Heart & lung : the journal of critical care
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The American Association of Critical-Care Nurses developed a Demonstration Project to document fiscal costs and patient care effectiveness of critical care nursing in a unit characterized by valued organizational attributes. Data were collected by interview, observation, and written surveys from 42 nurses, 68 physicians, and 192 patient admissions. ⋯ The proportion of charges for nursing-controlled factors was low compared with proportion of total stay spent in the unit. Aspects of structure, process, and outcome can be measured simultaneously in critical care; these measurements indicate that positive organizational and clinical outcomes coexist with valued aspects of the organizational environment.
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Epidural analgesia is an important intervention in patients with pain after surgery. This article presents a brief overview of the anatomy of the epidural space and the physiology of pain transmission, including the action of narcotics in pain relief. The importance of written nursing protocols and in-service education for nursing staff members is discussed as being a necessary prerequisite for the safe use of epidural analgesia. ⋯ The discussion emphasizes the management of potential side effects from epidural narcotics (respiratory depression, urinary retention, pruritus, pain on injection, dizziness, nausea, and vomiting) and includes information on the use of a narcotic antagonist. Recommendations are made for preoperative and postoperative teaching of the patient and family. A variety of tools for assessing patients' pain levels are described, and a comprehensive nursing care plan with nursing diagnoses and nursing interventions is provided.
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In this time series design study we investigated the effects of conversation on intracranial pressure (ICP). Two conversation types were used, and continuous measurements of ICP were recorded. Type 1 conversation was an emotionally referenced conversation that reflected an actual nursing report on the patient's current condition. ⋯ There was, however, a statistically significant decrease in ICP when minimum ICP measurements before type 2 conversations were compared with measurements recorded during type 2 conversation. The data also demonstrated a wide variation of individual patient responses. The results of the current study suggest that the direction of influence from conversation on the ICP is individual and may be influenced greatly by the patient's level of consciousness.