Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Jun 2007
The level of knowledge of respiratory physiology articulated by intensive care nurses to provide rationale for their clinical decision-making.
The combination of intensive care knowledge, and the ability to articulate analytical decision-making processes to the interdisciplinary team, enhances the clinical credibility of the intensive care unit (ICU) nurse. The objective of this paper is to outline a study firstly, assessing ICU nurses' ability in articulating respiratory physiology to provide rationale for their clinical decision-making and secondly, the barriers that limit the articulation of this knowledge. ⋯ Thematic analysis identified the barriers limiting this use of respiratory physiology as being inadequate coverage of concepts in some ICU programmes; limited discussion of concepts in clinical practice; lack of clinical support; lack of individual professional responsibility; nurses' high reliance on intuitive knowledge; lack of collaborative practice; availability of medical expertise; and the limitations of clinical guidelines and protocols. These issues need to be addressed if nurses' articulation of respiratory physiology to provide rationale for their clinical decision-making is to be improved.
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The implementation of tight glycaemic control (TGC) is becoming accepted best practice within intensive care units throughout the world. It is recommended by the Surviving Sepsis Campaign and is included in the sepsis care bundle. The major impact of TGC is currently thought to be associated with reduced morbidity and mortality. ⋯ The transfer of patients from the intensive care unit to the operating theatre or for computerised tomography during intensive insulin therapy is also hazardous. The purpose of this paper is to describe a series of nurse led pilot studies which aimed to introduce the process of TGC whilst maintaining patient safety. The results demonstrate the effectiveness of a staged approach and the achievement of TGC.
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Intensive Crit Care Nurs · Jun 2007
The impact of an evidence-based practice education program on the role of oral care in the prevention of ventilator-associated pneumonia.
Despite strong evidence in the literature on the role of oral care in the prevention of ventilator-associated pneumonia (VAP), nurses continue to view oral care as a comfort measure with low priority and utilise foam swabs rather than toothbrushes. Although an evidence-based oral care protocol existed and best-practice oral care tools were available, the VAP rates had not significantly decreased even though nurses reported providing oral care. ⋯ The implementation of an EBP educational programme focused on patient outcome rather than a task to be performed improved the quality of oral care delivered by the nursing staff.
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Intensive Crit Care Nurs · Apr 2007
ReviewNursing care of the mechanically ventilated patient: what does the evidence say? Part two.
The care of the mechanically ventilated patient is a fundamental component of a nurse's clinical practice in the intensive care unit (ICU). Published work relating to the numerous nursing issues of the care of the mechanically ventilated patient in the ICU is growing significantly, yet is fragmentary by nature. ⋯ In part one of this two-part paper, the evidence on nursing care of the mechanically ventilated patient was explored with specific focus on patient safety: particularly patient and equipment assessment. This article, part two, examines the evidence related to the mechanically ventilated patient's comfort: patient position, hygiene, management of stressors (such as communication, sleep disturbance and isolation), pain management and sedation.
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Intensive Crit Care Nurs · Apr 2007
ReviewSubstance use and its implications for the critical care nurses: a literature review.
Illicit drug use in Australia has been increasing and studies indicate that illicit drug users have a higher risk of accidents which may result in the user needing critical care. However, there is a significant gap in the literature specifically pertaining to the implications of drug use in critical care. ⋯ Both nursing and medical staff need to have a thorough understanding of how illicit substances work and how they can affect the critical care patient and the care they are given.