Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Apr 2001
Practice Guideline GuidelineClinical guidelines for the use of the prone position in acute respiratory distress syndrome.
The mortality associated with acute respiratory distress syndrome (ARDS) remains high. It has been suggested that use of the prone position may improve survival. However, approaches to the use of the position are often haphazard. ⋯ This is followed by presentation of the clinical guidelines. Included in these are the criteria and discussion which indicate consideration of the prone position, potential exclusion criteria, pre-turn considerations, the turning technique, monitoring the effectiveness of the prone position, passive movements and limb positioning and, finally, documentation of the problems associated with use of the prone position. The paper concludes with discussion concerning the potential for future research in this area.
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Intensive Crit Care Nurs · Apr 2001
Clinical signs of ICU syndrome/delirium: an observational study.
Some clinical signs of the intensive care unit (ICU) syndrome/delirium are probably known, but there may be additional signs that can be observed during the care of ICU patients. The aim of this study was to investigate and describe the clinical signs of the ICU syndrome in relation to patients' reactions and behaviour following the second day of their stay in an ICU. A total of 31 patients were observed during the weaning process and in the days following extubation. ⋯ Several patients also related unreal experiences only occasionally, while others experienced them during longer periods. The clinical signs did not seem to be separate phenomena but were inter-connected and part of a progression, and, therefore must be seen in the overall context and situation. Longer periods of observation and repeated interaction with patients are necessary in order to be aware of onset and clinical signs of the ICU syndrome.
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Intensive Crit Care Nurs · Feb 2001
The perceived learning needs of paediatric intensive care nurses caring for children requiring haemofiltration.
This paper reports on a small exploratory phenomenological study to describe the lived experiences of paediatric intensive care nurses, who extended their roles to care for critically ill children requiring continuous veno-venous haemofiltration. In describing and understanding this learning experience, an insight into the educational and support needs of these nurses is offered. ⋯ These included the overwhelming need to be a competent practitioner, which was perceived within the context of knowledge for effective practice and technical dexterity. While generalizability of findings is not intended, the findings could be of value to other intensive care settings to guide the identification and implementation of strategies to meet the needs of nurses undertaking similar roles.
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Nurses who work in a critical care area face many challenges within their daily role of caring for very sick patients in a stressful and high-tech environment. Underpinning their advanced skills should be a broad base of fundamental nursing skills that has been formulated from research-based evidence. ⋯ This paper considers why orally intubated patients are at particular risk of developing oral health problems, the use of oral assessment tools and the various techniques employed in oral cleansing. The consequences for the patient of poor oral care will also be discussed.
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This paper considers the ways in which the nursing handover involves a complex network of communication that impacts on nursing interactions. The critical ethnographic study upon which this paper is based involved a research group of six nurses who worked in one critical care unit. Data-collection methods involved professional journalling, participant observation, and individual and focus group interviews. ⋯ Nurses proceeded then to the bedside handover, where the intention changed from one that involved a broad overview of patients, to one that concentrated on a patient's individual needs. Data analysis identified five practices for consideration: the global handover serving the needs of nurse coordinators; the examination; the tyranny of tidiness; the tyranny of busyness; and the need to create a sense of finality. In challenging nurses' understanding of these practices, they can become more sensitive to other nurses' needs, thus promoting the handover process as a site for collaborative and supportive communication.