Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
-
Intensive Crit Care Nurs · Apr 1999
Case ReportsIatrogenic drug dependence--a problem in intensive care? Case study and literature review.
Use of sedative and analgesic pharmacological agents is a widespread practice in intensive care units (ICUs). Mainly, this involves opioid and benzodiazepine analogues, both known to induce dependence/tolerance states. This paper is based on a clinical scenario in which a patient treated with these agents developed problems when they had been discontinued, and exploration of the extent of such problems generally. ⋯ Although there may be a recognition that these drugs can typically cause dependence problems, little emphasis has traditionally been given to assessing these problems in ICUs. Yet the ICU may be an area where these drugs are used in high volumes. The recognition, physiology, management and prevention of iatrogenic drug dependence/tolerance in critical care environments is elucidated, with reference to relevant literature.
-
Intensive Crit Care Nurs · Feb 1999
Comparative StudyWorkforce dilemmas: a comparison of staffing in a generalist and a specialist intensive care unit.
Intensive care units are arguably one of the most costly resources a hospital has to maintain in terms of nursing staff, skills and technology. Given that the Government's agenda on quality remains one of obtaining cost-effective healthcare, it is imperative that nursing managers consider the implications of the new policy shift for how they currently provide services. The purpose in this paper is to compare the different staffing levels adopted by managers in generalized and neurosurgical intensive care in an acute hospital trust. The dilemmas facing managers making staffing decisions without any definitive guidelines for resourcing these specialized units are examined.
-
This paper describes the background to the publication of the paediatric intensive care framework (NHS Executive 1997a) and sets out the case for outcome assessment of paediatric intensive care. Issues relating to mortality and morbidity assessment are discussed and several assessment tools are outlined. It is proposed that functional and psychological outcome assessments are important indicators of the quality of health care provision.
-
Intensive Crit Care Nurs · Dec 1998
Patients' experience of being critically ill or severely injured and cared for in an intensive care unit in relation to the ICU syndrome. Part I.
The intensive care unit (ICU) syndrome is regarded principally as a complex interaction of several contributory factors, all of which can be seen as partly responsible for the development of the syndrome. The purpose of this study was to describe and give a deeper insight into patients' experiences and memory recall, both during and after their stay in the ICU. Nineteen patients who had been respirator treated (ventilated), and had stayed at least 36 hours in the ICU, were interviewed about one week after discharge, and again 4-8 weeks after their discharge from the ICU. ⋯ The caring relationship was perceived as providing an important degree of security and comfort. Nursing care actions can therefore be seen as vital factors in patients overcoming the accompanying horrific experiences to which they can be subjected. This state of chaotic feeling, and how it is combated and treated, appear to be one critical factor in the development and progression of the ICU syndrome.
-
Intensive Crit Care Nurs · Dec 1998
Intensive therapy unit nurses' beliefs about and attitudes towards visiting in three district general hospitals.
The beliefs and attitudes of intensive therapy unit (ITU) nurses regarding visiting of critically ill patients are believed to be influenced by many factors, such as the need to promote patient rest, the need to prevent physiological and psychological complications to the patient and the need to improve communications between all parties. In this paper, some of the factors are examined with attempts to establish whether there are any correlations between such factors as the length of time individual nurses have worked in the area, their professional qualifications, their job satisfaction and their perceptions of visiting and visitors. ⋯ The conclusion was that nurses still have many negative beliefs and attitudes towards visiting and visitors. ITU nurses in this study generally appeared to consider the effects of visiting pessimistically, suggesting they believe they are doing so in the best interests of the patients, themselves and the ITU itself.