American journal of critical care : an official publication, American Association of Critical-Care Nurses
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The role of clinical nurse specialists was formalized in the 1950s; the goal was to prepare inpatient, bedside nurses who would serve acutely ill patients via consultation and direct care. Clinical nurse specialists were to be expert clinicians, consultants, educators, and researchers. In the early stages of practice development, the focus was the specific needs of the assigned unit or floor. ⋯ The Synergy Model, developed by the AACN Certification Corporation, was introduced as a way of linking certified practice to patients' outcomes. The model describes 8 nurse characteristics and 3 spheres of influence. This article describes how a group of clinical nurse specialists applied the model to successfully change from a unit-based to a multisystem practice.
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Long-term effects on patients' families after a prolonged stay in a surgical intensive care unit are unclear. We hypothesized that illnesses requiring more than 7 days' stay in the surgical intensive care unit would have significant, long-lasting effects on patients' families that would be related to patients' functional outcome. ⋯ An acute surgical illness that results in a prolonged stay in an intensive care unit has a substantial effect on patients' families that is maximal between 1 and 3 months and parallels the patient's functional outcome. Systems that provide support to both patients and their families should be emphasized in the hospital and after discharge.
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Care of patients in an intensive care unit is among the most costly in hospitals. Little is known about high-cost patients within the intensive care unit or their outcomes of care. ⋯ A small group of patients accounts for a disproportionately higher amount of intensive care unit resources but has a relatively high survival rate. This cohort should be treated as an intact group that is not amenable to traditional cost-cutting measures.
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Research is limited on analgesic practices associated with the commonly performed procedures of turning, inserting central venous catheters, removing wound drains, changing dressings on nonburn wounds, suctioning the trachea, and removing femoral sheaths. ⋯ Most patients were not intentionally medicated even though pain intensity increased during their procedure. When used, analgesic amounts were low, and combination therapy was infrequent. Clinical trials are needed to evaluate optimal pain management for patients undergoing procedures.