How to Achieve Highly Professional Care in the Postoperative Ward: The Care of Infants and Toddlers.

PURPOSE: The purpose of this study was to describe the experiences of critical care nurses (CCNs) and registered nurse anesthetists (RNAs) when monitoring and observing infants and toddlers recovering from anesthesia. DESIGN: A qualitative design with a critical incident approach. METHODS: Semistructured individual interviews were conducted with a purposeful sample of CCNs and RNAs (n = 17) from postanesthesia care units at two hospitals. The critical incident technique approach was used to guide the interviews, and data were analyzed inductively using thematic analysis. FINDINGS: The main finding was the CCNs' and RNAs' description of how they "watch over the children and stay close" to provide emotional and physical safety. CCNs' and RNAs' experiences of observing and managing the children's small, immature airways were reflected in the theme "using situation awareness of the small, immature airways." The theme "understanding emergence agitation" describes the challenge that arises when children are anxious, feel insecure, and have pain, and the theme "having parents nearby" shows the necessity and value of involving parents in their children's care. CONCLUSIONS: Findings from this study suggest that caring for infants and toddlers recovering from anesthesia requires experience and both technical and nontechnical skills. These are prerequisites for achieving readiness for planning, setting priorities, and adapting one's behavior if an adverse event occurs. Alertness and the ability to solve acute problems and make quick decisions are essential because of the risks associated with children's small, immature airways, as is the ability to understand and respond to emergence agitation. Having parents nearby is equally important for creating the conditions for compassionate child- and family-centered care.

Family member perspectives on intensive care unit in-person visiting restrictions during the COVID-19 pandemic: A qualitative study.

BACKGROUND: Family member presence in the intensive care unit is important for patient well-being and recovery. Limitations to visits increase the risk of psychological distress in family members. During the COVID-19 pandemic, in-person visiting restrictions were introduced to prevent the spread of infection. PURPOSE: To explore the experience of in-person visiting restrictions imposed during the pandemic on family members of patients with COVID-19 admitted to an intensive care unit. METHOD: Qualitative method with thematic analysis. Individual semi-structured telephone interviews were conducted. FINDINGS: We interviewed 21 family members. The results are presented in one overall theme with two main themes and five sub-themes. The theme 'Striving for closeness even at a distance describes the experience of being kept at a physical distance when participants needed closeness the most. Even participants who were allowed in-person visits perceived a 'distance' due to personal protective equipment or because they could only view the patient from a window. Participants reported that contact with and information about the patient was of utmost importance. Visits were viewed as essential in providing for the patient's wellbeing. Meaningful contact with the ICU team was vital for getting useful information. Phone calls became a lifeline, with digital aids such as video calls used occasionally to overcome the feeling of distance. CONCLUSION: Visiting restrictions imposed during the COVID-19 pandemic made straightforward and comprehensible communication of information from the ICU team more essential to reduce family members' perceptions of distance and exclusion from the intensive care unit.

Radiographers' experience of preventing patient safety incidents in the context of radiological examinations.

AIM: To describe factors that prevent patient safety incidents in connection with the radiological examination from the radiographer's perspective. BACKGROUND: Radiology plays an important role in the care chain and involves diagnostic examinations and treatments using various radiation sources and different techniques. Risks for patient safety incidents exist in every phase of a radiological examination. Appropriate use of medical imaging requires a multidisciplinary approach involving staff of different categories to meet the medical objectives and the patient's care needs. In accordance with a Safety-II approach, it is therefore important to understand why things go right and ensure that they do by supporting the conditions for right things to happen. DESIGN: A qualitative study with a descriptive design. METHODS: Semi-structured interviews were conducted with 17 radiographers. The data were analysed using theoretical thematic analysis based on the Systems Engineering Initiative for Patient Safety model. RESULTS: The analysis yielded 20 sub-themes, which describe different success factors contributing to patient safety. CONCLUSION: Proactive work should focus on collaboration and sharing the necessary knowledge, internally and externally, for care in connection with the radiological examination. The radiological and peri-radiographic knowledge should include monitoring the patient's safety needs before, during and after the radiological examination. The referring clinician has a central role in writing relevant referrals and the radiographer's competence is crucial in monitoring the patient's safety needs. A good patient safety culture is required and working with standards is important.

Care practices for patients requiring mechanical ventilation more than seven days in Swedish intensive care units: A national survey.

OBJECTIVE: To identify care practices in Swedish intensive care units specific to patients requiring mechanical ventilation for >7 days. RESEARCH METHODOLOGY: We conducted a national cross-sectional survey inviting all adult Swedish ICUs (n = 79). Nurse managers were invited by email to complete a questionnaire by telephone. The questionnaire included seven domains: ventilator weaning, mobilisation, communication, nutrition, symptom assessment, psychosocial support and organisational characteristics. RESULTS: We received responses from 77 units (response rate, 97%). Weaning protocols were available in 42 (55%) units, 52 (68%) used individualised weaning strategies and 50 (65%) involved physicians and nurses in collaborative decision making. In 48 units (62%), early mobilisation was prioritised using bed cycling but only 26 (34%) units had mobilisation protocols. Most of the intensive care units (74, 96%) had nutrition protocols but only 2 (3%) had dedicated dieticians. Delirium screening tools were available in 49 (64%) ICUs, 3 (4%) assessed anxiety and none assessed dyspnoea. Nineteen (25%) units employed a primary nursing model and 11 (14%) indicated person-centred care policies. Regular case conferences, including family participation, were held by 39 (51%) units. CONCLUSION: We found that an individualised approach to ventilator weaning, decided by physicians and nurses in collaboration, was the predominant approach, although weaning protocols were available in some intensive care units. Most units prioritised early mobilisation, though few used protocols. Nutritional protocols were widely adopted, as few units had a dedicated dietician.

Smart Glasses for Anesthesia Care: Initial Focus Group Interviews with Specialized Health Care Professionals.

PURPOSE: Smart glasses are a kind of wearable technology that gives users sustained, hands-free access to data and can transmit and receive information wirelessly. Earlier studies have suggested that smart glasses have the potential to improve patient safety in anesthesia care. Research regarding health care professionals' views of the potential use of smart glasses in anesthesia care is limited. The purpose of this study was to describe anesthesia health care professionals' views of smart glasses before clinical use. DESIGN: A qualitative descriptive study. METHODS: Data were collected from focus group interviews and analyzed using thematic content analysis. FINDINGS: Three categories of participants' views of smart glasses were created during the analysis: views of integrating smart glasses in clinical setting; views of customized functionality of smart glasses; and views of being a user of smart glasses. One theme, striving for situational control, was identified in the analysis. CONCLUSIONS: Smart glasses were seen as a tool that can impact and improve access to patient-related information, and aid health care professionals in their struggle to gain situational control during anesthesia care. These are factors related to increased patient safety.

Prevalence and Intensive Care Bed Use in Subjects on Prolonged Mechanical Ventilation in Swedish ICUs.

BACKGROUND: The number of patients requiring prolonged mechanical ventilation (PMV) is predicted to escalate due to an aging population. International studies on prevalence and resource utilization of this patient group exist, but data are lacking from Scandinavian ICUs, where there is a relatively low number of ICU beds in relation to population. The primary aim was to identify prevalence of admissions requiring mechanical ventilation ≥ 7-21 d and PMV > 21 d, and their use of ICU bed days in Sweden. Secondary aims were to describe patient characteristics and outcomes. METHODS: We obtained data from the Swedish Intensive Care Registry on admissions age ≥ 18 y mechanically ventilated ≥ 7 d and used open source registry data to calculate the prevalence and use of bed days of admissions ventilated ≥ 7-21 d and PMV > 21 d. RESULTS: Of the 39,510 ICU admissions to Swedish ICUs in 2017, those mechanically ventilated ≥ 7-21 d accounted for 1,643 (4%) admissions, and those with PMV > 21 d accounted for 307 (0.8%) admissions. Of the 109,457 ICU bed days, 22% were consumed by admissions ventilated ≥ 7-21 d and 10% by those with PMV > 21 d. The ICU mortality of both groups was 21%. Admissions with mechanical ventilation ≥ 7 d had a median age of 65 y and were predominantly male (64%). CONCLUSIONS: Admissions to Swedish ICUs who required mechanical ventilation ≥ 7-21 d and PMV > 21 d form a relatively small proportion of all ICU admissions, but consume a significant proportion of ICU beds days. Prevalence of admissions, ICU bed days, and ICU mortality were lower than reports from other countries, but the admissions were predominantly elderly and male, in accordance with other reports.

Development and initial psychometric testing of the Intrahospital Transport Safety Scale in intensive care.

OBJECTIVE: To develop and evaluate the psychometric properties of a scale measuring patient safety during the intrahospital transport process for intensive care. DESIGN: The scale was developed based on a theoretical model of the work system and patient safety, and items generated from participant observations. A Delphi study with international experts was used to establish content validity. Next, a cross-sectional study was undertaken to inform item reduction and evaluate construct validity and internal consistency. SETTING: The questionnaire was distributed to healthcare practitioners at 12 intensive care units in Sweden. PARTICIPANTS: A total of 315 questionnaires were completed. Eligible participants were healthcare practitioners in the included units that performed an intrahospital transport during the study period. Inclusion criteria were (1) transports of patients within the hospital to undergo an examination or intervention, and (2) transports performed by staff from the intensive care unit. We excluded transports to a step-down unit or hospital ward. OUTCOME MEASURES: Psychometric evaluation, including item analysis, validity and reliability testing. RESULTS: Items were reduced from 55 to 24, informed by distributional statistics, initial reliabilities, factor loadings and communalities. The final factor model consisted of five factors, accounting for 59% of variance. All items loaded significantly on only one factor (>0.35). The original conceptual model of teamwork, transport-related tasks, tools and technologies, environment, and organisation was maintained with regrouping of items. Cronbach's alpha ranged from 0.72 to 0.82 for each subscale (ie, factor). CONCLUSIONS: The present study provides a self-report questionnaire to assess patient safety during intrahospital transport of patients in intensive care. The results indicate acceptable validity and reliability of the scale among a sample of Swedish healthcare practitioners. If further confirmatory testing supports the present results, this scale could be a useful tool to better understand safety prerequisites and improve clinical practice.

In safe hands: Patients' experiences of intrahospital transport during intensive care.

OBJECTIVES: Intrahospital transports are associated with complications and adverse events in intensive care patients. Yet, little is known about how patients' percive these tranfers. Thus, this study aimed to explore patients' experiences of the intrahospital transport process. RESEARCH DESIGN: An exploratory qualitative study compromising interviews with twelve patients. Data were analysed using thematic analysis. SETTING: Two intensive care units in a university hospital setting. MAIN OUTCOME: An understanding of patients' experiences of the intrahospital transport process. FINDINGS: The main finding was patients' description of "being in safe hands" during the transport. Patients' experience of transports as feasible and safe was reflected in the first main theme, "feeling prepared and safeguarded". The second theme, "being on the move", described patients' perceptions of the transport; although they were aware of movement, the transport was viewed as a minor event during their stay. The third theme, "entrusting myself to others", revealed how patients handed over control and decision making to the staff, confident that they would look after their best interest. CONCLUSIONS: Patients perceived intrahospital transports as an acceptable and safe process. Findings suggest that patients' experience could be improved by being provided with accurate and timely information and preparedness for transport-related events.

Patients prefer clinical handover at the bedside; nurses do not: Evidence from a discrete choice experiment.

BACKGROUND: Shift-to-shift bedside handover is advocated as a patient-centred approach, yet its enactment is challenging. OBJECTIVES: To describe and compare the preferences of both patients and nurses in the implementation of bedside handover in a Swedish University Hospital. DESIGN: A discrete choice experiment (DCE) survey. SETTINGS: University setting, four medical wards in two hospitals. PARTICIPANTS: Adult medical patients (n = 218) and registered nurses (n = 101) METHODS: The survey was administered by an electronic tablet-assisted face-to-face survey. Respondents made repeated choices between two hypothetical bedside handover alternatives and a third alternative of 'handover away from the bedside'. Handover alternatives were described according to six attributes: invitation to participate, number of nurses present at the handover, family member, carer or trusted friend (of the patient) allowed to be present, level of (patient) involvement, what information related to your (patient) care is discussed. Choice data were analyzed using a mixed logit model. RESULTS: A total of 1308 (patients) and 909 (nurses) choice observations were included in the preference models. Patients showed a strong preference for handover at the bedside compared to nurses. Nurses generally preferred handover away from the bedside. Patients perceived their level of involvement in handover as highly important, being able to speak, hear what was said being the most important characteristic, closely followed by being invited to participate and asked questions as well as being heard. Nurses considered patients being invited to participate most important, followed by level of involvement. Different options for handing over sensitive information were not perceived of importance by patients or nurses. There was substantial variation at the individual level across both patients and nurses for where and how handover is delivered. CONCLUSIONS: In this study, patients strongly preferred handover at the bedside, while the nurses considered patients to be invited to participate to be the most important preference but generally preferred handover to take place away from the bedside, all else equal. When implementing bedside handover in a Swedish context this must be considered, although participation is a prerequisite for bedside handover. Differences between patients and nurses' preferences could jeopardize future introduction of bedside handover in Swedish health care, and might explain why bedside handover is still not very common in hospital wards.

Improving quality and safety during intrahospital transport of critically ill patients: A critical incident study.

BACKGROUND: Intrahospital transport is a high-risk procedure for critically ill patients, yet there is little known about how the transport team manages critical incidents that occur. OBJECTIVES: The aim of this study was to explore critical care nurses' and physicians' experiences and practices associated with critical incidents during the transfer process in critically ill patients. METHODS: As a part of an ethnographic study, semistructured interviews were performed using the critical incident technique. Data were collected in two intensive care units at one university hospital in a Swedish metropolitan city. Critical care nurses (n = 15) and physicians (n = 5) were interviewed, together describing a total of 46 critical incidents. Data were analysed using qualitative content and thematic analysis approaches. RESULTS: Content analysis of nurses' and physicians' practices resulted in a description of requirements for safe transports, including organisational prerequisites, professional skills and attributes, as well as actions and behaviours of safely performing transfers. Exploring the experiences of nurses and physicians in transporting critically ill patients yielded three main themes. The first theme, a hazardous process, revealed how caring for critically ill patients during intrahospital transfers was perceived as an unsafe, demanding task that presents several threats to the patient's safety. However, despite worries and concerns, participants trusted their own abilities to handle unexpected events, resulting in the second theme, performing when it matters. The third theme, towards safe practice, captured suggestions for improvement and attitudes towards existing safety hazards. CONCLUSIONS: To prevent and manage critical incidents during intrahospital transport, findings of this study suggest that nontechnical skills such as situational awareness and teamwork are essential. In addition, the team must possess the requisite technical skills and knowledge to undertake transports. Finally, organisations are required to provide a supportive and sustainable transport environment that includes fewer transport-related hazards.

Person-centred care during prolonged weaning from mechanical ventilation, nurses' views: an interview study.

OBJECTIVE: To determine: 1) if the three elements of person-centred care (initiating, working and safeguarding the partnership) were present, and 2) to identify evidence of barriers to person-centred care during prolonged weaning from mechanical ventilation. RESEARCH METHODOLOGY: Secondary analysis of semi structured interviews with 19 critical care nurses using theoretical thematic analysis. SETTING: This study was conducted in three Swedish intensive care units, one in a regional hospital and two in a university hospital. FINDINGS: Three themes and nine subthemes related to person-centred care were identified. The three themes included: 1) 'finding a person behind the patient' related to the 'initiating the partnership' phase, 2) 'striving to restore patient́s sense of control' related to 'working the partnership' phase and 3) 'impact of patient involvement' related to 'safeguarding the partnership' phase of person-centred care'. Additionally a further theme 'barriers to person-centred care' was identified. CONCLUSION: We found evidence of all three person-centred care routines. Barriers to person-centred care comprised of lack team collaboration and resources. Facilitating patients to actively participate in decision-making during the weaning process may optimise weaning outcomes and warrants further research.

Developing and evaluating an instrument to measure Recovery After INtensive care: the RAIN instrument.

BACKGROUND: Measuring and evaluating patients' recovery, following intensive care, is essential for assessing their recovery process. By using a questionnaire, which includes spiritual and existential aspects, possibilities for identifying appropriate nursing care activities may be facilitated. The study describes the development and evaluation of a recovery questionnaire and its validity and reliability. METHODS: A questionnaire consisting of 30 items on a 5-point Likert scale was completed by 169 patients (103 men, 66 women), 18 years or older (m=69, SD 12.5) at 2, 6, 12 or 24 months following discharge from an ICU. An exploratory factor analysis, including a principal component analysis with orthogonal varimax rotation, was conducted. Ten initial items, with loadings below 0.40, were removed. The internal item/scale structure obtained in the principal component analysis was tested in relation to convergent and discrimination validity with a multi-trait analysis. Items consistency and reliability were assessed by Cronbach's alpha and internal item consistency. Test of scale quality, the proportion of missing values and respondents' scoring at maximum and minimum levels were also conducted. RESULTS: A total of 20 items in six factors - forward looking, supporting relations, existential ruminations, revaluation of life, physical and mental strength and need of social support were extracted with eigen values above one. Together, they explained 75% of the variance. The half-scale criterion showed that the proportion of incomplete scale scores ranged from 0% to 4.3%. When testing the scale's ability to differentiate between levels of the assessed concept, we found that the observed range of scale scores covered the theoretical range. Substantial proportions of respondents, who scored at the ceiling for forward looking and supporting relations and at floor for the need of social support, were found. These findings should be further investigated. CONCLUSION: The factor analysis, including discriminant validity and the mean value for the item correlations, was found to be excellent. The RAIN instrument could be used to assess recovery following intensive care. It could provide post-ICU clinics and community/primary healthcare nurses with valuable information on which areas patients may need more support.

Registered Nurses' experiences of patient participation in hospital care: supporting and hindering factors patient participation in care.

BACKGROUND: Promoting patient participation in care is an international priority identified by the World Health Organization and various national bodies around the world and an important aspect of person-centred care. AIM: The aim of this study was to describe Registered Nurses' experiences with patient participation in nursing care including their barriers and facilitators for participation. METHOD: The study setting was a University Hospital in Sweden. Interviews were conducted with twenty Registered Nurses working at medical wards in 2013. Thematic data analysis was used to analyse the transcribed interview data. RESULTS: Twenty nurses from four wards in two hospitals were included. Five themes emerged from the analysis including listening to the patient, engaging the patient, relinquishing some responsibility, sharing power and partnering with patients. The core theme 'partnering with patients' was enacted when nurses listened to and engaged patients and when they relinquished responsibility and shared power with patients. In addition, hindering and facilitating factors to participation were identified, such as patients wanted to take on a passive role, lack of teamwork which participants understood would enhance interprofessional understanding and improve patient safety. Patient participation was hindered by medical jargon during the ward round, there was a risk of staff talking over patients' heads but sometimes inevitable having conversations at the patient's bedside. However, nurses preferred important decisions to be made away from bedside. CONCLUSIONS: It all came down to partnering with the patient and participants described how they made an effort to respect the patients' view and accept patient as a part of the care team. Identified hindering factors for participation were lack of teamwork, patients' taking on passive roles and communication during ward rounds having conversations at the patient's bedside. Nurses wished for a change but lacked strategies on how. Nurses preferred important decisions to be made away from bedside.

Diaries and memories following an ICU stay: a 2-month follow-up study.

BACKGROUND: Many patients lack a clear recollection from their stay in the intensive care unit (ICU). Diaries have been introduced as a tool to complete memories and reduce the risk of posttraumatic stress disorder (PTSD). AIMS: To describe and compare patients' memories and PTSD in relation to having received and read or not received a diary and patients' experiences of having received and read their diary, without having discussed the contents with ICU staff. DESIGN: Descriptive and comparative. METHODS: Patients received their diaries at ICU discharge. After 2 months patients answered the ICU Memory Tool, a screening instrument for PTSD (PTSS-14) and a questionnaire including space for own comments about the diaries. RESULTS: Of 96 patients, 52(54%) received a diary, 44 did not. Patients with diaries had significantly longer stay and more mechanical ventilation. Of these, 40 patients responded to PTSS-14 and had evaluated and read the diary and 34 patients served as controls. No significant differences were found in presence/absence of memories between these groups. In the diary-group patients with emotional memories had lower APACHE. Feelings of being anxious or frightened were more common in the diary-group. At 2 months, 12% scored above cut-off on the PTSS14 with no difference between groups. The diaries were helpful for understanding the ICU-stay. CONCLUSIONS: Diaries seem valuable in understanding what happened, as an act of caring and as a tool for discussion with relatives and friends. Patients valued reading their diaries. None expressed the wish to have read the diary together with a member of staff. The diary and non-diary groups however reported similar memories. RELEVANCE TO CLINICAL PRACTICE: Diaries seem to be valuable in understanding what happened, giving a feeling of trust and for talking about their ICU-stay. As many patients described stressful memories, sessions should be offered with ICU staff.

Evaluation of a sound environment intervention in an ICU: A feasibility study.

BACKGROUND: Currently, it is well known that the sound environment in intensive care units (ICU) is substandard. Therefore, there is a need of interventions investigating possible improvements. Unfortunately, there are many challenges to consider in the design and performance of clinical intervention studies including sound measurements and clinical outcomes. OBJECTIVES: (1) explore whether it is possible to implement a full-scale intervention study in the ICU concerning sound levels and their impact on the development of ICU delirium; (2) discuss methodological challenges and solutions for the forthcoming study; (3) conduct an analysis of the presence of ICU delirium in the study group; and (4) describe the sound pattern in the intervention rooms. METHODS: A quasi-randomized clinical trial design was chosen. The intervention consisted of a refurbished two-bed ICU patient room (experimental) with a new suspended wall-to-wall ceiling and a low frequency absorber. An identical two-bed room (control) remained unchanged. INCLUSION CRITERIA: Patients >18 years old with ICU lengths of stay (LoS) >48h. The final study group consisted of 31 patients: six from the rebuilt experimental room and 25 from the control room. Methodological problems and possible solutions were continuously identified and documented. RESULTS: Undertaking a full-scale intervention study with continuous measurements of acoustic data in an ICU is possible. However, this feasibility study demonstrated some aspects to consider before start. The randomization process and the sound measurement procedure must be developed. Furthermore, proper education and training are needed for determining ICU delirium. CONCLUSION: This study raises a number of points that may be helpful for future complex interventions in an ICU. For a full-scale study to be completed a continuously updated cost calculation is necessary. Furthermore, representatives from the clinic need to be involved in all stages during the project.

Patient preferences for participation in patient care and safety activities in hospitals.

BACKGROUND: Active patient participation is a patient safety priority for health care. Yet, patients and their preferences are less understood. The aim of the study was to explore hospitalised patients' preferences on participation in their care and safety activities in Sweden. METHODS: Exploratory qualitative study. Data were collected over a four-month period in 2013 and 2014. Semi-structured interviews were conducted with 20 patients who were admitted to one of four medical wards at a university hospital in Sweden. Data were analysed using thematic analysis. RESULTS: Nine men and eleven women, whose median age was 72 years (range 22-89), were included in the study. Five themes emerged with the thematic analysis: endorsing participation; understanding enables participation; enacting patient safety by participation; impediments to participation; and the significance of participation. This study demonstrated that patients wanted to be active participants in their care and safety activities by having a voice and being a part of the decision-making process, sharing information and possessing knowledge about their conditions. These factors were all enablers for patient participation. However, a number of barriers hampered participation, such as power imbalances, lack of patient acuity and patient uncertainty. Patients' participation in care and patient safety activities seemed to determine whether patients were feeling safe or ignored. CONCLUSION: This study contributes to the existing literature with fundamental evidence of patients' willingness to participate in care and safety activities. Promoting patient participation begins by understanding the patients' unique preferences and needs for care, establishing a good relationship and paying attention to each patient's ability to participate despite their illness.

Safety Hazards During Intrahospital Transport: A Prospective Observational Study.

OBJECTIVE: To identify, classify, and describe safety hazards during the process of intrahospital transport of critically ill patients. DESIGN: A prospective observational study. Data from participant observations of the intrahospital transport process were collected over a period of 3 months. SETTING: The study was undertaken at two ICUs in one university hospital. PATIENTS: Critically ill patients transported within the hospital by critical care nurses, unlicensed nurses, and physicians. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Content analysis was performed using deductive and inductive approaches. We detected a total of 365 safety hazards (median, 7; interquartile range, 4-10) during 51 intrahospital transports of critically ill patients, 80% of whom were mechanically ventilated. The majority of detected safety hazards were assessed as increasing the risk of harm, compromising patient safety (n = 204). Using the System Engineering Initiative for Patient Safety, we identified safety hazards related to the work system, as follows: team (n = 61), tasks (n = 83), tools and technologies (n = 124), environment (n = 48), and organization (n = 49). Inductive analysis provided an in-depth description of those safety hazards, contributing factors, and process-related outcomes. CONCLUSIONS: Findings suggest that intrahospital transport is a hazardous process for critically ill patients. We have identified several factors that may contribute to transport-related adverse events, which will provide the opportunity for the redesign of systems to enhance patient safety.

After discharge home: a qualitative analysis of older ICU patients' experiences and care needs.

Most patients in intensive care units suffer from critical diseases/injuries and are in need of life-saving medical treatment. Recovery after such diseases/injuries may be lengthy and may vary. Little is known about older patients' own assessment of recovery following intensive care. The aim of this study was to explore and describe older patients' experiences of recovery and need of care within 2 months following discharge from hospital after being cared for in an intensive care unit. Fifteen patients 65 years or older, who had received care in an intensive care unit, were telephone-interviewed 2 months following discharge. The interview texts were analysed using qualitative content analysis. Six themes were identified: 'Discharge - a matter of physicians' and nurses' decisions', 'Wanted to go home', 'Feeling well and feeling better, but…', 'Recovered or not, that is the question', 'In need of help from others' and 'In need of care'. Patients trusted in the medical experts' assessment of their condition as regarded hospital discharge, but they also stated that they wanted to go home, as soon as possible, to their own familiar and private environment. Patients did not see the hospital as a place for recovery. Patients claimed that they were used to taking care of themselves within the limits of their strength and energy. If they need help, they first of all turn to family members or relatives. Patients who reported comorbidity did not assess themselves as recovered, while others stated that they had recovered but also suffered from a variety of discomforting symptoms.

Intrahospital transports of critically ill patients: critical care nurses' perceptions.

BACKGROUND: Between 30% and 70% of intrahospital transports is associated with some form of adverse event, compromising patient safety. AIMS: (1) To describe critical care nurses' perceptions of intrahospital transport problems, including the stress associated with transport and their perceived ability to respond appropriately to these problems; (2) to determine if there were associations between problems and responses. DESIGN AND METHODS: This survey was conducted in three intensive care units. Descriptive data and correlations between perceived problems and responses and correlations between perceptions of the problems and ability to respond appropriately were calculated. Results from the open-ended item were categorised. RESULTS: Eighty-six nurses completed the web survey, a response rate of 57%. Two-thirds said their intensive care Units had written transport guidelines, and two-thirds of the transports were performed by nurses without physicians. Circulatory failure was the most frequently perceived problem (4·2 ± 2·8) followed by decreased levels of consciousness (3·5 ± 2·9). Positive correlations between two perceived patient problems, circulatory failure and neurological deterioration and nurses' perceptions of how to respond appropriately to them, were identified. Failure in pulse oximetry and equipment-related problems were positively correlated to nurses' responses. Nurses described the transports as an unsafe and stressful task: 'It's like a marathon race'. CONCLUSION: Nurses report that undertaking transports were a stressful activity, but they perceived transport problems to be an infrequent occurrence. They stated that they respond appropriately to the problem. RELEVANCE TO CLINICAL PRACTICE: Nurses reported they were alert to the potential risks patients face during transport. Because fewer staff remained in the intensive care units, these remaining patients are also at risk during intrahospital transport.

Critical care nurses management of prolonged weaning: an interview study.

BACKGROUND: For most critically ill patients requiring mechanical ventilation in the intensive care unit (ICU) weaning is uncomplicated. For the remainder, weaning is a challenge and may result in further complications and increased risk of mortality. Critical care nurses (CCNs) require substantial knowledge and experience to manage patients experiencing prolonged weaning. AIM: The aim of this study was to explore CCNs approach for management of patients experiencing prolonged weaning in the ICU. DESIGN: A descriptive qualitative design. METHODS: Semi-structured interviews with 19 experienced CCNs were conducted. Data were analysed using content analysis. RESULTS: Participants used various strategies for weaning that were grouped into four categories: individualized planning for the weaning process, assessing patient's capacity, managing the process and team interaction. The overall theme that emerged was: CCNs drive the weaning process using both a patient centred and targeted approach. CONCLUSION: CCNs in these ICUs performed weaning using a patient centred approach to plan, initiate, assess and establish a holistic weaning process. Team collaboration among all health care practitioners was important. CCNs have a key role in prioritizing weaning and driving the process forward. RELEVANCE TO CLINICAL PRACTICE: Closeness to the patient and a key role in management of the mechanical ventilated patient in ICU gives the CCN unique potential to develop and create models and tools for prolonged weaning. These tools, specially designed for patients undergoing prolonged weaning, would give focus on continuous planning, collaborating, managing and evaluation in the process of liberating patients from mechanical ventilation.