transition of patients from intensive care unit to the ward
TRANSCRIPT
TRANSITION OF PATIENTS FROM INTENSIVE CAREUNIT TO THE WARD ENVIROMENT
A Ward Nursing Perspective
Appelles Ohanga
Bachelor’s ThesisOctober 2009
Degree programme in nursingSchool of Health and Social Studies
DESCRIPTION
Author(s)OHANGA, Appelles
Type of publicationBachelor’s Thesis
Date26102009
Pages53
LanguageEnglish
Confidential( ) Until
Permission for webpublication( X )
Title
TRANSITION OF PATIENTS FROM INTENSIVE CARE UNIT TO THE WARD ENVIROMENTA ward nursing perspective
Degree Programme
Degree programme in nursingTutor(s)
PAALANEN, Kaisu,TYRVÄINEN, Hannele
Assigned by
Jorvi Hospital Intensive Care UnitAbstract
This thesis was aimed to explore the expectation of Jorvi surgical ward nurses aboutcooperation with the intensive care unit nurses and other staff, when a patient is transferred tothe surgical ward to create a clear transfer process. The aim was to discover what information isrelevant to the nurses receiving the patients from the intensive care unit, to identify any issues/concerns that occur when receiving patients from the ICU.
The theoretical background was based on earlier studies on transition from ICU. The researchconsisted of open and closed ended questions which were used to collect data from the surgicalwards of Jorvi hospital. Questionnaires were in both Finnish and English so that the nurses mayexpress in the language that they are comfortable with. Permission to participate in this studyfrom the research group was assumed participation in the study. Analysis of data was donethrough reading, analysing and interpretation of the research questions. The research wasconducted in summer 2009
The results showed that communication as a form of information sharing was an importantaspect in this study, time to prepare was perceived as important by ward nurses when receivingICU patients, whereby nurses know what to expect when the patient arrives, what equipment isrequired, aspects of staffing levels and having appropriately experienced staff on the wards.Documentation as a continuation of patient care focuses on fluid balance and observationcharts, medication charts and transfer forms. Families needs is recognised as a part of nursingcare and the transition process, and lastly post ICU visits whereby introducing an ICU nurse ordoctor who goes to see the patients in the wards after discharge.
Keywordsintensive care or critical care, patient transfer, transitional care, continuity of care, patientdischarge’ and discharge planning
MiscellaneousThe bachelor’s thesis is available in the library of Jyväskylä university of applied sciences.
ACKNOWLEDGEMENT
I’m grateful to all the registered nurses of the surgical wards who participated in
this study and shared their opinions, and also to the hospital leaders for making
it possible to carry out this study.
I would also want to thank Anneli Övermark for being my mentor at the working
place and also for supervising my work through out the research process. And
Finally I would like to thanks my lecture Kaisu Paalanen and Hannele Tyrväinen
for being my mentors for this project.
And finally I would like to thank my family and friends for their ongoing support
throughout this journey.
CONTENTS
1 INTRODUCTION…………………………………………………...…..…..….…..5
2 TRANSITION AS A CONCEPT…………………………………........................6
3 TRANSITION OF PATIENT FROM ICU.........................................................8
3.1 Discharge of patients from Intensive care unit……………………....…...9
3.2 Impact on relocation of patients………………….………...…....………...12
3.3 Co-ordination between Intensive Care Unit and wards…………...........13
4 PURPOSE OF THIS BACHELOR’S THESIS AND RESEARCHQUESTION………………………………………………………………….…....…15
5 METHODOLOGY………………………….....……….….………...……..…......16
5.1 Sampling…………………………..……………………………....……...…17
5.2 Data collection………………………………………………………….......18
5.3 Data analysis……………...……………………......…...……………..…...19
6 FINDINGS......................................................................................................20
6.1Information sharing ……………………….………...........................……..22
6.2 Timing of the patient transfer and equipments.......... ……….................24
6.3 Documentation as a continuation of care……...………..........…...……..26
6.4 Intensive care unit and their families……………………………..........…27
6.5 Post ICU visits…………………….....…….………...………….…............28
7 DISCUSSION………………………....……………………….…..…....…….…..29
8 ETHICAL ISSUES, TRUST WORTHNESS AND FUTURE SUGGESTIONS
8.1 Reliability…………………………………………………...………..….......32
8.2 Ethical considerations…..……………………....…….……...…….….…..32
8.3 Trustworthiness……………...…………………....……….………..….…..33
8.4 Suggestions for the Future…………………..……....………….….…......34
9 CONCLUSION……………………………………..………..………....….......…36
REFERENCES……………………………………………………….…….……....38
TABLES
Table 1. Heading in general transfer form…………….......………….......….11
Table 2. Demographic characteristics of the sample………......……….…..21
APPENDICES
Appendix I. Clinical Nurse Leader letter ……………………...…….….…….42
Appendix II. Information sheet in Finnish…………,…………......….....……43
Appendix III. Information sheet in English…...……………………………...44
Appendix V. Research permit…………………………….......……………….45
Appendix VI. Questionnaire in Finnish…………………………........…..…..46
Appendix VI. Questionnaire in English……………………………........……50
5
1 INTRODUCTION
The intensive care unit can be stressful to the patients and their families.
Although discharge is a positive step in terms of physical recovery, patients
may not be psychologically ready to be transferred to the general wards.
Many patients experience high anxiety during relocation from the intensive
care unit to the wards. Admission to the ICU (intensive care unit) can be very
stressful to the families, but the sense of security provided by the intensive
care unit is more reassurance. (Chaboyer, Thalib, Alcorn & Foster 2007, 149-
157.)
Patients transfer out of the intensive care unit to the wards is a regular
occurrences and accepted part of the routine work of the intensive care.
During the transfer process patients are often not consulted nor given
opportunity to express their needs, which may be stressful to them. It is the
responsibility of the Intensive care nurses to assist with the coping process by
identifying the needs of the patients and making individual discharge plan for
them. (Wu & Coyer 2007, 48-53.)
It is important to understand the role of intensive care unit nurses and the
views of the ward nurses of their roles in discharge planning for easier
transferring process. Intensive care unit nurses’ role is to support the patients
and their families, and also providing resources that will assist the ward
nurses during the transfer process. However, the views of ward nurses are
often ignored; some studies indicate that ward nurses usually complain of not
receiving enough information to provide immediate care to the patients. (Wu &
Coyer 2007, 48-53.)
The purpose of this bachelor’s thesis is to explore the expectation of Jorvi
surgical ward nurses about cooperation with the intensive care unit nurses
and other staff, when a patient is transferred to the surgical ward to create a
clear transfer process. The aim is to discover what information is relevant to
the nurses receiving the patients from the intensive care unit, to identify any
issues/ concerns that occur when receiving patients from the intensive care
unit.
6
2 TRANSITION AS A CONCEPT
According to the North American ed. Bloomsbury Publishing (2005) transition
is a period in which something undergoes a change and passes from one
stage to another. Healthcare transitions ensure safe and efficient movements
of patients between different sectors of care within the healthcare system.
Critically ill patients in the intensive care unit often experience a lot of changes
as they move through different levels of care.
Transition as a concept is central to the nursing discipline as a whole. Nurses
often are the primary health professionals involved in encounters with patients
and their families that relate to transitional periods of instability. (Meleis,
Sawyer, Im, Messias & Schumacher, 2000.)
This article defines ICU transitional care as care provided before, during and
after the transfer of an ICU patient to another care unit that aims to ensure
minimal disruption and optimal continuity of care for the patient (Chaboyer,
James and Kendall 2005, 16-28). This definition incorporates Naylor’s (2000)
theory on transitional care in relation to the movement of patients from one
level of care to another.
Chaboyer, Heather and Kendall (2005) recognise that multiple transitions
occur for ICU (intensive care unit) patients; the two most significant are the
transition to an intermediate care and then to home. Four major current
strategies for ICU transitional care include: changes in ICU discharge planning
practices, the use of ICU liaison or discharge nurses and step down units for
example, high dependency units and outpatient follow-up clinics. Discharge
planning is aimed at improving patients’ preparation for discharge from ICU
and further developing ICU discharge planning practices; extended nursing
roles and step down units are largely targeted as the transition from ICU to the
immediate care unit; and outpatient clinics are more focused on the transition
from hospital to community
7
The development of transition theories has been a focus of nursing and other
disciplines. Although management models tend to equate transition with
change, nursing theory offers broader perspectives for the conceptualization of
transition. For example, in describing the strategies that organizations use to
effect change, McCarthy (1995:4–5) Suggested that transitional activities are
merely strategies for change and that in order to effectively ensure that
transition occurs smoothly, a transitional plan must be developed.
Furthermore, transitional care ensures the safe and timely transfer of patients
from one level of care to another, for example, acute to sub acute or from one
type of setting to another, for instance, hospital to home. The research
developed from testing and refining a transitional care model with hospitalised
elders. (Naylor 2000, 1-14.)
The essential properties of a transition include awareness, engagement,
change and difference, time span, and critical points and events. This
conceptualization is clearly much broader than definitions of transition as
change alone. A concept analysis and concluded that transitions are
processes that occur over time and that involve change in identity, role,
relationships, abilities, and behaviours. (Meleis, Sawyer, Im, Messias and
Schumacher, 2000.)
The role of nurses in transition is to understand, support, and guide the
patients and their families during transition to help them settle in the new
environment.
8
3 TRANSITION OF PATIENT FROM INTENSIVE CARE UNIT
The search strategy adopted during the literature review included terms such
as: ‘INTENSIVE CARE’ or ‘CRITICAL CARE’ (which takes into account the
English and American terminology), ‘PATIENT TRANSFER’, ‘TRANSITIONAL
CARE’, CONTINUITY OF CARE’, ‘PATIENT DISCHARGE’ and ‘DISCHARGE
PLANNING’.
These keywords were identified based on their commonly used clinical terms,
a technique recommended by Brown (1999). A search of Cinahl, Medline and
Ovid databases was carried out using the above key words. Other search
techniques include Boolean operators, truncation searching and reference
lists (Brown). Boolean operators, such as ‘and’, were used to combine multiple
search terms as a way of narrowing the search and identifying articles with
common multiple keywords. Limits were set to refine the search such as
English and Finnish written articles and those published within the last 15
years. Reference lists from relevant articles were also checked as a method of
finding similar articles or to source a primary reference. Internet searches
using ‘Google Scholar’ and yahoo.
Themes within the literature include transitional care, patient and families’
experiences of transfer from ICU, discharge planning and the experiences of
ward nurses receiving patients from ICU. The concept of transitional care is
examined and how it relates to the nursing discipline and its significance in
ICU.
9
3.1 Discharge of patient from intensive care unit
The discharge criteria in the intensive care unit involves:
Substantial resolution of the problems responsible for admission.
Anticipation of prolonged medical stability.
Establishment of status (e.g. DNR) such that intensive care supervision
is not required even if the patient remains critically ill.
Elimination of need for mechanical ventilation/airway protection and the
need for invasive haemodynamic monitoring.
Discontinuation of medications/treatments requiring
haemodynamic monitoring.
(Scorthern 2009, 2.)
The discharge of patients from the Intensive care unit to the wards can be
described as part of the continuity of the hospital care that prepares the
patient for their return to the community. However, due to inadequate
procedure and training, the ability of the staff to recognize and meet the needs
of the patients and their family is limited. (Wu & Coyer 2007, 49-53.)
Patients transferred by ICU to the wards are often highly dependent patients
with multiple complex needs, both physical and psychological. These patients
ongoing care is provided in the ward environment and ultimately impact on
ward nurses, an area that is under-researched. Stress and emotional
difficulties often relates to concerns about the state of the patients upon
transfer, nurses are unsure about what to expect in terms of the level of acuity
or stability of the patient. (Whittaker & Ball, 2000 135-143.)
Discharge is also considered as a positive step in the recovery process, but at
the same time it may cause anxiety to the patient and his family as it involves
leaving behind familiar faces ( intensive care unit staff) and the whole
environment moving to a new environment, new people and also have to learn
new routine. The patients no longer get the special attention that they used to
get whole in the intensive care unit, the one-to-one nurse patient relationship
is lost once the patient is transferred from the intensive care unit, making the
patient and also their family feeling deserted. (Odell 2000, 322-329.)
10
Despite the initial recovery in the intensive care unit from critical illness, many
patients are still at risk of their condition deteriorating, resulting to readmission
in the intensive care unit or even death. A patient who is discharged from the
intensive care unit and is readmitted within 48h of discharge may be indicating
as premature discharge. (Wu & Coyer 2007, 48-53.)
The discharge needs of the patients admitted in the intensive care unit is
complex, diverse and dynamic, due to expansion of technology difference
kinds of illness can be treated, leading to increase in degree of complexity in
the discharge planning needs. The patients may have adverse feelings about
the severance of therapeutic relationship they may have build with the
personnel in the critical care area. Coping with the new environment, new
health care staff and reduction in the amount of observation may all serve to
add to stress and anxiety of the patients. (Reed1998, 52-68.)
In the past, when a patient was admitted to the critical care unit and survives
to return to the ward was seen as a success, over the years there have been
advancement in the critical care in that not only do they want the patients to
survive, but it also emphasizes on continuity of care for restoration of health
with minimal physical and psychological distress. ( Aidin & Vidar 2002, 149-
157.)
Due to limited number of beds, and high demand in the intensive care unit and
also high cost in the health care system, there is increase pressure to move
the patients back to the community as soon as possible. Apart from bed
demands in the intensive care unit research suggest that other environmental
factors may contribute to the transfer of patients from the intensive care unit,
this include, inadequate nurses in the critical care unit, inadequate monitoring
equipments. (Wu & Coyer 2007, 48-53.)
It is important to understand the role of intensive care unit nurses and ward
nurses’ perception of their role during discharge planning. The role of the
intensive care unit nurse is to support patients and their family during the
transfer and providing resources to assist general ward staff to assume
11
responsibility of the patient. However perspective of the ward nurse is often
ignored, some studies suggest that ward staff have complained of insufficient
report given to provide immediate care to the patient. (Wu & Coyer 2007, 48-
53.)
The nursing policy outlines the process of transferring patients out of
(Intensive care unit) ICU and encompasses: Ringing the wards’ in charge
nurse to check for bed availability, arranging a suitable time for transferring,
notifying the relatives on pending transfer, completing relevant nursing
transfer form, nursing management being informed of patient transfer and the
ICU admission book being filled out
Currently within the intensive care unit there are different transfer documents
that existing in order for the transfer process to be completed. The general
patient transfer form from Jorvi intensive care unit are given in table 1 below.
TABLE 1 Heading in general transfer form in Jorvi ICU
Reason for admission in the ICU
Medical history
Summary of treatment
Allergies
Contagious diseases
Present condition
Invasive lines
Intravenous fluids and drug infusion
Analgesia
Wounds, drains, tracheostomy in-situ
Transfer check list (Medical /nursing documentation and patients belongings
Psychological needs
(Jorvi hospital, ICU data base.)
12
3.2 Impact on relocation of patients
Patients stay in the intensive care unit may have both short- and long-term
effects on their overall recovery. These patients make several healthcare
transitions within the healthcare setting during their recovery. However, like
other hospital patients, intensive care unit patients may be transferred to other
hospitals, rehabilitation facilities, and nursing homes, all of which require a
time of transitional care. Each transition represents unique challenges for
patients, their family members, and the healthcare professionals involved in
the patients’ care. (Chaboyer, James & Kendall 2005, 16-28.)
Patients in the critical care unit may suffer psychological and physical problem
caused by stress of being in the intensive care unit. This stress may continue
even after the patient has been transferred to the wards. Some of the major
physical responses emerging after the discharge from the intensive care unit
is; disrupted sleeping pattern, disorientation, tiredness, confusion depression,
weakness such that they are unable to get out of bed or even taking few steps
during rehabilitation.
(Odell 2000, 322-329.)
Once transferred to the general wards, intensive care unit patients may be the
sickest patients on the ward and may need close observation and constant
nursing care. Some patients experience physical impairments, such as muscle
weakness, difficulties in eating, swallowing, chewing, coughing, moving the
upper extremities, toileting, and mobilizing. Patients may experience anxiety,
panic attacks, and, in some instances, signs and symptoms of acute post
traumatic distress disorder. patient-to-nurse ratio in the wards does not always
accommodate the complex emotional and physical needs of these patients.
Consequently, the patients may take much longer to achieve the goal of self-
care status in this setting, further complicating this initial transition and
affecting the next major transition to home. (Chaboyer, James & Kendall 2005,
16-28.)
13
According to Prinjha, Field, and Rowan (2008) many patients felt unprepared
for the busy atmosphere of a general ward and found that they were made
anxious and insecure by noise from other patients and their visitors.
3.3 Co-ordination between the intensive care unit and the wards
In Finland there has been no much research done on Intensive care unit nurse
consultation. (Lahtinen & Tuuliainen 2006, 57-59). Little nursing literature has
explored the phenomena of ward nurse receiving patients from the intensive
care unit. Whittaker and Balls (2000.) This thesis explores the nature of
receiving patients from ICU to the wards from a ward nurse perspective in
order to understand the issues faced by ward nurses.
A liaison nurse is typically a nurse with advance practice experience or clinical
nursing specialist, found in different departments for instance intensive care
unit, stroke, accident and emergency amongst others. They are basically used
to improve discharge planning and facilitate the transfer of patients to the
wards or even community. The role of a liaison nurse is based to improve
communication, increase continuity of care, and to improve the transfer
process. (Chaboyer, Gillespie, Foster & Kendal 2005, 16-28.)
Some studies indicate that patients who have been discharged from the
intensive care unit and their families prefer that the intensive care unit staff
visit them while in the wards for a certain period of time after discharging
them. According to these studies follow up services help to improve transfer
anxiety from the patients and also improves communication between wards
and the intensive care unit. It also helps in identifying early warning signs if the
condition of the patient is deteriorating. ( Prinjha , Field & Rowan 2009.)
Use of an intensive care unit liaison or discharge nurse generally requires
integrating the services of a qualified intensive care unit nurse and support
services from the intensive care unit medical consultants. Some studies
suggests that the liaison nurse who visits the wards should have worked in the
intensive care unit because they understand better the experiences of
patients and their families of being in the intensive care unit and the reactions
to being transferred to the wards. (Prinjha, Field & Rowan 2009.)
14
Intensive care unit liaison nurses must develop their roles in collaboration with
the ward staff so that ward nurses must not feel threatened by this specialty
role, but rather perceive it as a collaborative venture to improve care for
patients and patients’ families. Intensive care unit liaison nurses must be able
to train and support ward staff in developing critical care skills relevant for
transferred patients and empower the staff members to manage transitional
care with confidence and competence. (Chaboyer, Gillespie, Foster & Kendal
2005.)
There is a clear recognition in the literature of the value of follow up services
by the intensive care unit staff of their former patient. Not only does the follow
up services benefit the patient, it also benefits the family and also the ward
staff in terms of job satisfactions. Intensive care unit tends to operate as a
closed unit, and has little interaction with other departments beyond admission
and discharge of patients. This can lead to inadequate communication with
the wards, leading to ward staff failing to seek the necessary assistance from
the intensive care unit. (Cheboyer, Gillespie, Foster & Kendal 2005.)
15
4 PURPOSE OF THE BACHELOR’S THESIS
The purpose of this bachelor’s thesis is to explore the expectation of Jorvi
surgical ward nurses about cooperation with the intensive care unit nurses
and other staff, when a patient is transferred to the surgical ward to create a
clear transfer process.
The aim of this bachelor’s thesis is
To discover what information is relevant to the nurse receiving patients
from ICU.
To highlight issues or concerns that occur at discharge from the ICU
and how to address them for instance through the consulting the ICU
nurses.
To improve cooperation between ICU and surgical wards.
Research question/Operational definitions
What is the experience, issues or concerns of Jorvi surgical ward nurse when
receiving patients from the ICU?
16
5 METHODOLOGY
A qualitative study will be used on this research. Qualitative research is a
subjective approach used to describe experiences and give them a meaning.
A qualitative study is rather used to develop a research plan rather than test
an already developed plan. Qualitative research involves perceptually, putting
the pieces together to produce a meaning. (Burns & Grove 2001, 61.)
Quantitative methods are research techniques that are used to gather
quantitative data - information dealing with numbers and anything that is
measurable. Statistics, tables and graphs, are often used to present the
results of these methods. The process of measurement is central to
quantitative research because it provides the fundamental connection
between empirical observation and mathematical expression of quantitative
relationships. (Marketing directory: Quantitative research). Quantitative design
was used in this research to analyse the demographic part of the participants
This research utilises a qualitative descriptive design. Such a design is suited
to areas of investigation of human endeavour where little previous research
has been undertaken. (Sandelowski, 2000.)
The research aimed to describe the transition of patients from intensive care
to the ward environment from ward nurses’ perspective’. In keeping with a
qualitative descriptive methodology this study aimed to describe this area of
interest in a way that clearly describes the event in the everyday terms of that
event and in ways that the participants can recognise as their experience.
17
5.1 Sampling
A purposive non-random sampling will be used in this study. Purposive
sampling involves the conscious selection by the researcher of certain
subjects. (Burns & Grove 2001, 374.)
The research group in this study are registered nurses from the surgical ward.
There are five surgical wards in Jorvi hospital. These surgical wards includes;
K3, K4, K5, K6, K7.
K 3 ward usually deals with breast tumour surgery, plastic surgery, and
gynaecological surgery, K 4 deals with orthopaedic surgery, K 5 deals with
orthopaedic surgery, trauma and also gastro organ surgery, K 6 deals with
gastro organ surgery, and K 7 deals with Blood vein surgery and Gastro
organs surgery. (Kirurgia osastot.)
Registered nurses were selected to participate in this study since they are the
ones who receive the patient during transfer from the ICU to the surgical
wards and they are also the ones who plan for the patients care with the rest
of the multi professional team.
Research groups involve a gathering of people who have a perspective on a
particular research topic, who are chosen deliberately for their knowledge and
insight in the area in which the research relates (Roberts & Taylor, 2002). In
this case for their ability to describe their experience of the transition of
patients from intensive care to the wards
18
5.2 Data collection
Data collection is a process of selecting subjects and gathering data from the
subjects. The actual step of collecting data is dependant on the research
design. (Burns & Grove 2001, 460). Data collection in this research was done
through Questionnaire that were sent to the surgical wards.
As no reliable and valid tool could be found that was accessible to the
researcher, a questionnaire tool was developed by the researcher. The
questionnaire was specifically developed to collect data from the registered
nurses working in the surgical wards. The development of the questionnaire
was through literature searches and also discussing with the critical care unit
nurses in order to gather information from all sources and use to formulate a
draft questionnaire for the pilot study.
Questions was designed to elicit descriptions of the nurse’s experience and
explore issues and concerns related to each of the questions were then asked
and group discussion facilitated by the research related to each objective
ensued.
This plan was sent to the head nurse for approval of this research. After
approval, the head nurse of intensive care unit emailed all the surgical wards
head nurses outlining the proposed research and an attachment of the
research permit. The surgical nurses emailed back outlining the number of
questionnaires to be given to the wards. The researcher then took the
questionnaire to the wards, before handing then over she explained to the
research group in brief about the research. Concept to participate in the
research is assumed from completing the questionnaires.
The number of questionnaires given to each ward varied depending on the
number of registered nurses working in those wards at that time. But an
average of fifteen questionnaires was issued to each ward. The research
period was two weeks for all the wards in June 2009, thereafter the
researched collected the questionnaires from the wards for data analysis.
19
Since most of the nurses in the surgical wards are Finnish, questionnaires
was also translated from English to Finnish since they may be comfortable
and able to express themselves better when answering in Finnish than
English. And in order not to bias immigrant nurses working in these wards the
original questionnaire in English was also sent to the wards so that they may
be able to choose from what language they would like to answer.
5.3 Data analysis
Data analysis is done to reduce, organise and give the meaning of the data.
Data analysis in quantitative research may involve the use of explanatory
procedures. Data analysis process will vary depending on the research
question. (Burns & Grove 2001, 5.)
Qualitative analysis techniques use words rather than numerically during data
analysis. In qualitative research, the researcher rather gathers data and
interprets the meaning of the data as near close to the material as possible.
Analysis involves cross checking each bit of data collected. Some researchers
believe that using computer in data analysis of qualitative data is quicker and
easier without the researcher loosing track of the data. (Burns & Grove 2001,
591-593.)
20
6 FINDINGS
(n=32)
Registered nurses from all the surgical wards in Jorvi hospital participated in
this study. Demography characteristics of the participants are displayed in
table 2 below.
The age range of the research group varied from twenty years to over sixty
years. Majority of the participants were between the ages of 41-60 while there
were no participants over the age of 60. About eighty five percent of the
participants were working full time on their respective wards.
There was a wide range in the years of work experiences ranging from 1 -20
years and even more. Those nurses with more years of work experience
participated more in this research ranging from 51-60 years and above which
represents 37.5% of the research group while those with 1-5 years of work
experience participated the least in this study representing 9% of the research
group, maybe because they have handled more patients who have been
transferred from the intensive care unit, unlike those with less that five years
experience
Other than that, two other nationality, over 90% of the participants were of
Finnish nationality.
21
TABLE 2 Demographic characteristics of the sample
Characteristics Values
Age groups
20-30years 3
31-40 years 7
41-50 years 11
51-60 years 11
>60 years 0
Working times
Full time 27
Part time 5
Surgical wards
K3 6
K4 6
K5 5
K6 5
K7 10
Years of experience as a registered nurse
1-5 years 5
6-10years 7
11-20 years 8
>20 years 12
Citizenship
Finnish 30
Other 2
22
Research groups were used to explore the transition of patients from ICU to
the ward from a ward nurse’s perspective at the study setting hospital. The
objectives of the focus groups were to explore and describe the perspective of
ward nurses; to identify any concerns and expectations; to highlight specific
problems that occur; and to address what information is pertinent to ward
nurses upon patient transfer.
Five themes emerged from the finding in this study. Communication was the
most significant aspect in all the themes.
Information sharing
Timing of patient transfer
Documentation as a continuation of patient care
Intensive care patient family members
Post ICU visit
6.1 Information sharing
It is discussed in regards to patient being in an ICU state, it reflected both the
experiences of ward staff and their expectations and concerns that information
on patients being transferred to wards be an accurate reflection of the
patient’s condition and state of care.
Ward nurses described information sharing as a significant component of
communication between wards when transferring patients; it needs to be
thorough in order to plan for patient care, and actually needs to occur prior to
the patient transfer. Ward nurses also described situations where sometimes
information about a patient could be vague or inadequate regarding crucial
information, such as the patient has been agitated or confused thereby
requiring restraints.
“depending on the type of patient we receive --- bit of preparation when we
hear the news that we are receiving a patient from ICU --- the difference being
that the patient in ICU comes from a one-to -one nurse ratio to the ward where
the nurse has five to six patients and out of that five, two to three other
23
patients already need three to four hours of extra care. Many times we have
that problem ---suddenly we get a patient from ICU”.
The participants described verbal handover between nurses as the main form
of a communication as part of the transfer process. Nurses felt they relied
considerably on a good verbal handover, especially when busy. Most of the
nurses were satisfied with the reporting from the ICU nurses.
Tehokas raportointi, ja myös voivat ohjeistaa ja opastaa meitä meille
vieraissa asioissa. Kirjaa selvästi esille osaston tarvitsemat potilastiedot. Jos
erikoislääkkeitä tai laitteita, niiden ohjauksen opetus.
Communication between nurses largely consists of information sharing via
verbal processes. Ward staff rely on these processes in order to plan for
patient transfers, provide ongoing nursing care and ensure continuity. Patients
arriving on the ward in the condition stated by the transferring ward would be
considered ideal by ward staff, whereby ward staff would know what to expect,
this often meant basic nursing care actually been done prior to patient
transfer. Some nurses complained of poor reporting and also poor interaction
between the ICU nurses and the ward nurses.
Huono raportointi, ja hoitajat ajoittain huonolla tuulella.
Jollakin hoitajille tapana odottavat hanskat kädessä valmista tapahtuvaksi –
voisi osallistua aktiivisempaan siirtoon.
Potentially due to the time it takes to settle the patient in and locate patient
information within the medical notes, ward nurses felt that the transfer process
should be given appropriate time to ensure thorough patient handover.
Some nurses felt that it is important that full report of the patients’ condition
should be handed in advance while others felt that short report should be
given in advance and a detailed report should be given during handing over of
the patient.
24
6.2 Timing of patient transfer and equipments
It was perceived as important by ward nurses when receiving ICU patients,
whereby nurses know what to expect when the patient arrives, know what
equipment is required and the overall timing of the patient transfer.
There was no consensus on a preferred time of patient transfer within this
study, although during the afternoon seemed preferable so that the nurses
coming for the evening shift would receive the patient.
On hyvää kun usein sovitaan että potilas siirtyy iltapäivällä jolloin iltavuoron
hoitajat vastaanottamassa.
Communication before the patient arrives on the ward is crucial to allow
nursing staff to prepare for receiving an ICU patient. It was recognised from
nurses’ experiences that receiving ICU patients takes more preparation,
requires more time and input, especially on initial arrival to the ward. In order
to prepare for the patient from ICU, ward nurses felt it would be ideal to know
about the patient, their dependency level, know what the patient needs and
know what to expect upon receiving the patient. This included specific
information such as: dependency level, equipment required, restraints in-situ,
whether there were special needs required, patients Not For Resuscitation
Status (DNR), or any specific family concerns. If it is a burns patient then part
of that preparation needs to incorporate negotiation with ward nurses from
plastics to have their dressing done prior to transfer. This essential type of
information needs to be passed onto the ward nurses prior to patient transfer.
Premature transfer from the ICU to the wards is commonly associated with
creating bed availability for a new patient admission to the ICU, hence a
planned versus unplanned transfer to the wards has an impact on the wards
ability to prepare to receive the patient. Due to nature of the acute hospital
settings, there are occasions where the wards are required to take the patient
earlier that expected due to bed demands for new ICU admissions with no
empathy on the impact it may have on the ward nurses.
25
Tehon paikkatilanteen vuoksi siirretään vaikka kunto edelleen vaatisi
vierihoitajaa. Huolimatta tilan alaspäin menosta ja ei potilas oteta aina takaisin
teholle. Huonokuntoisia potilaita tullut/ lähetetty osastolle ja jouduttu
palauttamaan takaisin teholle.
Acquiring equipment, such as intravenous pumps, creates difficulties for ward
staff. Often this is exacerbated by the limited number of intravenous pumps
available within the clinical equipment pool within the hospital. Ward nurse
recognized that essential equipment needs to be accessed prior to patient
transfer for continuity of patient care and safety.
They preferred patient having minimal devices attached for instance central
venous catheters, tracheotomy, and drains since they have minimal recourses
and experience on how to handle them, and that patient should be in a
condition that rehabilitation can commence.
Olisi hyvä jos ei olisi kauheasti piuhoja ja systeemejä kiinni potilaassa koska
emme osaa hoitaa niitä eikä ole resursseja sellaiseen. Potilaan tilaan tulisi olla
vakaa ja kuntoutus voida aloittaa.
Nurses from the surgical ward felt that before a patient is discharged from the
intensive care unit to the surgical ward, the patient should be in a condition
that does not need continuous monitoring, such that the patient can be left
alone in his room without wondering his safety, since there are few nurses in
the in the wards and are not able to be by the patients side at all times.
Potilas tulisi olla vuodeosastokuntoinen eli ei seurantoja koko ajan ja hänen
vointinsa on siinä määrin stabiili, että hänen turvallisuutensa ei ole vaarassa
ilman hoitajan jatkuvaa läsnäoloa ja Vitaalielintoiminnot ovat vakaat, ettei
tarvitse valvonta.
The majority of participants in the research groups felt that intensive care
nurses forget what it is like to be a ward nurse and having to managing the
complex needs of multiple patients. All participants shared concerns regarding
26
suitable staffing levels and appropriately experienced staff on the wards when
managing ICU patients as part of the transfer process
Ei ystävällinen vastaanotto henkilökunnan puolelta, joskus tuntuu ettei
vuodeosaston osastojen henkilökunnan taitoihin luoteta.
6.3 Documentation as a continuation of patient care
Documentation was highlighted by the participants in a number of areas such
as medication charts, fluid balances, handover sheets and overall organisation
of paperwork. It was acknowledged that ICU documentation is different,
particularly in relation to the recording of vital signs and fluid balances, this
highlights the significance of transferring complete or partial shift worth of
patients data from the ICU 24hour chat in order for the ward to fully
comprehend the patient recent 24hour history .
The charting of medication was occasionally an issue for ward staff described
from their various experiences. Ward nurses sometimes have to get
medication prescribed once the patient is transferred to the ward, or get the
patients medication reviewed post surgery, hence requiring them to locate a
doctor.
The nurses also emphasised on the fact that the medication list of the patients
should be updated during the time of discharge. There should be enough pain
medication prescribed, and clear instruction of administration, preferably
intramuscular. Some of the nurses also said that they should indicate clearly
about the upcoming examinations for instance blood tests or even x-rays.
Kirjaa selvästi esille osaston tarvitsemat potilastiedot, jos erikoislääkkeittä,
niiden ohjauksen opetus esimerkiksi jos IV lääkitys ei tuttu osastolla, mihin
sekoitetaan ja millä nopeudella.
27
6.4 Intensive care unit patient and their family
This means that they had to recognise families as a part of nursing care and
the transition process. Caring for families involves providing explanations to
families, which a less experienced nurse stated she found frustrating as she
did not always know the answers. Ward nurses also have the added
responsibility to reassure the family that the patient is in a safe environment.
Some participants suggested that patient should be taken care of holistically,
and that during transfer of patient to the ward a detailed report should be
given. Inform the patient in advance about the system of the ward, explain to
the patient that his condition does not need continuous monitoring.
Hoitaa potilas kokonaisvaltaisesti. Kertoa potilaalle etukäteen vuodeosaston
toiminnasta. Selittää potilaalle että hänen vointinsa ei enää vaadi jatkuvaa
valvontaa.
They also felt that it is important to be informed more about family members
such as, who are the official next of kin, to whom can the patients’ information
be given. In case the patient is of a foreign nationality, they want to know if
the family has been contacted whether in Finland or abroad. They also felt
that it is important for them to know the official mother tongue of the patient if it
is a foreigner and the mail language of communication in the ward.
Miten potilas/ omaiset sopeutunut tilanteeseen ja siirtoon osastolle. Hyvää
olisi saada tietoa perhetausta ja kenelle tietoja lupa antaa.
Mental status of the patients such as if the patient is depressed, motivated,
and any possible problems that can arise, so that they may know how to
proceed during the rehabilitation process.
Potilas sen hetkinen vointi? Mitä ollut ongelma? miten seuranta/toimenpiteet
jatkossa. Millainen potilas psyykkinen tila, sekavuus-> mahdollisesti tarvittava
lääkitys olisi jo hyvää olla olemassa.
28
6.5 Post ICU visits
This means that a doctor from the intensive care unit or a nurse goes to see
the patient a day or two after being transferred to the ward.
Most of the nurses thought that consultation from Intensive care unit if
needed, and also cooperation between intensive care unit and the different
surgical wards could be handful in the patients care. while another said that
intensive care unit nurses should assist them in solving problems that might
have been encountered from the patients discharged from the intensive care
unit instead of saying that problems is not their issue.
Tarvittaisiin konsultaatio apua ja myös hyvä yhteydenpito tehon ja eri
kirurgisten osastojen välillä, ja myös he voisivat auttaa ongelmassa, eikä vain
sanoa ettei asia ole heidän ongelma.
Most of the nurses said that it would be nice if anaesthesiologist from the
intensive care unit would come and visit the patients in the wards since in
particular multi-sick patients, since surgeons are not so much a position about
internal medicine, for instance medications and fluids.
Tehon lääkärin olisi hyvä käydä katsomassa potilas osastolla etenkin meidän
monnisairas potilas.
29
7 DISCUSSIONS
The aim of this study was to discover what information is relevant to the nurse
receiving patients from ICU. To highlights problems that occur at discharge
from the ICU and how to address them for instance through the consulting the
ICU nurses. To standardise the discharge protocol the will address the need
of both the ICU and surgical ward staff.
Communication emerged as a common element and pertained to information
sharing, the verbal handover and the timing of patient transfer; yet having a
flow-on effect within the other areas. Good communication is pivotal to any
successful patient transfer, accentuating its significance in the continuity of
patient care. Information sharing was seen as a major component of the
communication process within this study no matter what format it takes,
whether it is via telephone, verbally or written as long as it is concise and
patient related. Ward nurses believed that the process of information sharing
concerning patient transfer should ideally occur directly between bedside
nurses in order to get a more thorough handover and to negotiate a suitable
transfer time, a similar finding to Whittaker and Ball’s study (2000).
Communication as part of the preparation process is vital in order for the ward
to plan for receiving a patient from ICU. This research has revealed that the
ICU patient group takes more preparation and require more time and input,
especially for wards with already high nurse-to-patient ratios. This is
supported by Haines and Coad (2001) study, which notes that it takes time
and experience for ward nurses to accept patients from ICU. Ward staff within
this current study emphasised that as part of that preparation process it was
important to know about the patient, know what the patient needs and know
what to expect upon receiving the patient. This uncertainty regarding a
patient’s severity was universal amongst ward nurses within this research.
Often, premature transfers from ICU to the ward are commonly associated
with creating bed availability for a new patient admission to ICU. Hence a
planned versus unplanned transfer to the ward has an impact on the ward’s
ability to prepare for receiving the patient, as noted within the study. Due to
30
the nature of the acute hospital setting, there are occasions when wards are
required to take patients back earlier than expected due to bed demands for a
new ICU admission, with no empathy for the impact this may have on ward
staff. This occurrence is noted in Whittaker and Ball’s (2000) study who
suggest that a planned transfer is less likely to cause added stress for both
ward staff and patients alike
Whittaker and Balls (2000) believe that the level of experience of nurses
receiving the patient from the intensive care unit plays a significant factor on
the stress levels. Junior nurses experience more negative feelings receiving
patients from intensive care unit while senior nurses are the once that accept
patients from intensive care unit, making decisions and ultimately having
control over nursing staff workload. Compared to this study, majority of the
participants were registered nurses with work experience of over twenty years
According to Whittaker and Ball’s 2000 availability of suitable resources such
as staffing levels and appropriately experienced staff on the wards is a
common concern, a factor which ICU nursing staff tend to forget due to the
nature of one-to-one nursing ratios, a diversity of experienced staff available
during all shift patterns and the general isolation of ICU as a whole. Staffing
levels on the wards fluctuate during different shifts, so there is more staff
available in the mornings due the predicted ‘busyness’ of the shift, hence
more support available and less staff during the afternoons and at night.
Documentation as part of the transfer forms and within medical notes was
considered insufficient within this research. It was recommended both within
this research and as part of Whittaker and Ball’s (2000) study that transfer
forms should provide a summary of events outlining the main problems
experienced by the patient. Although, recognising that transfer forms are only
as thorough as the nurse completing them. Hall-Smith, Ball and Coakley
(1997) ICU clinical practice group developed a similar form: an ICU summary
sheet relevant to staff in wards and an assessment sheet outlining the ability
of each patient and the care required in order to promote continuity of patient
care by providing brief and relevant information.
31
Minimal reference was made to follow-up of patients within this research;
nevertheless, it was identified that there is a lack of ICU involvement from the
view that once patients are treated ICU is no longer involved in their care. This
is particularly in relation to a lack of understanding of what ward staff can
manage regarding knowledge/skill level and experience, where assumptions
can be made and ICU does not always appreciate the ward situation. Poor
communication between departments, along with a busy ward, a lack of
knowledge/skills, and a lack of resources (experienced staff) can potentially
lead to inadequate care on the wards Russell (1999.) Russell (1999) also
emphasises that one of the key factors to re-admissions to ICU is inadequate
follow-up on the general wards.
The provision of psychological support to patients and families by ward nurses
has been documented as a problem within the literature Haines (2001.) A
similar perception was revealed within this research regarding families. If
anything, caring for patients and families was seen as a part of nursing care
and not perceived as a cause of additional stress.
A study by Paul, Hendry and Cabreilli (2003) has lead to the development on
an information booklet the patients and their relatives preparing them for
transfer from the intensive care unit. Most importantly the study acknowledged
the need of greater staff education in regards to patients and the relatives
needs when transferring to the wards.
32
8 ETHICAL ISSUES AND TRUSTWORTHINESS
8.1 Reliability
Reliability means the ability of the instrument to produce consistent result.
(Bradley, 1993, 427). Since most of the nurses in the surgical wards are
Finnish, some of the questionnaires will be translated from Finnish to English
since they may be comfortable to in Finnish than English. And in order not to
bias immigrant nurses in these wards the original questionnaires in English
will also be sent to the wards so that they may be able to choose to answer
with whatever language they are comfortable with.
8.2 Ethical consideration
Ethics is the science of criteria, norms and values for human action and
conduct. It is engaged in reflection and analysis of morals concerning whether
an act is good or bad and how it influences our basic quest for meaning, our
search for humanity and our attempt to create a humane society. (South
African Medical Research Council 1993, 13). The researchers should ensure
Confidentiality in that it must be respected under all circumstances.
Documentation should be safeguarded and viewed as strictly private in terms
of the limits set by the research project. (South African Medical Research
Council 1993, 14). Informants and participants have a right to remain
anonymous. This right should be respected when no clear understanding to
the contrary has been reached. In ensuring confidentiality, the researcher may
not report private data that identifies participants that is questionnaires were
answered anonymously.
Ethics approval was sought and obtained from the overall head nurse of the
surgical ward department. Informed consent was given at the beginning of
each research group which outlined the purpose of study, their rights, and
issues surrounding the confidentiality of the study. Consent to participate to
this study was assumed with the filling of the questionnaire.
33
The researcher then went in person and explained to the participants the aim
of the research and went on by submitting the questionnaires to the respective
wards. After completing this research the researcher will take a copy of the
research to all the wards that participated in this study, and also go in person
to the wards and explain to them the feedback of the research.
8.3 Trustworthiness
Trustworthiness can be divided into four sections. Credibility, transferability,
dependability, conformability (Bradley, 1993.)
Credibility refers to the adequate representation of the constructions of the
social world under study (Bradley, 1993, 436). The questionnaires were
translated from English to Finnish to allow the Finnish speaking participants to
freely express their experiences. Since the researcher had enough Finnish
language skills, it was easier for her to conduct the research in Finnish.
Transferability refers to the extent to which the researchers’ working
hypothesis can be applied to another context. The researcher recommended
that this research be further utilised to examine the transition of patients from
ICU to the ward from an ICU nurses perspective
Dependability refers to the coherence of the internal process and the way the
researcher accounts for changing conditions in the phenomena (Bradley,
1993, 437). The information is not biased and is a true depiction of the study
carried out.
Conformability refers to the extent to which the characteristics of the data, as
posited by the researcher, can be confirmed by others who read or review the
research results
(Bradley, 1993, 437). Before the study, the researcher consulted all the
surgical head nurses who in turn forwarded the information to the participants.
34
8.4 Suggestions for the future
For intensive care nurses to appreciate the ward nurses’ workload.
To device a booklet for the families and patients to prepare them for the
discharge of patient to the ward.
It is recommended that there is the potential to explore the
development of extended roles such as an ICU Discharge/Liaison
Nurse to co-ordinate/oversee the transition of patients from ICU to the
general wards, with involvement in activities such as a ward liaison,
patient care and support, ward staff support and family education and
support. Such a role would assist in networking between different
areas, improve understanding of different workload pressures and
assist in breaking down perceived barriers between ICU and the ward.
Ward nurses stated that transfer forms did not cover everything the
ward needed to know. In view of this it is recommended that a clinical
practice group be established to review of all three transfer forms in
consultation with the wards to ensure relevant information required by
the wards is given, to ensure continuity of patient care.
It is recommended that a shared collaborative process occurs to gain
multiple perspectives on new ways to facilitate the transition of patients
from ICU to the ward to ensure continuity of patient care and improve
communication process between ICU and the ward involving ICU
nurses, ward nurses, patients and families.
It is recommended that a mechanism be established to address the
feasibility of all ward conducting pre-transfer visits to ICU prior to
patient transfer. Pre-transfer visits would assist ward staff in knowing
what to expect and allows them to prepare for receiving the patient
from ICU. This process would also allow the ward to allocate suitably
experienced staff to care for that patient and determine overall acuity
and therefore plan nursing workloads.
35
The nurses stated that they felt ICU nurses forget what it is like in the
ward environment. In light of this it may be useful for a mechanism to
be established so that transfer processes and experiences can be
shared between ICU staff and ward staff. In this way recommendations
for practice change to enhance patient outcomes can be developed
jointly.
Family pre transfer visit to the wards would prepare the family members
psychologically on what is to come ahead in the continuation of care.
36
9 CONCLUSIONS
When patients are critically ill, they require access to sophisticated technology
and skilled heath care practitioners in the intensive care unit. After a close
surveillance in the intensive care unit and specialised medical and nursing
care, patients in this study were discharged to the general wards where there
is a significant reduction in the provision of the health care services. Unlike the
intensive care unit the general wards were predominantly staffed by
inexperienced health care practitioners. This study has identified the need of
collaboration between the intensive care unit nurses and the surgical ward
nurses as a mutual endeavour, which will ultimately advance the care of
patients and their families.
The finding in this study and the examination of the available literature could
support the useful changes in the way transfer from the intensive care unit to
the general wards is organized. By planning and discussion with the
multidisciplinary team within the intensive care unit and the general wards, the
transfer process can be redesigned in order to reduce the patients stress.
The ability of the general wards to manage patients with significant heath care
needs, such as pleural or ascetics drains, tracheotomies, central venous
catheters may lead to readmission to the intensive care unit.
Communication is also an important part of the process, as it allows
professionals to give and ask for opinions, defends themselves, find out where
they stand in relation to others, and formulate a discharge plan. Apart from the
depth and richness of our qualitative data, the main strengths of this study lie
in the narrating of the nurses themselves which enable them to give voice to
their experiences, allowing greater understanding of how surgical nurses
make sense of their experience.
37
It is recommended that further research be done in exploring the experiences
and challenges for ward nurses in receiving patients from ICU due to the
limited nursing literature available, and the findings from this research be
utilised to conduct a wider study, using a different methodology, of all ward
nurses experiences of receiving patients from ICU within the study setting
hospital.
38
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42
Appendix 1
Jyväskylän ammattikorkeakoulu
Hyvinvointiyksikkö
Terveysala
PL 207
40101 Jyväskylä
Hyvä Johtava Ylihoitaja,
Olen hoitotyönopiskelija Jyväskylän ammattikorkeakoulusta Hyvinvointiyksiköstä
terveysalalta. Valmistun syyskuussa 2009 Degree programme in Nursing –
koulutusohjelmasta. Kysyn lupaa opinnäytetyöhön, jonka aiheena on Sairaanhoitajien
odotukset potilaan siirrettyessä, teho –osastolta kirurgiselle osastolle.
Opinnäytetyöni tavoitteena on selvittää Jorvin kirurgisten vuodeosastojen
sairaanhoitajien odotuksia yhteistyöstä teho-osaston sairaanhoitajien ja muun
henkilökunnan kanssa, kun potilas on siirretty kirurgiselle osastolle. Lisäksi
tavoitteena on selvittää, millainen informaatio on tärkeää sairaanhoitajan kannalta
otettaessa potilas vastaan teho-osastolta kirurgiselle vuodeosastolle. Tarkoituksena
on myös kehittää ja yhtenäistää siirtoprotokollaa teho-osaston ja kirurgisen osaston
välillä.
Yhteistyökumppaneina ovat Jorvin sairaalan teho-osasto sekä kirurgian osastot K3,
K4, K5, K6 ja K7. Työelämän ohjaajana toimii teho-osaston osastonhoitaja (ts,TtM)
Anneli Övermark. Opinnäytetyön ohjaajana toimii Jyväskylän ammattikorkeakoulun
lehtori Kaisu Paalanen
Tutkimuksen aineiston keruu suoritetaan kyselylomakkeen avulla. Aineiston keruu
tapahtuu keväällä 2009. Kyselylomakkeeseen vastataan nimettömänä, eikä
sairaanhoitajien henkilöllisyys tule esille mitenkään tutkimuksen missään vaiheessa.
Ystävällisesti
Espoossa 8.4.09
Opinnäytetyöntekijä
Appelles Ohanga 044 935 2440.
E-mail: [email protected]
43
Appendix 11
Arvoisat vastaanottajat
Olen hoitotyönopiskelija Jyväskylän ammattikorkeakoulusta Hyvinvointiyksiköstä
terveysalalta. Valmistun syyskuussa 2009 Degree programme in Nursing –
koulutusohjelmasta. Teen opinnäytetyötä, jonka aiheena on Sairaanhoitajien
odotukset potilaan siirretyssä, teho –osastolta kirurgiselle osastolle. Opinnäytetyö,
kuten muukin opiskelu, suoritetaan englanninkielellä.
Opinnäytetyöni tavoitteena on selvittää Jorvin kirurgisten vuodeosastojen
sairaanhoitajien odotuksia yhteistyöstä teho-osaston sairaanhoitajien ja muun
henkilökunnan kanssa, kun potilas on siirretty kirurgiselle osastolle. Lisäksi
tavoitteena on selvittää, millainen informaatio on tärkeää sairaanhoitajan kannalta
otettaessa potilas vastaan teho-osastolta kirurgiselle vuodeosastolle. Tarkoituksena
on myös kehittää ja yhtenäistää siirtoprotokollaa teho-osaston ja kirurgisen osaston
välillä.
Tutkimus kohderyhmänä ovat Jorvin sairaala kirurgian tulosyksiköstä osastot K3, K4,
K5, K6 ja K7. Työelämän ohjaajana toimii teho-osaston osastonhoitaja (ts,TtM) Anneli
Övermark. Opinnäytetyön ohjaajana toimii Jyväskylän ammattikorkeakoulun lehtori
Kaisu Paalanen
Tutkimuksen aineiston keruu suoritetaan kyselylomakkeen avulla. Aineiston keruu
tapahtuu 17.6.2009 – 25.6.2009. Kyselylomakkeeseen vastataan nimettömänä, eikä
sairaanhoitajien henkilöllisyys tule esille mitenkään tutkimuksen missään vaiheessa.
Ystävällisesti
Espoossa 28.5.09
Opinnäytetyöntekijä
Appelles Ohanga
044 935 2440. E-mail: [email protected].
44
Appendix 111
Dear Nurse
I’m a nursing student in Jyväskylä polytechnic, health care department, taking Degree
programme in Nursing, hoping to graduate in September 2009. I’m doing my
bachelors thesis with the topic: Registered nurses expectations when a patient is
transferred from the intensive care unit to the surgical ward. This research is
conducted in English just like my studies.
The purpose of this bachelor’s thesis is to explore the expectation of Jorvi surgical
ward nurses about cooperation with the intensive care unit nurses and other staff,
when a patient is transferred to the surgical ward to create a clear transfer process.
The aim of this bachelor’s thesis is
To discover what information is relevant to the nurses receiving patients from
the intensive care unit.
To highlights problems that occur at discharge from the ICU and how to
address them for instance through the consulting the ICU nurses.
To standardise the discharge protocol that will address the need of both the
ICU and surgical ward staff.
The research will be conducted in Jorvi hospital, surgical wards K3, K4, K5, K6, and
K7. Working life connection Mentor is intensive care unit, head nurse Annelli
Övermark. Bachelors’ thesis mentor is Jyväskylä polytechnic lecture Kaisu Paalanen.
Data will be collected through questionnaires that will be sent to the wards between
28.5.2009-10.6.2009. Questionnaires will be answered anonymously so that nurses’
identity will not be revelled in any state of the research.
Thank you for participating.
28.5.2009
Bachelors’ thesis Author
Appelles Ohanga
0449352440. E:mail: apalaceohanga(at)hotmail.com
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Appendix 1V
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Appendix V
KYSYMYSLOMAKE
Ikäryhmä
20-30
31-40
41-50
51-60
>60
Ammattinimike…………………………………………………………………………
Työaika
koko päivä
osa aika
Osasto
K3
K4
K5
K6
K7
Työkokemus
1-5 vuotta
6-10 vuotta
11-20vuotta
>20 vuotta
Kansallisuus
Suomi
Muu, mikä?...............................................................................................
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1 Mitkä ovat odotuksesi potilaan voinnista kun potilas vastaanotetaan
teho osastolta?
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2 Millaista tietoa haluaisit saada tavallisen raportin lisäksi potilaan siirtyessä
teho osastolta?
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3. Oletko kohdannut ongelmia potilaan siirryttyä teho osastolta?
Kyllä
Ei
Jos kyllä, millaisia ongelma?……………………………………………………..
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4. Kuinka teho osaston hoitajat voivat olla avuksi ongelmissa?…………….
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5 Millainen teho osaston hoitohenkilökunnan ja lääkärien osallistuminen
tukisi potilaan toipumista kirurgisella vuodeosastolla?....................
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Appendix V1
QUESTIONNARE
Age group
20-30
31-40
41-50
51-60
>60
Basic qualification………………………………………………………………
Working times
Full time
Part time
Ward
K3
K4
K5
K6
K7
Years of experience
1-5 years
6-10 years
11-20years
>20 years
Citizenship
Finnish
Other, Which one?................................................................................
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1. What are your expectations of the patients condition, when receiving a
patient from the intensive care unit?..........................................................
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2. What information would you like to be given apart from the usual
discharge information when a patient is discharged from the intensive
care unit?
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6 Have you ever experience problems from patients discharged from the
intensive care unit?
Yes
No
If yes, what kind of problems? ………………………………..
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4. How can the intensive care unit nurses help resolve there problem?
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5. What kind of involvement from the intensive care unit nurses and doctors
do you think would support patients discharged from the intensive care unit
during recovery in the surgical wards?
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