Ostomy/wound management
-
Ostomy/wound management · Dec 2003
ReviewIndwelling catheter management: from habit-based to evidence-based practice.
Indwelling urinary catheters are used in the care of more than five million patients per year. Prevalence rates range from 4% in home care to 25% in acute care. Catheter-associated urinary tract infections account for more than 40% of all nosocomial infections and can be associated with significant complications. ⋯ Practices such as routine catheter irrigation should be avoided. Current recommendations related to the management of encrustation and blockage also are discussed. Providing evidence-based catheter management strategies may reduce the rate of catheter-associated urinary tract infection, catheter encrustation, and leakage as well as the discomfort and costs associated with these complications.
-
With few exceptions, personal privacy has long been an ethical right and legal mandate. Clinicians, policy makers, and consumers are challenged to find a balance between allowing consumers to be protected and allowing clinicians to meet patient care needs. ⋯ The ethical principle of patient confidentiality, including the right to personal privacy, is reviewed along with its relationship to computer-generated wound care tracking programs that transcend practice settings. Options for Health Insurance Portability and Accountability Act (HIPAA) compliance are presented.
-
Assessing a patient's capacity to make competent decisions concerning her own care is an important clinical skill in healthcare, especially among those who are elderly, chronically ill, and institutionalized. Competency is an important presupposition to autonomous decision making. ⋯ The essence of autonomy is described as it relates to defining meaningful informed consent. This article includes a model for assessing competence.
-
The debate surrounding euthanasia may have existed before recorded history, yet it continues today. Advanced technology, with its implication on prolonging life and postponing death in some cases, further complicates the debate. This column includes a historical review of euthanasia, related terminology, and proposed guidelines. The implications of recent legislation on enhancing discussions around terminal care are also reviewed.