American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Skillful communication between and among clinicians and patients' families at the patients' end of life is essential for decision making. Yet communication can be particularly difficult during stressful situations such as when a family member is critically ill. This is especially the case when families are faced with choices about forgoing life-sustaining treatment. ⋯ Although family members who experienced conflict were in the minority of the larger study sample, their concerns and needs are important for clinicians to examine. Paying careful attention to these communication needs could reduce the occurrence of conflict between clinicians and patients' families in caring for dying patients and reduce stress for all involved.
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Comparative Study
Paramedic and emergency department care of stroke: baseline data from a citywide performance improvement study.
Rapid diagnosis and transport by paramedics and efficient, effective emergency management are essential to improving care of acute stroke patients. ⋯ More than half of patients with suspected stroke arrive at hospitals while thrombolytic treatment is still feasible. Although the current rate for thrombolytic treatment in Houston exceeds the national rate, performance of paramedics and hospitals in treating acute stroke can be improved by increasing efficiency and standardizing medical practices.
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Comparative Study
Management of patients in the intensive care unit: comparison via work sampling analysis of an acute care nurse practitioner and physicians in training.
Little is known about aspects of practice that differ between acute care nurse practitioners and physicians that might affect patients' outcomes. ⋯ The nurse practitioner and the physicians in training spent a similar proportion of time performing required tasks. Because of training requirements, physicians spent more time than the nurse practitioner in nonunit activities. Conversely, the nurse practitioner spent more time interacting with patients and patients' families and collaborating with health team members.
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Atrial fibrillation is the most common complication after cardiac surgery and a major cause of morbidity and increased cost of care. ⋯ Atrial fibrillation is common after cardiac surgery and often occurs after discharge from the hospital and without accompanying symptoms. Outpatient monitoring may be warranted in patients with characteristics that place them at increased risk for atrial fibrillation.
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Use of protocols to reduce weaning time for patients receiving mechanical ventilation helps reduce cost and length of stay. However, implementation of this type of protocol is not easy and requires a consistent collaborative effort. ⋯ The need to provide efficient care requires the collaboration of all disciplines involved in providing patients' care. The weaning protocol introduced in this study demonstrates the benefits of using a collaborative team to identify best practices and implement them in a practice setting.