Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Oct 2006
An evaluation of an early warning clinical marker referral tool.
The purpose of this study was to evaluate the introduction of a clinical marker tool using a pre- and post-test design in a tertiary university-affiliated hospital. The clinical marker tool was designed to assist in the early identification of unstable patients in the general surgical and medical ward environment based on abnormal vital signs. ⋯ The clinical marker tool implemented by an ICU Liaison Team improved the management of patients in the ward environment, including proactive admission of patients to the ICU. Additionally, implementation of the clinical marker tool was associated with a reduction in the number of cardiac arrests and improvement in hospital mortality for patients experiencing a medical emergency call. The timeframe of instability on the ward prior to the ICU admission may be used as a quality indicator to measure ICU Liaison Team performance. Further research is required to substantiate these findings.
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Intensive Crit Care Nurs · Oct 2006
Case Reports Comparative StudyA comparative study examining the decision-making processes of medical and nursing staff in weaning patients from mechanical ventilation.
A prolonged period of mechanical ventilation is costly for both the patient, in terms of the risk of complications such as ventilator-acquired pneumonia, and to the health service due to the high cost of maintaining a patient in intensive care. The recognition of the role nurses can play in the weaning process and the desire to try and reduce weaning times led to the introduction of nurse-managed weaning on the intensive care unit which is the focus of this study. This means that both doctors and nurses are now responsible for making decisions about weaning. ⋯ This study examined the ways doctors and nurses make these decisions. Semi-structured interviews were conducted with doctors and senior nurses. A grounded theory approach was used to analyse the results and the key themes of Treatment, Balance, Making Progress and The Individual were identified which were found to be linked with particular methods of decision-making.
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Intensive Crit Care Nurs · Oct 2006
The experiences of trained nurses caring for critically ill patients within a general ward setting.
The concept that critical care is a service rather than a location has been increasingly highlighted. However, there is limited information regarding nurses' perceptions of caring for critically ill patients outside of high dependency areas. ⋯ Whilst the findings of this study cannot be generalised, analysis of the data has provided an insight into the complex factors that effect care delivery. In order to respond to this study's findings, there are resource implications. Educational requirements and communication skills will need to be developed.
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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.