Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Dec 2001
Using nurse-sensitive outcomes to improve clinical practice.
With the many uncertainties in the current health care milieu and continuing movement from general guidelines to ensure an optimal practice approach, it is especially vital that critical care nurses facilitate a research culture in their workplace and strive to improve clinical practice through understanding and evaluating research. Outcomes research helps to identify discipline-specific accountability in patient care. ⋯ Outcomes research continues to be instrumental in defining a base for nursing practice. Although it is not necessary or even desirable that all nurses conduct research, nurses are accountable for providing scientific and appropriate care to ensure the optimal outcome for the patient.
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Crit Care Nurs Clin North Am · Jun 2001
ReviewAssessment and management of pain in the critically ill pediatric patient.
Alhough considerable progress has been made in the past decade in the study of pain in children, numerous myths, inadequate assessment, and insufficient knowledge of available treatment continue to contribute to the lack of effective management of children's pain. Clinicians who lack knowledge have misconceptions about pain contribute more to the problem than to the problem's solution. Adequate analgesia is to be provided to even the sickest child the medications, techniques, and approaches reviewed here.
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Crit Care Nurs Clin North Am · Jun 2001
ReviewMonitoring and improving pain management practices. A quality improvement approach.
The development of a multidisciplinary pain management committee is a critical step in monitoring and improving pain management practices. The systematic evaluation of the quality of pain management using the principles of QI establishes a process that can lead to improvements in the care that patients receive. Clinicians need to develop a 1- to 2-year plan to improve the quality of pain management. Changes in clinicians' behaviors occur slowly; thus, members of pain management committees should not become discouraged but continue to move forward one step at a time.
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Management of pain in the trauma patient is a complex issue requiring the ability to selectively match different injuries and patient situations with the most optimal pain management methods. Having an understanding of the various stages of trauma care helps clinicians to best support the goals of patient care while decreasing the detrimental effects of the stress response through good pain control interventions. When nurses have a good understanding of the various pain management interventions they are better able to assess the effectiveness, potential side effects, and goals of therapy. ⋯ Use of nonopioid drugs, if not contraindicated should be considered in all trauma patients. This is especially true for patients sustaining trauma and being discharged to home within 24 hours. They need to be educated about the pain they can expect the next day and how to judge if it is normal and expected or possibly the sign of a missed injury or developing complication (i.e., compartment svndrome infection).
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Accurate assessment of pain in the critically ill is undoubtedly a challenge. In this setting, however, the nurse can rise to the challenge and have a significant impact on pain management. Some careful thought and planning may allow the nurse to adapt usual assessment tools for use by patients who have difficulty in communicating. ⋯ In addition, more studies are needed to document the reliability and validity of scales based on behavioral and physiologic indicators of pain in critical care settings. In the meantime, nurses can take several steps to ensure adequate pain assessment: (1) use all means possible to document the patient's self-report of the pain experience, (2) supplement these ratings with behavioral and physiologic indicators of pain status, and (3) document findings to comunicate the patient's pain to others caring for the patient. A careful thorough attempt to assess pain can ensure better pain, outcomes as well as a quicker and more positive return to health.