Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Mar 2012
ReviewCritical care nursing and delirium management in the mentally ill client.
The critical care environment is an experience of stress for the patient and the practitioner. Turbulence can occur during the critical care course, which can cause exacerbation of chronic conditions. These exacerbations can lead to delirium and/or psychosis. ⋯ On the contrary, mental disorders are chronic conditions, not unlike diabetes mellitus or congestive heart failure. What the critical care nurse needs is a knowledge base in order to feel more comfortable in caring for these clients. Knowledge is empowerment.
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Crit Care Nurs Clin North Am · Mar 2012
Review Meta AnalysisHow professional nurses working in hospital environments experience moral distress: a systematic review.
The experience of moral distress for professional nurses working in hospital environments causes a myriad of biological, psychological, and stress-related reactions. There is an institutional culpability in producing an environment where moral distress is experienced. This is particularly true when nurses feel the need to advocate for patients' well-being while coping with institutional constraints. ⋯ Critical care nurses need to recognize moral distress and its adverse impact on providing optimal patient care. Critical care nurses should make a personal commitment that moral distress will not impact their nursing care and take a leadership role in their units to address this issue with their employing institution and develop strategies to lessen the impact of moral distress. These strategies should be based on the best available evidence such as this systematic review and other relevant appraised works.
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The health care costs for patients with delirium were estimated to be more than double the costs for patients without delirium and potentially exceeded the costs for falls, diabetes mellitus, and hip fractures; yet the fluctuating nature of the condition makes it a difficult condition for health professionals to recognize and treat. The key, then, is in recognition and prevention.
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Crit Care Nurs Clin North Am · Mar 2012
ReviewStraddling the fence: ICU nurses advocating for hospice care.
A key factor in nurses' experiencing moral distress is their feeling of powerlessness to initiate discussions about code status, EOL issues, or patients' preferences. Moreover, nurses encounter physicians who give patients and their families a false picture of recovery or, worse, block EOL discussions from occurring. Since its release in 1995, the landmark study of almost 10,000 patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) reported a widespread gap with physicians' discussions in honest prognosis and EOL issues. ⋯ The ICU nurse should be proficient in communication skills, using evidence-based communication related to functional status, performance scales, disease trajectory, and prognosis. ICU nurses recognize that not every patient survives their ICU stay; yet, for those patients who will not survive, every ICU nurse wants their patient to experience a "good death." Hospice and the palliative care are important aspects of our care continuum and should not be ignored until the last days or hours of a patient's life. Recognizing eligibility for hospice and its alignment with patient EOL preferences can result in optimal EOL care.