Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Dec 1998
Analgesics in the management of chronic pain. Part four: Step 3 oral analgesic drug therapy.
Reluctance to commence treatment with a Step 3 drug on the Analgesic Stepladder is a common reason for failure to manage chronic severe pain in many situations. The fourth article in the series reviews the potent opioid analgesics for oral use and in doing so addresses the various prejudices that surface when such therapy is denied.
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Intensive Crit Care Nurs · Dec 1998
ReviewInhaled nitric oxide: are the safety issues being addressed?
Interest in the therapeutic uses of Nitric Oxide (NO) has gathered pace over the last decade. It is no exaggeration for the UK Guidelines on the Use of Inhaled Nitric Oxide (Cuthbertson et al. 1997) to say that 'the use of inhaled nitric oxide in the UK has become commonplace'. ⋯ It also holds promise in the treatment of acute respiratory distress syndrome (ARDS). It is in this context that this discussion will seek to raise fundamental questions about the health and safety aspects of this substance.
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Intensive Crit Care Nurs · Dec 1998
ReviewShould relatives of patients with cardiac arrest be invited to be present during cardiopulmonary resuscitation?
Witnessing the attempted resuscitation of a loved one is likely to be traumatic and distressing. However, because the majority of patients requiring cardiopulmonary resuscitation (CPR) die, this raises the question, within the hospital environment, of whether relatives should be invited to be present. ⋯ With particular reference to the intensive care unit (ICU), the discussion in this paper includes not only family presence during CPR from the perspective of the patient, relatives and healthcare professionals, but also the potential legal implications. Recommendations for nursing practice are offered.
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This paper reports the findings of a study which aimed to identify the barriers to evidence-based practice in an acute National Health Service (NHS) trust. The study was carried out as part of an action research project designed to promote evidence-based practice. ⋯ The results of this study demonstrate that structures and cultures within organizations can be important barriers to evidence-based practice. Factors which are external to individual trusts are also important. Existing hierarchical structures both in the NHS and within and between the different professional groups, are manifest in the existence of a largely deferential culture which emphasizes the routine in practice decision making. Given this reality, organizations will have to adopt multiple strategies to facilitate and promote the use of evidence in practice decision making.
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Intensive Crit Care Nurs · Oct 1998
ReviewTo bag or not to bag? Manual hyperinflation in intensive care.
Manual hyperinflation or bagging is a physiotherapy technique commonly used on mechanically ventilated patients on intensive care. The way it is performed appears to vary widely, and in the past there has been little or no monitoring of what is actually happening during the technique in terms of what airway pressures and tidal volumes are being delivered to the patient. Conclusive evidence from large scientific studies of the benefits and side effects of manual hyperinflation are to date still lacking.