich Observation Pain Assessment with the Behavioural Pain Scale and the Critical Care Pain Observation Tool in nonverbal patients in the intensive care unit: A prospective observational study.

OBJECTIVES: To determine the concordance of Zurich Observation Pain Assessment (ZOPA) with the behavioural Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT) to detect pain in nonverbal ICU patients. DESIGN: Prospective observational study [BASEC-Nr. PB_2016-02324]. SETTING: A total of 49 ICU patients from cardiovascular, visceral and thoracic surgery and neurology and neurosurgery were recruited. Data from 24 patients were analyzed. MAIN OUTCOME MEASUREMENTS: Three independent observers assessed pain with the BPS, the CPOT or ZOPA prior, during and after a potential painful nursing intervention. Tools were randomized concerning the pain management after each pain assessment. Frequency of nine additional pain indicating items from a previous qualitative, explorative study was calculated. RESULTS: ZOPA was positive in 32 of 33 measuring cycles (97.0%; 95%CI: 84.2-99.9%), followed by the CPOT (28/33 cycles, 84.8%; 95%CI: 68.1-94.9%) and the BPS (23/33 cycles, 67.0%; 95%CI: 51.3-84.4%). In 22/33 cycles all tools were concordant (66.7%; 95%CI: 48.2-82.0%). Analgesics were provided in 29 out of 33 cycles (87.9%; 95%CI: 71.8-96.6%). Additional pain indicating items were inconsistently reported. CONCLUSION: ZOPA is concordant with the BPS and the CPOT to indicate pain but detects pain earlier due to the low threshold value. Inclusion of further items does not improve pain assessment.

Wann und wie berücksichtigen Intensivpflegende Schmerz im Behandlungsprozess von Patientinnen und Patienten auf der Intensivstation? - Eine qualitative Studie.

When and how do intensive care nurses consider pain in the treatment process of ICU patients? A qualitative study Abstract. Background: Pain management is important in the therapeutic spectrum of the intensive care unit. However, guideline recommendations are not consistently implemented. Strategies in clinical reasoning and decision-making regarding pain are hardly described. AIM: Guided by the question "When and how do intensive care nurses consider pain in the treatment process of patients with impaired consciousness and cognition?", we wanted to explore their patterns of thought and decision-making in the context of pain management. METHODS: As part of a Mixed Methods research program on pain assessment in nonverbal intensive care patients we performed a secondary analysis of data from the qualitative substudy using qualitative content analysis according to Mayring. RESULTS: Pain plays an important but subordinate role in the treatment process. After vital functions have been initially stabilized, intensive care nurses assess patients' consciousness and cognition in order to receive further information directly from them. Intensive care nurses differentiate between pain, anxiety, stress and discomfort. Their decisions are based on experience and intuition. CONCLUSIONS: Education promotes intensive care nurses' knowledge and awareness in pain management. Observational pain assessment instruments provide valid information. They support an analytical approach and thus the development of competence in clinical reasoning and decision-making.

[End-of-Life Care in Intensive Care Units: Nursing strategies of family involvement at the end of life]. / End-of-Life-Care auf der Intensivstation.

Background: Family members of people dying in the intensive care unit (ICU) are exposed to many stress factors and they often do not experience involvement in End-of-Life (EoL) situations. For example, they criticize a low degree of participation in patients care, delayed or incomplete information and lack of privacy. Even nursing staff is facing various obstacles in EoL situations in ICUs. Aim: This study investigates strategies used by ICU nursing staff in German-speaking Switzerland to increase family members participation in situations at the end of life. Method: Data was collected by conducting 12 semi-structured interviews using an approach based on Grounded Theory. A model was developed to explain nursing strategies for family involvement in EoL situations in the ICU. Conclusions: Nurses provide personal space and tranquillity for family members and allow them to be present at any time. Against this background, they support family members and enable them to say goodbye consciously to a loved one. Subsequent work should examine the effectiveness of the strategies described, particularly in terms of stress reactions displayed by family members in the aftermath of EoL situations. In practice, family members should be provided space for privacy. The entire healthcare team is recommended to identify and pursue common values and objectives. Moreover, intradisciplinary exchange and mentoring need to be encouraged. In order to prepare future nursing staff for EoL situations in the ICU, recognizing and promoting their educational skills is mandatory.

Safe swallowing and communicating for ventilated intensive care patients with tracheostoma: implementation of the Passy Muir speaking valve / Sicheres Sprechen und Schlucken bei tracheotomierten, beatmeten Patientinnen und Patienten auf der Intensivstation: Implementierung des Passy Muir Sprechventils

Background: Between 4 to 45 % of intensive care patients suffer from prolonged ventilator dependence. Due to impeded weaning, verbal communication is impossible. The tracheal cannula affects breathing and swallowing. The Passy Muir speaking valve (PMV) allows patients on ventilators to speak. It counteracts pharyngeal as well as laryngeal desensitization and prevents an insufficient swallowing reflex. Aim and methods: To implement the PMV, we conducted a multiprofessional practice- and quality development project. The objective was to ensure safe swallowing and communicating for ventilated patients with tracheostoma. Results: Intensive care nurses, doctors and physiotherapists assessed patient safety as being high. In nine patients with 51 PMV applications, we observed three undesirable events in terms of dyspnea and oxygen desaturation. On one occasion, it was necessary to remove the PMV. Conclusion: A combination of mandatory training for the entire treatment team, presence of two professionals during PMV application, and a newly developed guiding document resulted in a high level of patient safety. By means of PMV, ventilated intensive care patients are able to communicate verbally and to swallow better. Complications can be identified early and solved effectively.

Vibrotactile Sensitivity in Active Touch: Effect of Pressing Force.

An experiment was conducted to study the effects of force produced by active touch on vibrotactile perceptual thresholds. The task consisted in pressing the fingertip against a flat rigid surface that provided either sinusoidal or broadband vibration. Three force levels were considered, ranging from light touch to hard press. Finger contact areas were measured during the experiment, showing positive correlation with the respective applied forces. Significant effects on thresholds were found for vibration type and force level. Moreover, possibly due to the concurrent effect of large (unconstrained) finger contact areas, active pressing forces, and long duration stimuli, the measured perceptual thresholds are considerably lower than what previously reported in the literature.

[Standardized impartial assessment of pain in unconscious patients with the Zurich Observation Pain Assessment on a neurosurgical intensive care unit - a case report]. / Die standardisierte Fremdeinschätzung von Schmerzen bei bewusstseinsbeeinträchtigten Patienten mit dem Zurich Observation Pain Assessment (ZOPA©) auf einer neurochirurgischen Intensivstation - Eine Fallstudie.

BACKGROUND: International studies show that the majority of patients undergoing treatment in ICUs report moderate to strong levels of pain. It has been established that undetected or insufficiently treated pain can cause severe physical and emotional distress. Therefore, early and effective pain assessment is a primary treatment goal of intensive care, which is a challenge with patients having cognitive impairment. AIM: This article shows how using the Zurich Observation Pain Assessment (ZOPA(©)) as part of a standardized assessment can close this gap. METHOD: An interpretive single case study evaluates the use of ZOPA(©) in nursing practice and its influence on pain management. RESULTS: The study case involved an intensive care patient with a severe subarachnoid haemorrhage for whom a total of 126 single ZOPA(©) assessments were analyzed. A total of 19 assessments showed behavioral characteristics indicative of pain. Immediate interventions to alleviate pain were taken in three quarters of these assessments. The study ICU has used ZOPA(©) for the past five years. This unit has a standard medication procedure, so nurses can administer analgesics on an "as needed" basis and take their responsibility in implementing pain management. CONCLUSION: This study supports the finding that ZOPA(©) can contribute to early and effective detection of pain in cognitively impaired patients, resulting in improved pain treatment.