Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Dec 2007
ReviewPart 2. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: a patient perspective.
An important goal of the care for the mechanically ventilated patient is to minimize patient discomfort and anxiety. This is partly achieved by frequent use of chemical and physical restraints. The majority of patients in intensive care will receive some form of sedation. ⋯ However, very few papers illuminate the patient's experience of physical and chemical restraints as a treatment strategy. In Part 1 of this two-part review, the evidence on chemical and physical restraints was explored with specific focus on definitions of terms, unplanned extubation, agitation, delirium as well as the impact of nurse-patient ratios in the ICU on these issues. This paper, Part 2, examines the evidence related to chemical and physical restraints from the mechanically ventilated patient's perspective.
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Intensive Crit Care Nurs · Dec 2007
Controlled Clinical TrialThe effect of an ICU liaison nurse on patients and family's anxiety prior to transfer to the ward: an intervention study.
While an admission to the Intensive Care Unit (ICU) is stressful, the impending transfer from ICU to the ward can also result in anxiety for patients and their families. The aim of this study was to identify the effect of an ICU liaison nurse on anxiety experienced by patients and their families just prior to transfer to the ward. This block intervention study used a repeated before and after design, with the first control and intervention periods of 4 months, a wash-out period of 1 month, and then a second control and intervention period of 4 months duration. ⋯ A total of 115 patients (62 control, 53 intervention) and 100 families (52 control, 48 intervention) were enrolled in the study. There was no difference in anxiety scores between the control and intervention groups in either patients or family groups. This study did not demonstrate a statistically significant beneficial effect of the liaison nurse in terms of pre-transfer anxiety, however it highlights several methodological issues that must be considered for future research including sample size estimates, timing and measurement of transfer anxiety and finally the intervention itself.
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Critically ill patients are admitted to intensive care units (ICUs) to receive advanced technological and medical treatment. Some patients seem not to benefit from the treatment, and sometimes questions are raised as to whether treatment should be withheld or withdrawn. This study was conducted using ICU nurses' experiences with the aim of acquiring a deepened understanding of what good nursing care is for these patients. ⋯ The results show that good nursing care depended on several basic conditions: continuity, knowledge, competence and cooperation, and included clear goals to give appropriate life-saving -- or end-of-life treatment and care. Cornerstones in good nursing care were nurses' verbal communication and nurses' use of their hands. The study emphasises several consequences for future ICU nursing practice and education to enhance good nursing care to patients on the edge of life.
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Intensive Crit Care Nurs · Dec 2007
Nursing activities score (NAS): a proposal for practical application in intensive care units.
For over 30 years in an attempt to demonstrate the cost-benefit ratio of the intensive care unit (ICU) a variety of tools have been developed to measure not only the severity of illness of the patient but also to capture the true cost of nursing workload. In this context, the nursing activities score (NAS) was developed as a result of modifications to the therapeutic interventions scoring system-28 (TISS-28). ⋯ This paper discuss the introduction of the NAS into everyday use in an intensive care unit in Brazil and highlights the challenges of standardisation of operational definitions, training requirements and accurate completion of the documentation when using such a tool. The rationale and steps undertaken to achieve this are outlined and the benefits of such a process are highlighted.