Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialA randomised controlled trial of weaning from mechanical ventilation in paediatric intensive care (PIC). Methodological and practical issues.
Most children admitted to the Paediatric Intensive Care Unit (PICU) require assistance with breathing via a mechanical ventilator. Weaning from mechanical ventilation is the transition from ventilatory support to spontaneous breathing. Traditionally weaning has been with the authority of the medical staff. However, current opinion suggests that weaning could be performed by nurses using a standardised protocol [Schultz TR, Lin RJ, Watzman HM, Durning SM, Hales R, Woodson A, et al. Weaning children from mechanical ventilation: A prospective randomised trial of protocol-directed versus physician-directed weaning. Respir Care 2001;46(8):772-82]. The potential advantages of nurse-led (protocol-directed) weaning include: A reduction in weaning time and PICU stay with cost savings. Reduced complications. Improved quality of care. Appropriate use of resources. ⋯ The trial was unsuccessful due to Recruitment issues. Physical constraints. Impractical entry criteria. Limited randomisation service. Ethical constraints. Barriers to parental participation. The methods, the difficulties encountered and the implications for future research are addressed.
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Intensive Crit Care Nurs · Apr 2005
Development of a new eye care guideline for critically ill patients.
Ventilated, critically ill patients have an increased risk of corneal exposure and microbial keratitis; however there is evidence that eye care is a neglected area of patient care. An audit of eye surface disease and eye care documentation revealed a problem within one general intensive care unit (GICU). An education programme was developed to highlight the incidence of eye surface disease and importance of eye care in the ventilated patient.
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Intensive Crit Care Nurs · Apr 2005
Finding the voice of clinical experience: participatory action research with registered nurses in developing a child critical care nursing curriculum.
The voice of clinical nurses is important to find and hear in the design of curricula. A participative action research project proposed to add this voice to the design of a new Critical Care Child Nursing programme at the University of Cape Town (UCT). Nurses' experiences of nursing critically ill children and their perceived learning needs in this context, were the central focus of the study. ⋯ Findings indicate that the Critical Care Child Nurse needs not only a specialised knowledge base and acutely developed assessment skills, but also astute interpersonal skills. The nurse's professional identity and integration into the multidisciplinary team need exploring. Together with the development of interpersonal skills, the nurse needs to engage the child and family.
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Between 1995 and 2002 seven clinical audits were undertaken in consecutive periods over twelve months to determine the frequency and risk factors associated with reported unplanned extubation (UE) within a 22-bed general and surgical Intensive Care Unit (ICU). Nursing and medical staff provided information on the patient's age, diagnosis, mental status, precipitating causes and investigations/treatment ordered. Following the first audit, modifications were made to include anonymous reporting. ⋯ Unplanned extubation incidence subsequently decreased in Surgical ICU following the introduction of clinical pathways, early weaning and nurse led extubation. Monitoring UE in ICU provides important information on the quality of care. We would recommend a system of anonymous reporting to more freely reflect incidence.