American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Randomized Controlled Trial Comparative Study
Intensive versus modified conventional control of blood glucose level in medical intensive care patients: a pilot study.
Critically ill postsurgical patients fare better with intensive control of blood glucose level. The link between glucose control and outcome is less well studied for medical intensive care patients. Whether intensive glucose control requires additional staffing is unclear. ⋯ Target levels for blood glucose were achieved with both protocols. Severe hypoglycemia was rare and uncomplicated regardless of type of glucose control. Additional staffing may be needed for intensive glucose control.
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To review the literature on use of the Trendelenburg position as a position for resuscitation of patients who are hypotensive. ⋯ The general "slant" of the available data seems to indicate that the Trendelenburg position is probably not a good position for resuscitation of patients who are hypotensive. Further clinical studies are needed to determine the optimal position for resuscitation.
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Comparative Study
Frequency of oral care and positioning of patients in critical care: a replication study.
Oral care and head-of-bed elevation are interventions to decrease risk of aspiration pneumonia in hospitalized patients. In a previous study, nurses' self-reports of how often they performed oral care did not match documented provision of such care. ⋯ Despite inadequate estimates of survey reliability, findings generally were comparable to results of the original study; nurses report more frequent oral care than is documented. Intensive care nurses elevate the head of patients' beds in accordance with self-reports.
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Demand for complementary and alternative therapies is increasing and is affecting all healthcare settings, including critical care. ⋯ Educational programs that provide information about use of complementary and alternative therapies and the underlying evidence base most likely will increase the appropriate use of the therapies to achieve desired outcomes.
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Critical care nurses care for dying patients daily. The process of dying in an intensive care unit is complicated, and research on specific obstacles that impede delivery of end-of-life care and/or supportive behaviors that help in delivery of end-of-life care is limited. ⋯ The biggest obstacles to appropriate end-of-life care in the intensive care unit are behaviors of patients' families that remove nurses from caring for patients, behaviors that prolong patients' suffering or cause patients pain, and physicians' disagreement about the plan of care.