Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Weaning from mechanical ventilation is challenging and requires expert knowledge and skill. Weaning can be defined as the process of assisting patients to breathe spontaneously without mechanical ventilatory support [Am. J. ⋯ Other reasons include, delay in tracheostomy placement. Staff are not initiating weaning guidelines early this may be due to lack of knowledge, lack of support or failure of the guidelines. Mechanisms are in place to support nurses at the bedside.
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Intensive Crit Care Nurs · Aug 2002
Factors influencing the patient during weaning from mechanical ventilation: a national survey.
Successful weaning depends on the application of skilled judgement and decision making to nursing and medical interventions. The intensive care nurse is in an unique position for adopting a holistic approach to weaning. Such an approach needs teamwork and consideration of all the factors that could influence the outcome of the weaning phase. ⋯ The results identified that nutrition, communication, analgesics and sedatives, psychological and metabolic factors, as well as weaning methods and measurable parameters were taken into consideration. Written instructions for weaning were used by only three ICUs and weaning protocols were not common. A holistic approach to the discontinuation of mechanical ventilation is a valuable means of improving the quality of care and merits further research.
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Intensive Crit Care Nurs · Jun 2002
Multicenter StudyAdmissions for critically ill children: where and why?
Planning services for critically ill children requires identification of overall critical care activity as well as an assessment of population needs. METHOD AND OBJECTIVES: This prospective needs assessment took a census approach to estimating population-based admission rates for paediatric critical care irrespective of where care was provided. A survey form was completed for every child in the study population for all of their admissions. ⋯ This baseline study shows a significant number of critically ill children who are never cared for in PIC units. With national changes in UK policy to regionalise care for these children, monitoring care in all locations by cause of admission remains important. While the data were collected in 1997, the findings from this study remain relevant and provide the basis for planning regional critical care services for children. Results are also relevant to other geographical areas in that measuring the use of services for critically ill children must go beyond documenting admission to ICUs for children and adults. All settings for critical care must be identified, the activity documented, and the use of services measured against existing resources. Clear clinical criteria are needed to identify children who can be cared for appropriately on high dependency units.
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Intensive Crit Care Nurs · Jun 2002
ReviewFrom ward-based critical care to educational curriculum 1: a literature review.
There has been recent recognition in the literature, and a longer standing awareness amongst clinicians, that critically ill patients are to be found outside of intensive care units. These patients are not always well managed and some have concluded that their care is 'suboptimal' [Br. Med. ⋯ In response the government has mandated formal critical care education for ward nurses [Comprehensive Critical Care: a Review of Adult Critical Care Services (2000) Department of Health]. In this two-part paper, the literature around education for ward-based critical care is examined (Part 1) prior to a report of the findings (Part 2) of a case study exploring the everyday practices, context and culture of an acute surgical ward where seriously ill patients were cared for prior to the introduction of a critical care outreach service (Part 2). Implications for practice, education and future research are discussed.