Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Jun 1994
Comparative StudyCoronary care unit patients' and nurses' ratings of intensity of ischaemic chest pain.
In 100 patients admitted to a coronary care unit with a history of chest pain thought to be due to myocardial infarction, the intensity of pain was independently rated by the patient and the primary nurse caring for the patient soon after admission. Pain intensity was assessed using a visual analogue scale designed to yield a score of 0-100. 10 experienced coronary care nurses who had participated in a short programme of pain assessment and management were included in the study. A strong positive correlation between the patients' and nurses' ratings was found. Possible explanations for these findings are discussed.
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In the current climate of scarce financial resources health care managers have had to question the financial viability of a 36-hour stay in an ICU for patients undergoing cardiac surgery. The management of this group of patients has had to be reexamined. The solution to this problem appears to lie in the utilisation of a designated recovery area for the management of this group of patients. ⋯ Possible methods of improving the utilisation of a recovery area in the management of postoperative cardiac patients are discussed. The conclusion is that utilisation of a designated recovery area for the immediate postoperative management of cardiac surgical patients is a financially viable alternative to an intensive care environment. More importantly, high quality service and care is maintained without increasing the utilisation of resources.
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Intensive Crit Care Nurs · Mar 1994
A study into the uses and effects of do-not-resuscitate orders in the intensive care units of two teaching hospitals.
Do-not-resuscitate (DNR) orders pose many ethical and moral dilemmas for health professionals. When placed in the context of an Intensive Care Unit (ICU), these dilemmas are magnified. Data were obtained on all admissions to two ICUs over a 3-month period, using a descriptive survey design. ⋯ In six (24%) cases DNR orders were verbal only. These units demonstrate generally good practice regarding DNR decision-making and nursing care. However, explicit documentation is necessary in all cases.
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Intensive Crit Care Nurs · Mar 1994
Maintaining the patency of transduced arterial and venous lines using 0.9% sodium chloride.
Using dilute concentration of heparin in continuous flush systems for arterial and venous invasive cannulae is an established practice in intensive care units (ICUs) throughout the UK. It is, however, practical to maintain the patency of these lines using 0.9% sodium chloride, thus reducing the possibility of drug interactions, systemic anticoagulation and cost. A small feasibility study was carried out in a 10-bedded general ICU on both arterial and venous lines using 0.9% sodium chloride over a 3-month period. The study has subsequently changed unit policy.
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Intensive Crit Care Nurs · Mar 1994
Ethical decision-making in intensive care: a nurse's perspective.
Technology has increased our ability to sustain life, but to what end? Ethical dilemmas abound in intensive care units (ICUs), but in the author's experience nurses are rarely formally involved in ethical decision-making. Should nurses be involved? This article is an attempt to answer this question by considering the unique position of an intensive care nurse, the stress caused by ethical dilemmas, the ethical and legal responsibilities of the nurse and the educational and psychological factors influencing the decision-making process. The current involvement of nurses in ethical decision-making is reviewed and a framework for ethical decision-making is suggested. Implications for education and practice are drawn from the discussion.