Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Aug 2006
Review Case Reports'Death rattle' after withdrawal of mechanical ventilation: practical and ethical considerations.
The noise produced by oscillatory movements of secretions in oropharynx, hypopharynx and trachea during inspiration and expiration in unconscious terminal patients is often described as 'the death rattle'. The reported incidence of death rattle in terminally ill patients varied between six and 92%. It is most commonly reported in patients dying from pulmonary malignancies, primary brain tumours or brain metastases, and predicts death within 48 hours in 75% of the patients. ⋯ This article provides practical and ethical considerations in the management of this near-death symptom. The fact that relatives were relieved in almost all cases, in which a positive effect was obtained, makes treatment in anticipation of death rattle an ethical demand. In practice, injectable scopolamine is the reference drug for symptomatic treatment of death rattle.
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The purpose of this project was to audit clinical practice and to investigate the time taken to wean patients using continuous positive airway pressure (CPAP) as a method of respiratory support prior to the introduction of a weaning protocol. Data was collected over a two-month period and 43 patients were included in the audit. Criteria for inclusion were that each patient had previously received mechanical ventilation and was subsequently weaned with the aid of CPAP or had received CPAP and was weaning from CPAP alone. ⋯ However, there was a consistency in the time spent on CPAP as a percentage of the total weaning time. The audit identified large variations in the process and time taken to wean patients from CPAP. This might suggest that CPAP is used in a routine or arbitrary manner rather than a selective response to patients' specific needs.
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Intensive Crit Care Nurs · Aug 2006
The influence of patient complexity and nurses' experience on haemodynamic decision-making following cardiac surgery.
Critical care nurses' haemodynamic decision-making in the immediate postoperative cardiac surgical context is complex. To optimise patient outcomes, nurses of varying levels of experience are required to make complex decisions rapidly and accurately. In a dynamic clinical context such as critical care, the quality of such decision-making is likely to vary considerably. ⋯ The quality of nurses' decision-making was influenced by interplay between the complexity of patients' haemodynamic presentations, nurses' levels of cardiac surgical intensive care experience, and the form of decision support provided by nursing colleagues. Two factors specifically influenced decision-making quality: nurses' utilisation of evidence for practice and the experience levels of both nurses and their colleagues. The findings have implications for staff resourcing decisions and postoperative patient management, and may be used to inform nurses' professional development and education.
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Intensive Crit Care Nurs · Aug 2006
A description of healthcare providers' perceptions of the needs of significant others in intensive care units in Norway and Sweden.
Healthcare providers (registered nurses, physicians and enrolled nurses) at intensive care units (ICU) in Norway and Sweden participated in a survey, the purpose of which was to investigate their perceptions of the needs of critically ill adult patients' significant others based on the Critical Care Family Needs Inventory (CCFNI). Four categories were revealed through qualitative content analysis of handwritten responses to the open ended item. 'The need to feel trust in the healthcare providers' ability' and 'the need for ICU and other hospital resources' had the highest response frequency and, together with the category 'the need to be prepared for the consequences of critical illness', confirmed factors revealed in previous statistical analysis that employed this structured tool. ⋯ In conclusion, needs not previously explored when examining the CCFNI, but perceived by healthcare providers to be important to significant others in ICUs, were revealed by means of quantitative and qualitative analyses employing the instrument. These findings can contribute to the development of interventions that could be tested to evaluate whether they improve the ICU experiences of patients and their significant others.