American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Multicenter Study
Intensive care nurses' experiences with end-of-life care.
With much attention being focused on how patients die and whether or not they are provided appropriate care, the care of dying patients in intensive care units must be described and improved. ⋯ Disagreement among patients' family members or among caregivers, uncertainty about prognosis, and communication problems further complicate end-of-life care in intensive care units. Changes in the physical environment, education about end-of-life care, staff support, and better communication would improve care of dying patients and their families.
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A total of 26 research studies on patients' experiences of being in an intensive care unit were reviewed. The studies were selected because they focused on experiences typical in intensive care units. Many patients recalled their time in the intensive care unit, sometimes in vivid detail. ⋯ Negative experiences included impaired cognitive functioning and discomforts such as problems with sleeping, pain, and anxiety. The review indicates steps critical care staff can take to develop better ways to understand patients' experiences. Meeting such challenges can improve the quality of patients' experiences and reduce anxiety and may offset potential adverse effects of being a patient in an intensive care unit.
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The limited literature on closed-system suctioning suggests a need for further research in this area. Information is lacking about the frequency of use of the closed versus the open system of suctioning and about the current patterns of practice of closed-system suctioning among nurses. ⋯ Further research on closed-system suctioning is warranted, especially on the practices of hyperoxygenation and hyperinflation and the effect of these interventions on the prevention of suctioning-induced hypoxemia.