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Title: INTENSIVE CARE IN ONCOLOGY: ADMISSION AND OUTCOMES IN ADULT PATIENTS WITH CANCER.
Creator: John, Surya, Loerzel, Victoria, University of Central Florida
Abstract / Description: Background: Historically, patients with cancer have been perceived as poor candidates for ICU admission. General ICU admission criteria lists cancer patients as low priority in ICU admission depriving them of the care they rightfully deserve. The purpose of this literary synthesis was to examine ICU admission criteria, risk factors, and outcomes of ICU admission in relation to hematological and solid tumor cancers and discuss ways that practitioners and nurses can educate patients with cancer...
Show moreBackground: Historically, patients with cancer have been perceived as poor candidates for ICU admission. General ICU admission criteria lists cancer patients as low priority in ICU admission depriving them of the care they rightfully deserve. The purpose of this literary synthesis was to examine ICU admission criteria, risk factors, and outcomes of ICU admission in relation to hematological and solid tumor cancers and discuss ways that practitioners and nurses can educate patients with cancer and their families on appropriateness of ICU care. Methods: A total of 768 articles were found in a literature search including all literature from 2005 to 2016 from all countries using the databases CINAHL Plus, MEDLINE, PsycINFO, and Academic Search Premier. These were further narrowed down based on relevancy by topic or reading abstracts. A total of 13 articles utilizing the inclusion and exclusion criteria of the literature search were included in the final literature synthesis. Results: In addition to general ICU admission criteria several other criteria and scores can be helpful in admitting patients with cancer to the ICU including cancer specific criteria, mortality predictor tools, performance status, and ICU trials. Mortality predictors, in combination with other patient characteristics, demonstrated effectiveness to predict outcomes in patients with cancer. Survival rates in hematological and solid tumor cancers have improved from the past, and lower prognostic scores can predict who will have better outcomes. Conclusion: Cancer specific criteria, mortality predictor tools, performance status, and ICU trials in addition to general ICU criteria should be used for admission of cancer patients into ICU. Practitioners and nurses should become familiar with the newest outcomes in patients with cancer to make collaborative informed decisions about ICU admission.
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Date Issued: 2016
Identifier: CFH2000093, ucf:45522
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000093

Title: THE EFFICACY OF NON-PHARMACOLOGICAL PAIN MANAGEMENT METHODS AMONGST PREMATURE NEONATES IN THE NEONATAL INTENSIVE CARE UNIT (NICU).
Creator: Martinez, Hannah R, D'Amato-Kubiet, Leslee, University of Central Florida
Abstract / Description: The purpose of this study was to conduct an integrated review of the literature examining the use of non-pharmacologic pain management strategies in premature neonates and to explore the relationship between health outcomes and time to discharge from the neonatal intensive care unit (NICU). Non-pharmacologic pain management strategies include human touch, facilitated tucking, non-nutritive sucking, and kangaroo care. A systematic review of the literature was conducted from multiple online...
Show moreThe purpose of this study was to conduct an integrated review of the literature examining the use of non-pharmacologic pain management strategies in premature neonates and to explore the relationship between health outcomes and time to discharge from the neonatal intensive care unit (NICU). Non-pharmacologic pain management strategies include human touch, facilitated tucking, non-nutritive sucking, and kangaroo care. A systematic review of the literature was conducted from multiple online databases. Peer reviewed, English-language articles containing the keywords 'pain management', 'neonatal intensive care unit', and 'non-pharmacologic' were included for synthesis. Exclusion criteria included articles with a focus on infants not admitted to the NICU and infants with a gestational age greater than 37 weeks. Results revealed positive outcomes when alternative pain-relieving methods, rather than drug therapy, were used in the NICU. A majority of articles suggest facilitated tucking is very successful in lowering a preterm infant's pain. However, facilitated tucking alone was significantly less effective in relieving procedural pain compared to facilitated tucking in combination with oral sucrose administration. Kangaroo care and gentle human touch also proved to reduce physiologic and behavioral signs of pain in neonates. The literature reveled an overall positive outcome when non-pharmacologic pain interventions are used in the NICU, with some behavioral interventions showing better efficacy than others at relieving neonatal pain. None of the reviewed articles explored the relationship between reduced length of stay and parameters assessing health outcomes based on pain control in neonates. The literature indicated nurses play a significant role in the use of pain-relieving methods in neonatal populations. Implications for future research that focuses on successful behavioral based pain management strategies that assists in refining neonatal pain relief would be of great benefit to improving health outcomes related to infant survival after discharge from the NICU.
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Date Issued: 2016
Identifier: CFH2000079, ucf:45503
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000079

Title: The Development and Testing of a Measurement System to Assess Intensive Care Unit Team Performance.
Creator: Dietz, Aaron, Salas, Eduardo, Jentsch, Florian, Sims, Valerie, Rosen, Michael, Burke, Shawn, University of Central Florida
Abstract / Description: Teamwork is essential for ensuring the quality and safety of healthcare delivery in the intensive care unit (ICU). Complex procedures are conducted with a diverse team of clinicians with unique roles and responsibilities. Information about care plans and goals must also be developed, communicated, and coordinated across multiple disciplines and transferred effectively between shifts and personnel. The intricacies of routine care are compounded during emergency events, which require ICU teams...
Show moreTeamwork is essential for ensuring the quality and safety of healthcare delivery in the intensive care unit (ICU). Complex procedures are conducted with a diverse team of clinicians with unique roles and responsibilities. Information about care plans and goals must also be developed, communicated, and coordinated across multiple disciplines and transferred effectively between shifts and personnel. The intricacies of routine care are compounded during emergency events, which require ICU teams to adapt to rapidly changing patient conditions while facing intense time pressure and conditional stress. Realities such as these emphasize the need for teamwork skills in the ICU. The measurement of teamwork serves a number of different purposes, including routine assessment, directing feedback, and evaluating the impact of improvement initiatives. Yet no behavioral marker system exists in critical care for quantifying teamwork across multiple task types. This study contributes to the state of science and practice in critical care by taking a (1) theory-driven, (2) context-driven, and (3) psychometrically-driven approach to the development of a teamwork measure. The development of the marker system for the current study considered the state of science and practice surrounding teamwork in critical care, the application of behavioral marker systems across the healthcare community, and interviews with front line clinicians. The ICU behavioral marker system covers four core teamwork dimensions especially relevant to critical care teams: Communication, Leadership, Backup and Supportive Behavior, and Team Decision Making, with each dimension subsuming other relevant subdimensions. This study provided an initial assessment of the reliability and validity of the marker system by focusing on a subset of teamwork competencies relevant to subset of team tasks. Two raters scored the performance of 50 teams along six subdimensions during rounds (n=25) and handoffs (n=25). In addition to calculating traditional forms of reliability evidence [intraclass correlations (ICCs) and percent agreement], this study modeled the systematic variance in ratings associated with raters, instances of teamwork, subdimensions, and tasks by applying generalizability (G) theory. G theory was also employed to provide evidence that the marker system adequately distinguishes teamwork competencies targeted for measurement. The marker system differentiated teamwork subdimensions when the data for rounds and handoffs were combined and when the data were examined separately by task (G coefficient greater than 0.80). Additionally, variance associated with instances of teamwork, subdimensions, and their interaction constituted the greatest proportion of variance in scores while variance associated with rater and task effects were minimal. That said, there remained a large percentage of residual error across analyses. Single measures ICCs were fair to good when the data for rounds and handoffs were combined depending on the competency assessed (0.52 to 0.74). The ICCs ranged from fair to good when only examining handoffs (0.47 to 0.69) and fair to excellent when only considering rounds (0.53 to 0.79). Average measures ICCs were always greater than single measures for each analysis, ranging from good to excellent (overall: 0.69 to 0.85, handoffs: 0.64 to 0.81, rounds: 0.70 to 0.89). In general, the percent of overall agreement was substandard, ranging from 0.44 to 0.80 across each task analysis. The percentage of scores within a single point, however, was nearly perfect, ranging from 0.80 to 1.00 for rounds and handoffs, handoffs, and rounds. The confluence of evidence supported the expectation that the marker system differentiates among teamwork subdmensions. Yet different reliability indices suggested varying levels of confidence in rater consistency depending on the teamwork competency that was measured. Because this study applied a psychometric approach, areas for future development and testing to redress these issues were identified. There also is a need to assess the viability of this tool in other research contexts to evaluate its generalizability in places with different norms and organizational policies as well as for different tasks that emphasize different teamwork skills. Further, it is important to increase the number of users able to make assessments through low-cost, easily accessible rater training and guidance materials. Particular emphasis should be given to areas where rater reliability was less than ideal. This would allow future researchers to evaluate team performance, provide developmental feedback, and determine the impact of future teamwork improvement initiatives.
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Date Issued: 2014
Identifier: CFE0005482, ucf:50356
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005482

Title: ORAL HYGIENE PRACTICES IN NON-VENTILATED INTENSIVE CARE UNIT PATIENTS.
Creator: Emery, Kimberly P, Guido-Sanz, Francisco, University of Central Florida
Abstract / Description: Introduction: Oral hygiene is a significant aspect of nursing care. Endocarditis, stroke, lung cancer, and hypertension have been associated with poor oral hygiene. Research exploring oral care practices for mechanically ventilated patients is well documented. In contrast, oral hygiene for the non-mechanically ventilated acute care population remains underestimated. The purpose of this study was to establish a baseline of the type, frequency, and consistency of oral hygiene being performed on...
Show moreIntroduction: Oral hygiene is a significant aspect of nursing care. Endocarditis, stroke, lung cancer, and hypertension have been associated with poor oral hygiene. Research exploring oral care practices for mechanically ventilated patients is well documented. In contrast, oral hygiene for the non-mechanically ventilated acute care population remains underestimated. The purpose of this study was to establish a baseline of the type, frequency, and consistency of oral hygiene being performed on non-mechanically ventilated ICU patients and explore how the oral care provided was documented. Methodology: A literature search was conducted and reported as a literature review. The databases CINAHL Plus with Full Text, MEDLINE, PsychINFO, Academic Search Premier, and Cochrane Database of Systematic Reviews were searched. Key terms used were "oral hygiene," "oral care," "oral intensity," "mouth rinse," "mouth care," chlorhexidine rinse and ICU, "intensive care unit," "critical care" and infection*, pneumonia*, NV, non-ventilat*, and nonventilat*. The articles' selection addressed type, frequency, consistency, and/or documentation of oral hygiene in ICU patients, particularly non-mechanically ventilated patients, if available. Inclusion criteria consisted of English language, and academic journal articles. No specified publication date was placed as a restriction. The results were limited to English language, academic journal articles, peer reviewed research articles, evidence-based articles or practices, and articles published within the last ten years (2006 to 2016). All articles on oral hygiene practices in the ICU or critical care population were included. Articles that did not relate to oral hygiene practices in acute care, ICU patients, or critically ill hospitalized patients were excluded. Articles focused solely on the mechanically ventilated or intubated population were also excluded. Results: The review yielded very few articles focusing solely on non-mechanically ventilated ICU patients. Nevertheless, resulting data showed four areas common to oral hygiene practices in non-mechanically ventilated patients in the ICU: type of documentation, type of products, frequency of care, and personnel providing care. Documentation was found to be lacking compared to personnel's self-reported frequency of oral care. Oral hygiene products were found to be consistent in non-mechanically ventilated patients, while there was no consistency of products used in the general acute care population. Oral hygiene was self-reported by staff members to have been performed an average of two to three times per day for non-mechanically ventilated patients. Oral hygiene self-reported frequency was found to be inconsistent among the general acute care population. Lastly, registered nurses (RNs) were the primary providers of oral hygiene to patients. Conclusions: Findings support the existing gap in the literature on oral hygiene practices in non-mechanically ventilated patients in the ICU. Despite evidence documenting the impact of oral hygiene on health, further research is guaranteed.
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Date Issued: 2017
Identifier: CFH2000156, ucf:46036
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000156

Title: THE EFFECTS OF KANGAROO CARE ON THE NEURODEVELOPMENT OF PRETERM INFANTS IN THE NEONATAL INTENSIVE CARE UNIT (NICU).
Creator: Sarg, Tiffany, Quelly, Susan, University of Central Florida
Abstract / Description: Preterm birth disrupts the development of the brain and other critical organs of the infant body. Since the brain is one of the last organs to finish developing during pregnancy, the risk for substantial neurological deficits increases as the gestational age decreases. One way to combat these deficits is to reconnect the preterm infant with the mother via skin-to-skin contact, also known as kangaroo care (KC). This intimate touch helps to replicate aspects of the environment that the preterm...
Show morePreterm birth disrupts the development of the brain and other critical organs of the infant body. Since the brain is one of the last organs to finish developing during pregnancy, the risk for substantial neurological deficits increases as the gestational age decreases. One way to combat these deficits is to reconnect the preterm infant with the mother via skin-to-skin contact, also known as kangaroo care (KC). This intimate touch helps to replicate aspects of the environment that the preterm infant experienced in utero. The purpose of this literature review was to analyze the current literature to better understand the effects that KC may have on facilitating neurodevelopment of preterm infants in Neonatal Intensive Care Units (NICUs). Emphasis was placed on neurophysiologic functioning, autonomic functioning, and neurobehavioral functioning. A database search of CINAHL Plus with Full Text, PsycINFO, MEDLINE, Cochrane Central Register of Controlled Trials, and Health Source: Nursing/Academic Edition was conducted, and a total of six articles were reviewed based on their relevance and application towards this thesis. KC is a low-cost, relatively easy intervention to initiate that can have positive impacts on many aspects of preterm infant growth and maturation. There is limited research regarding the use of KC as an intervention to support neurodevelopment, especially with regards to long-term effects. Existing research supports the use of KC as an intervention to facilitate neurodevelopment in preterm infants in the NICU.
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Date Issued: 2016
Identifier: CFH2000010, ucf:45577
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000010

Title: THE EFFECTS OF AUDITORY STIMULI ON STRESS LEVELS OF ADULT PATIENTS IN THE CRITICAL CARE SETTING.
Creator: Ellermets, Jessica, Heglund, Stephen, University of Central Florida
Abstract / Description: The purpose of this review of literature is to explore the effects of interventional and environmental auditory stimuli on the adult critical care population. Current research has yet to compare and contrast the effectiveness of various interventional auditory stimuli on stress relief, an oversight this thesis aims to remedy. Modern day critical care settings demand the identification of the most therapeutic interventional auditory stimulus and the most stress-inducing environmental stimuli,...
Show moreThe purpose of this review of literature is to explore the effects of interventional and environmental auditory stimuli on the adult critical care population. Current research has yet to compare and contrast the effectiveness of various interventional auditory stimuli on stress relief, an oversight this thesis aims to remedy. Modern day critical care settings demand the identification of the most therapeutic interventional auditory stimulus and the most stress-inducing environmental stimuli, so that interventions can be made to optimize patient stress levels and improve outcomes. Suggestions will be made on how to simultaneously reduce harmful or stress inducing auditory stimuli in the critical care setting and implement the optimal stress-relieving interventional auditory stimuli.
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Date Issued: 2015
Identifier: CFH0004853, ucf:45482
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004853

Title: AN INVESTIGATION OF THE ECONOMIC VIABILITY AND ETHICAL RAMIFICATIONS OF VIDEO SURVEILLANCE IN THE ICU.
Creator: Bagge, Laura, Heglund, Stephen, University of Central Florida
Abstract / Description: The purpose of this review of literature is to investigate the various roles of video surveillance (VS) in the hospital's intensive care unit (ICU) as well as its legal and ethical implications. Today, hospitals spend more money on the ICU than on any other unit. By 2030, the population of those 65 and over is expected to double. 80% of older adults have at least one chronic diseases (Centers for Disease Control and Prevention, 2013). As a consequence, the demand for ICU services will likely...
Show moreThe purpose of this review of literature is to investigate the various roles of video surveillance (VS) in the hospital's intensive care unit (ICU) as well as its legal and ethical implications. Today, hospitals spend more money on the ICU than on any other unit. By 2030, the population of those 65 and over is expected to double. 80% of older adults have at least one chronic diseases (Centers for Disease Control and Prevention, 2013). As a consequence, the demand for ICU services will likely increase, which may burden hospital with additional costs.. Because of increasing economic pressures, more hospitals are using video surveillance to enhance quality care and reduce ICU costs (Goran, 2012). Research shows that VS enhances positive outcomes among patients and best practice compliance among hospital staff. The results are fewer reports of patient complications and days spent in the ICU, and an increase in reported hospital savings. In addition, VS is becoming an important tool for the families of newborns in the neonatal ICU (NICU). The belief is that the VS can facilitate parent-baby bonding. In the United States of America, privacy rights impose legal restrictions on VS. These rights come from the U.S. Constitution, Statutory law, Regulatory law, and State law. HIPPA authorizes the patient to control the use and disclosure of his or her health information. Accordingly, hospitals are under obligation to inform patients on their right to protected health information. It is appropriate that hospitals use VS for diagnostic purposes as long as they have obtained patient consent. According to modern day privacy experts Charles Fried and Alan Westin, a violation of a person's privacy equates a violation on their liberty and morality. However, if a physician suspects that a third party person is causing harm to the patient, than the use of covert VS is justifiable.
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Date Issued: 2013
Identifier: CFH0004475, ucf:45138
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004475

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