Dimensions of critical care nursing : DCCN
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The grief and anxiety of complex medical illness, with a high likelihood of death, strains communication between medical staff and patients' families in the intensive care unit (ICU). For decades, the emphasis has been on curative intent and a paternalistic approach to decision making, which has been fostered by physicians, when patients are unable to communicate for themselves. However, the past 15 to 25 years have seen a paradigm shift in both what families expect from physicians and what physicians see as the goal of medical (especially ICU) care with respect to the patient and family wishes. This article will address this topic.
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Dimens Crit Care Nurs · Mar 2005
A philosophical yet user-friendly framework for ethical decision making in critical care nursing.
Nurses must frequently make ethical decisions. These decisions require judgment, knowledge, and skills. This article will provide one framework for ethical decision making and provide several examples of the process.
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Strong and effective clinical leadership is needed by practicing nurses as our healthcare systems continue to decentralize and shift decision making closer to the bedside. Innovation and new ways of leading and following are required. New forms of clinical leadership can energize and transform today's work environments.
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Cancer cachexia is a syndrome of progressive body wasting characterized by loss of adipose tissue and skeletal muscle mass. It is the most common side effect of malignancy occurring in approximately one-half of untreated cancer patients. The pathophysiology of cancer cachexia is not fully understood; however, studies have shown that cytokines are important in the alteration of carbohydrate, lipid, and protein metabolism. ⋯ An uncertainty with cachexia is whether nutritional support is feeding the patient or the tumor. Often, cachexia is not responsive to simple nutritional interventions. Furthermore, appetite stimulants, cytokine inhibitors, and Cori cycle inhibitors have been used to treat cancer cachexia.