Critical care nursing quarterly
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Heideggerian hermeneutics is used to illuminate the dialogues of 23 participants who experienced the death of a family member in the critical care unit within the past year. Those constructs that were considered helpful and satisfying during the process of losing the family member included information from the hospital staff, support from the family, and unrestricted visits. ⋯ Constructs that were considered helpful and satisfying in the time since death were family, friends, and clergy. Those that were considered unhelpful and dissatisfying since death included legal/financial problems, dealing with bureaucracies, dealing with other bereaved family members, funeral homes, and organ donation.
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Review Case Reports
Special feature: exploring the benefits and myths of enteral feeding in the critically ill.
Patients in the intensive care unit setting have been nutritionally deprived for various reasons. Many patients who are critically ill cannot absorb nourishment by traditional routes. Enteral feeding should be considered for all patients who cannot meet caloric needs. ⋯ Many critical care nurses subscribe to myths for not feeding their patients. The myths for not feeding critically ill patients involve gut motility, feeding residuals, and patient positioning. There is significant evidence both to support nutrition as integral to recovery from a critical illness and to suggest that enteral feeding is efficient and effective at providing nutrition.
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Clinical Trial
Effect of head positioning on intracranial blood flow velocities in acute ischemic stroke: a pilot study.
Current nursing practice for the care of patients with ischemic stroke advocates routine elevation of the head of the bed (HOB) to 30 degrees. Evidence supporting this practice is lacking, and it may reflect inappropriate generalization of findings from studies conducted primarily on traumatic brain injury patients with associated increased intracranial pressure to the ischemic stroke population. We used a repeated measures design to conduct a pilot study of the effect of three HOB positions on middle cerebral artery mean flow velocities (MCA-MFV) in patients with acute ischemic stroke. ⋯ Mean arterial pressure, heart rate, and pulse pressure remained stable without significant change throughout the positioning intervention and measurement period. The overall increase in MCA-MFV achieved from lowering the HOB position from 30 degrees to a flat position was 13.1% (p = .054). Our findings from this small sample suggest that patients with acute ischemic stroke may benefit from lower HOB positions, in particular flat positioning, to promote an increase in flow to ischemic brain tissue that may ultimately reduce brain infarct volume.
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Hospitals are planning and designing new environments to accommodate a greater concentration of critically ill patients and to permit the installation of sophisticated technology required for the care of this high-acuity population. A serious nursing shortage, customer demands for privacy and personal amenities, and cost constraints pose numerous problems in planning and design processes. The flexible, acuity-adaptable room concept has been introduced as a platform for changing care processes to achieve a cost-effective care model that fosters nursing efficiency and increased customer satisfaction.
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The task of designing a new critical care unit is best accomplished with the input of people representing multiple disciplines including architects, engineers, physicians, nurses, and equipment manufacturers. It is imperative that the critical care nursing staff and management take an active role in planning the layout of the unit and patient rooms, as the nurses will be the bedside providers 24 hours a day. The new unit should be designed to offer efficient patient care as well as a healing, comfortable environment for both the patients and their families.