[Nursing in anesthesia and intensive care. Safety at the work place--legal implications].
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Humans↗
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Remifentanil.
Remifentanil is a synthetic opioid receptor agonist that was introduced in 1997 for analgesia during general anaesthesia. However, it recently received a license for analgesia and sedation in ventilated intensive care patients and so is now of interest to those working in intensive care.
Analgesics, Opioid↗
An investigation of distress and discontent in various types of nursing.
It has been claimed that nurses in intensive therapy units are prone to high levels of distress and discontent. A questionnaire was designed to assess nurses' reactions to intensive therapy work and thus provide an object check on these claims. Nurses from eight intensive therapy units in England took part in the survey together with comparison groups from two renal units, a medical ward and a surgical ward. High levels of job satisfaction were registered in all the intensive treatment units with very few nurses indicating distress or a wish to leave their job. Some features of the work did attract criticism though, in particular the large fluctuations in work load, the level and adequacy of support, and the sparse amount of feedback given to nurses by senior staff. Much the same pattern was recorded with the medical and surgical nurses, and from one of the renal units. The second renal unit was known to be in a state of crisis at the time and it was predicted that a high level of discontent would be registered there. This proved to be the case and was taken as conformation of the validity of the questionnaire, and also as giving insight into the psycho-social conditions which may foster distress in nurses.
Attitude of Health Personnel↗
Job satisfaction among neonatal nurses.
PURPOSE: The purpose of this study was to understand the job satisfaction of nurses who work in intensive care nurseries. The design used a convenience sample of eight nurses with an average of 11 years of active and current experience as neonatal intensive care nurses. METHOD/DATA COLLECTION: Human rights were protected according to the institutional guidelines. Data collection included semi-structured, intensive face-to-face interviews, observation, and field notes. The interviews were tape recorded and transcribed. Collaizzi's (1978) interpretation method was used to interpret and analyze the data using significant statements, formulated meanings, and clustering. Each participant was allowed to review the typed interview as one means of credibility. RESULTS: Analysis of the described experiences revealed that nurses were able to identify enough satisfying situations that compelled them to continue working in the neonatal intensive care unit (NICU). These rewards included compensation, team spirit, support from physicians, and advocacy. CONCLUSION: Knowledge of the factors that contribute to nurses' job satisfaction can provide a useful framework to implement policies to improve working conditions for nurses.
Adaptation, Psychological↗
Clinical role of rapid-incremental tests in the evaluation of exercise-induced bronchoconstriction.
STUDY OBJECTIVE: To determine whether rapid-incremental work rate (IWR) testing would be as useful as standard high-intensity constant work rate (CWR) protocols in eliciting exercise-induced bronchoconstriction (EIB) in susceptible subjects. DESIGN AND SETTING: A cross-sectional study performed in a clinical laboratory of a tertiary, university-based center. SUBJECTS AND MEASUREMENTS: Fifty-eight subjects (32 males, age range, 9 to 45 years) with suspected EIB were submitted to CWR testing (American Thoracic Society/European Respiratory Society guidelines) and IWR testing on different days; 21 subjects repeated both tests within 4 weeks. Spirometric measurements were obtained 5, 10, 15, and 20 min after exercise; a FEV1 decline > 10% defined EIB. RESULTS: Twenty-seven subjects presented with EIB either after CWR or IWR testing; 21 subjects had EIB in response to both protocols (kappa = 0.78, excellent agreement; p < 0.001). Of the six subjects in whom discordant results were found, two had EIB only after IWR. Assuming CWR as the criterion test, IWR combined high positive and negative predictive values for EIB detection (91.3% and 88.6%, respectively). Tests reproducibility in eliciting EIB were similar (kappa = 0.80 and 0.72 for CWR and IWR, respectively; p < 0.001). Total and intense (minute ventilation > 40% of maximum voluntary ventilation) ventilatory stresses did not differ between EIB-positive and EIB-negative subjects, independent of the test format. There were no significant between-test differences on FEV(1) decline in EIB-positive subjects (25.7 +/- 10.8% vs 23.7 +/- 10.0%, respectively; p > 0.05). Therefore, no correlation was found between exercise ventilatory response and the magnitude of EIB after either test (p > 0.05). CONCLUSIONS: Rapid-incremental protocols (8 to 12 min in duration) can be as useful as high-intensity CWR tests in diagnosing EIB in susceptible subjects. Postexercise spirometry should be performed after incremental cardiopulmonary exercise testing when EIB is clinically suspected.
Adolescent↗
Management of nutrition in European intensive care units: results of a questionnaire. Working Group on Metabolism and Nutrition of the European Society of Intensive Care Medicine.
OBJECTIVE: To describe the practical aspects of nutritional management in intensive care units (ICUs). DESIGN: A 49-item questionnaire was sent to the physician members of the European Society for Intensive Care Medicine. The issues addressed included: medical environment, assessment of nutritional status and current practice for enteral and parenteral nutrition. SETTING: 1608 questionnaires were sent in 35 European countries. ANALYSIS: The answers were pooled and stratified by country. RESULTS: 271 questionnaires were answered (response rate 17%). Assessment of nutritional status was generally based on clinical (99%) and biochemical (82%) parameters rather than on functional (24%), anthropometric (23%), immunological (18%) or questionnaire-based (11%) data. Two thirds of 2774 patients hospitalised in the corresponding ICUs at the time the questionnaire was answered were receiving nutritional support; 58% of those were fed by the enteral route, 23% by the parenteral route and 19% by combined enteral and parenteral. The preferred modality was enteral nutrition, instituted before the 48th h after admission, at a rate based on estimated caloric requirements. Specific and modified solutions were rarely used. Parenteral nutrition was less commonly used than enteral, although the practices differed between countries. It was mainly administered as hospital-made all-in-one solutions, at a rate based on calculated caloric requirements. CONCLUSIONS: European intensivists are concerned by the nutritional management of their patients. The use of nutritional support is common, essentially as early enteral feeding.
Critical Care↗
Intensive care: situations of ethical difficulty.
Twenty enrolled nurses (ENs), 20 registered nurses (RNs) and 20 physicians working in intensive care in northern Sweden narrated 255 stories about their experience of being in ethically difficult care situations. The ENs' stories mainly concerned problems relating to relationship ethics, the stories narrated by the physicians mainly concerned problems relating to action ethics, while the RNs' stories gave equal attention to both kinds of problems. The most common theme of both the RNs' and the physicians' stories was that of too much treatment. An obvious similarity between the ENs, RNs and physicians was that they saw themselves as equally lacking in influence in ethically difficult care situations. The only apparent difference between the three groups, however, was that the ENs brought up relationship problems more often than the others. Thus, the differences between the RNs and the physicians were fewer than usually reported in the literature. This might be related to the specialization of intensive care.
Adult↗
[The practice of intensive care medicine as a stress situation].
A study about the problem of stress in physician who work in intensive care units requires a previous reflection about the stress concept itself. Selye's conception undoubtedly signified a great progress for the comprehension of the processes of biological adaptation, but it seems it can not be easily applied to the psychological and social field. The decrease of psychosomatic diseases during the last world war is one of the many examples that make question the causal relationship between stress and disease. The concept of life event in anglo-saxon psychiatry is also discussed, as well as its attempt to measure the stressor character of these circumstances through a scale of points. The concept of "pathogenic situation" of German psychiatry is proposed in exchange. From this perspective, medicine in general and intensive medicine in particular can be seen as human activities constituting "pathogenic situations" for the ones who exercise them. The corresponding literature allows to establish that medicine generates more pathology in physicians than other professions, but intensive medicine does not seem to be more pathogenic than other specialties. The elements of the "medical act" which could be responsible for the stress or pathogenic situation are studied. Respecting intensive medicine, two are the characteristics which seem to contribute to make it "pathogenic" for those who exercise it: a mistaken vision of death as an "enemy" which has to be fought à outrance, and the "temporality of urgency", proper to an ICU, which makes that the doctor can not give himself time enough for listening to the patient and telling him the adequate word of consolation.
Adaptation, Psychological↗
Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain.
STUDY DESIGN: A prospective clinical randomized controlled trial. OBJECTIVES: To determine the long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic and recurrent low back pain (LBP). SUMMARY OF BACKGROUND DATA: There is agreement on the importance of exercise during the course of chronic LBP. However, it is well known that long-term adherence with exercises is particularly low. METHODS: A total of 93 patients with LBP were randomly assigned to the control group (standard exercise program) or the motivational group (combined exercise and motivational program). Follow-up assessments were performed at 3.5 weeks, 4 months, 12 months, and 5 years. Main outcome measures were disability scores, pain intensity, and working ability. In addition to classic statistics, the sophisticated linear partial credit model was used to test the effects of treatment on disability scores. RESULTS: In both groups, significant improvements in the disability scores were found at all points of follow-up assessment, however, the cumulative effect of the treatment in the motivational group was more than twice as much as in the control group. This result is in accordance with the increasing divergence in pain intensity between groups between 12 months and 5 years after intervention. A significant, positive long-term effect at the 5-year reassessment in working ability was only seen in the motivational group. All statistically significant results were confirmed by intention-to-treat analyses. CONCLUSIONS: Regarding long-term efficacy, the combined exercise and motivation program was superior to the standard exercise program. Five years after the supervised combined exercise and motivational program, patients had significant improvements in disability, pain intensity, and working ability.
Chronic Disease↗
Injuries in home health care workers: an analysis of occupational morbidity from a state compensation database.
BACKGROUND: Home health services represent one of the fastest-growing segments of the US economy. Home health care workers (HHCWs) might be expected to have a high incidence and increased severity of injury because of inherent difficulty in control over their work environment, and the limited amount of research on injuries in home health care appears to support this hypothesis. METHODS: Using data on workers' compensation claims for 1995-1996 from a large state database, we calculated the incidence, frequency, and types of injuries occurring in this working population. Comparison data were drawn from nursing home (NH) and hospital-based nursing personnel. RESULTS: An incidence of 52 injuries per 1,000 workers per year was calculated; this rate lies between nursing home workers (132/1,000) and hospital-based workers (46/1,000). The percentage of indemnified (> 3 days lost-time) injuries was increased over those occurring in nursing home personnel. Mean number of days lost from work by home health workers was 44, significantly increased from the average 18 and 14 days lost by NH and hospital nursing workers, respectively. Mean indemnity payment was $1,523 and mean medical costs were $1,276 per injury. Permanent partial disability awards were made to 19 (4.9%) of the injured HHCWs during the 2-year study period; back injuries accounted for 63% (12) of these awards. Overexertion injuries and falls accounted for 63% of total injuries in this group of workers, while 13.5% occurred as a result of motor vehicle accidents. The incidence of injury attributed to motor vehicles in HHCWs was 7 per 1,000 workers per year, an order of magnitude greater than in NH and hospital workers. CONCLUSIONS: These data indicate that injuries to HHCWs, though less frequent than in their nursing home counterparts, result in greater lost time from work and accompanying costs, which may indicate greater severity of injury. Characteristics of home health work, including increased intensity and speed of work, adverse working conditions, and the necessity of motor vehicle transportation as a condition of work may be contributors to injury in this setting. Further investigation of determinants of accidents and injuries in home health care, both in the actual setting where the work takes place and in the way it is structured, is warranted.
Accidents, Occupational↗
Glutathione S-transferases and cytochrome P450 detoxifying enzyme distribution in human cerebral glioma.
Malignant astrocytomas are frequently resistant to cytotoxic chemotherapy. A possible mechanism of chemoresistance is drug inactivation within malignant astrocytes by detoxifying enzymes (glutathione transferases (GST) and cytochrome P450's). The aim of this study was to assess whether there was differential expression of these detoxifying enzymes in the central nervous system and any relationship to histological grade (WHO) of the tumours. Immunostaining was performed in 30 consecutive glioma samples, using class specific polyclonal antibodies to subtypes of GST (pi, alpha, mu) and to human cytochrome P450 reductase. GST immunostaining was evident in astrocytes and endothelium but not neurones or oligodendrocytes in normal brain. Immunostaining for GST increased in intensity from well differentiated tumours to glioblastoma. Staining was least evident in surrounding normal brain, strong in reactive astrocytes and astrocytic tumour cells and very intense in gemistocytic and giant tumour cells. Small anaplastic tumour cells had very little GST staining. Where endothelial proliferation was evident, GST staining in endothelial cells was increased. Pi was always the predominant subclass, although GST alpha and mu were also expressed in some tumours. Cytochrome P450 reductase immunostaining was present in normal neurones and malignant astrocytes. Gemistocytic astrocytic tumour cells stained intensely. Further work is necessary to see if there is any correlation between immunostaining intensity survival or response to chemotherapy.
Astrocytes↗
Atmospheric baseline levels of PCDD and PCDF in the region of Oporto.
An external monitoring plan (EMP) is being implemented in the region of Oporto, Portugal, to follow the potential effects of a future incinerator of municipal solid waste. Polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/PCDF) were measured during 1998 and the first semester of 1999, prior to the working up of the incineration unit. The baseline levels obtained through this intensive monitoring work are presented and discussed in the present paper.
Air Pollutants↗
Collecting data in the operating department: issues in observational methodology.
The UK literature contains few references to nursing in the operating department and even fewer to methods for researching nursing in what is often a complex and stressful environment. Nursing staff work under intense pressure and this presents a challenge, not only for nurses who work in the operating department, but also for researchers who choose to study nursing within its bounds. This paper focuses on some of the key issues which emerged during one study of nursing in the operating department where an observational methodology was used. The author suggests that observation, as a research method, is an important feature of contextual investigation. However, like other methods of investigation, it requires careful planning and preparation. Furthermore, the author believes that sensitivity and skill are required for the enactment of the observer role when researching nursing within this specialized environment.
Data Collection↗
Enhancing the health professional's role in requesting transplant organs.
The shortfall in organs for transplant continues in the UK. To address this problem, methods of organ procurement are continuously widening with the recent development of protocols in elective ventilation and non-heart beating donors. Until recently, the nurse's role in the success of organ procurement was largely limited to those working in intensive care units involved in cadaveric transplant and community-based nurses working with patients on kidney dialysis who may become involved with live related transplant. Involvement in organ procurement has now extended to nurses working in general wards and accident and emergency centres. It is imperative that health professionals are aware of the large numbers of patients for whom donors have not been found. They need to be aware of the possible reasons which deter relatives from giving consent for potential donors and prevent relatives themselves from becoming potential live donors. Those who are involved in the organ request process need to be alerted to the factors that affect the decision to give consent. It is hoped that these efforts will help to reduce the drastic shortage of available organs for transplant in the UK.
Family↗
Mental ability and psychological work performance in Chinese workers.
This study was to explore the relationship among mental ability, occupational stress, and psychological work performance in Chinese workers, and to identify relevant modifiers of mental ability and psychological work performance. Psychological Stress Intensity (PSI), psychological work performance, and mental ability (Mental Function Index, MFI) were determined among 485 Chinese workers (aged 33 to 62 yr, 65% of men) with varied work occupations. Occupational Stress Questionnaire (OSQ) and mental ability with 3 tests (including immediate memory, digit span, and cipher decoding) were used. The relationship between mental ability and psychological work performance was analyzed with multiple linear regression approach. PSI, MFI, or psychological work performance were significantly different among different work types and educational level groups (p<0.01). Multiple linear regression analysis showed that MFI was significantly related to gender, age, educational level, and work type. Higher MFI and lower PSI predicted a better psychological work performance, even after adjusted for gender, age, educational level, and work type. The study suggests that occupational stress and low mental ability are important predictors for poor psychological work performance, which is modified by both gender and educational level.
Adult↗
Utilization of working time by nurses in intensive cardiological care units.
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Cardiac Care Facilities↗
Nursing perspectives for intensive care.
Within health care, market forces increasingly determine what services have economic value. For nursing to survive this economic onslaught, nurses must clarify their values and roles. While nurses working in intensive care develop useful technical skills and normally work within a constructive multi-disciplinary team framework, they have a potentially unique contribution to care, focusing on the patient as a whole person rather than intervening to solve a problem. The need for both physiological and psychological care creates a need for holistic values, best achieved through humanistic perspectives. Humanistic nursing places patients as people at the centre of nursing care, as illustrated by the limitations of reality orientation compared with the potentials of validation therapy. Intensive care nurses asserting and developing such patient-centred roles offer a valuable way forward for nursing to develop into the 21st century.
Attitude to Health↗
Prediction of success from a multidisciplinary treatment program for chronic low back pain.
STUDY DESIGN: The study included 90 disabled patients with chronic low back pain recruited from a pain clinic who were admitted to an 8-week program of functional restoration and behavioral support. Initial evaluations included a medical examination, rating of the physical impairment, a personal interview, a visual analogue scale to record pain intensity, an assessment of limitations for daily activities, a pain disability index, a depression and psychovegetative scale, and a scale to evaluate general living standards. The physical assessment included different flexibility measurements, measurement of power and endurance through standardized exercises, and measurements of isokinetic trunk and lifting strength and general endurance. The measurements were repeated at the end of the 8-week program and thereafter an intervals of 6 and 12 months. Final analyses were carried out on 82 patients. OBJECTIVES: To determine whether objective or subjective signs most influence the outcome of rehabilitation. SUMMARY OF BACKGROUND DATA: In recent years, several studies have shown that active and intensive multimodal treatment of chronic low back pain is successful. Until now there has been lack of information about which patients will respond to the therapy and what is the most effective part of treatment. METHODS: Prognostic factors (return to work, pain intensity, self-assessment of treatment success by patients) were tested by studying variance and regression analyses for their ability to predict treatment outcome. RESULTS: Certain factors were identified that had a significant impact on determining the probability of a patient's return to work and the reduction of pain intensity. These factors included self-evaluation for predicting a return to work, the length of absence from work, application for pension, and a decrease is disability after treatment. Overall satisfaction with treatment was best determined by the number of medical consultations before treatment, the extent of disability, previous measures taken for coping with the disease, and reduction of disability during treatment. Medical background, medical diagnosis, and physical impairment had no predictive value. Physical variables (i.e., mobility, strength, endurance, and physical performance) also demonstrated only limited predictive value. CONCLUSION: This study has demonstrated that the most important variable in determining a successful treatment of chronic low back pain is the reduction of subjective feelings of disability in patients.
Adult↗