Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Aug 2003
End-of-life decisions in Swedish ICUs. How do physicians from the admitting department reason?
To study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs). ⋯ This study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.
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Intensive Crit Care Nurs · Jun 2003
ReviewOptimisation of oxygenation and tissue perfusion in surgical patients.
Surgical patients with limited cardiovascular reserve have much worse prognosis than patients with normal hearts. This review identifies 17 randomised controlled clinical trials that have investigated peri-operative therapy designed to increase tissue perfusion in surgical patients, many of whom have limited cardiovascular reserve. ⋯ Further research needs to be undertaken in the identification of patients with limited cardiovascular reserve and for investigating proposed treatment strategies. Despite this, it appears that such patients have improved outcome if they are admitted to intensive care unit pre-operatively and have suitable therapy given to improve tissue oxygen delivery.
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Intensive Crit Care Nurs · Jun 2003
Pain assessment in critical care: what have we learnt from research.
Despite an ongoing acknowledgement in the literature that pain is a significant problem within the critical care environment, this issue has not been adequately addressed by critical care nurses. This paper examines strategies for changing pain management practices in critical care, including reviewing documentation practices, the utilisation of guidelines and algorithms to augment clinical decision making, and increasing educational opportunities available to critical care nurses. It is recommended that pain assessment be given a higher priority within the clinical context, particularly as inadequate pain assessment and management has been linked to increased morbidity and mortality within critical care. Importantly, critical care nurses need to not only be aware of research-based pain management practices, but also lead the way in implementation and continuous evaluation as a measure of decreasing patient pain in the future.
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It is clear that current government policy places increasing emphasis on the need for flexible team working. This requires a shared understanding of roles and working practices. However, review of the current literature reveals that such a collaborative working environment has not as yet, been fully achieved. ⋯ Both medical and nursing staff identify conflict during patient management discussions. However, it is predominantly nurses who seek to redress this conflict area through developing specific behaviours for this clinical forum. Using this approach to resolve such team issues has grave implications if the government vision of interdisciplinary team working is to be realised.
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Intensive Crit Care Nurs · Jun 2003
Pressure sore prevention in the critically ill: what you don't know, what you should know and why it's important.
The critically ill are particularly vulnerable to pressure sore development. These expensive and often painful complications have been largely ignored for many years and the entire problem has been managed by nursing staff. Current methods for identifying patients at risk are inadequate and subjective. ⋯ What is certain, though, is that a voluminous amount of work needs to be conducted in order to verify their continued use. It is increasingly apparent that the complex nature of pressure sore development means that it is unrealistic to expect a single discipline to manage the problem effectively. A multidisciplinary team approach is the most appropriate way to improve management in this vital area.