Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Jun 2006
Severely ill ICU patients recall of factual events and unreal experiences of hospital admission and ICU stay--3 and 12 months after discharge.
There is a lack of knowledge regarding how critically ill patients recall of the ICU and their life-threatening condition changes over time. The purpose of this study is to describe critically ill and ventilator-treated patients' recollections of both factual events and unreal experiences at 3 and 12 months following discharge from the ICU. The study is qualitative and encompasses nine critically ill ICU patients, ventilator-treated for more than 72 h. The participants were interviewed twice, at 3 and 12 months after their discharge from the ICU. The interviews were analysed using qualitative content analysis. The patients in this study reported unreal experiences, memory confusion and/or disturbances before admittance to the ICU and before their respirator treatment. Their "unreal experiences" were far clearer than their memories of factual occurrences. Patients' fragmentary memories of factual events and their recall of unreal experiences were practically unchanged after 12 month. Their unreal experiences could still be recalled and related after 12 months, but not with the same expression and feeling as earlier (3 months). The unreal experiences were not - after 12 months - their initial recollections, as they had been after 3 months. ⋯ Patients' recollections of both factual events and unreal experiences show very little variation between 3 and 12 months. The stability of long-term memory after 12 months shows that the recollection of their experiences had been both traumatic and emotionally charged. This study shows that critically ill patients were affected by cognitive disturbances and/or disturbed memory before their arrival at the ICU. This result indicates the need of ICU follow-up clinics.
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Intensive Crit Care Nurs · Jun 2006
Voices from the floor: Nurses' perceptions of the medical emergency team.
Nurses are the main group of clinicians who activate the medical emergency team (MET), placing them in an excellent position to provide valuable insights regarding the effectiveness of this system. This descriptive study aimed to explore nurses' satisfaction with the MET, perceived benefits and suggestions for improvement. The study also sought to examine the characteristics of nurses who were more likely to activate the MET. ⋯ Overall, nurses were satisfied with the MET, with suggestions for improvement including more education on medical emergencies for both ward and MET staff. Whilst the MET system is meeting the expectations of the majority of ward nurses, there is room for improvement, which includes a more positive attitude of the MET when summoned for 'borderline' cases. Investment in ongoing education of clinicians and interdisciplinary communication is likely to encourage less experienced nurses to utilise this system, whilst decreasing the reticence of some nurses to call the MET.
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Intensive Crit Care Nurs · Apr 2006
Nurses' roles in discharge decision making in an adult high dependency unit.
An ethnographic approach was used to investigate the roles which nurses take in the discharge decision making process in an adult High Dependency Unit (HDU). Participant observation and unstructured interviews were the data collection methods used. Four themes were identified. ⋯ They had substantial responsibility for bed management and became more proactive in decision-making when there was pressure on HDU beds. Issues associated with decision making were highlighted, as although nurses wanted to contribute to discharge decision making, they were often uncomfortable with this role. There is scope for further investigation into the working relationship of nurses and medical staff, how administrative roles of nurses influence their ability to provide patient care and whether the opinions expressed with regard to decision making are widespread within the nursing community.
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Intensive Crit Care Nurs · Apr 2006
Enteral feeding in the critically ill: are nursing practices contributing to hypocaloric feeding?
Enteral feeding is the preferred method of nutritional support for the critically ill; however, a significant number of these patients are under-fed. It is possible that common nursing practices associated with the delivery of enteral feeding may contribute to under-feeding although there is little data available describing nursing practice in this area. ⋯ The findings of this survey support the contention that nursing practices associated with the delivery of enteral feeds may contribute to under-feeding in the critically ill patient population.