American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Visiting policies have been liberalized in ICUs, but the process and outcome of policy modifications have not been well described. ⋯ Effective implementation of liberalized visiting depends on assessment of the following: nurses' beliefs, attitudes, and satisfaction about a change toward a more open visiting policy; staff involvement in determining the policy; and nurse manager and clinical nurse specialist support.
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Neuromuscular blockade is a frequently used therapy in the ICU. However, recent reports of prolonged paralysis and general muscular weakness in patients treated with this procedure have raised concerns about its use in intensive care. ⋯ Among the respondents, variations existed in monitoring practices and in the use of peripheral nerve stimulators, including the frequency of monitoring and use of the baseline milliamperage. Appropriate monitoring and titration of neuromuscular blocking agents by ICU nurses may aid in preventing adverse effects, including the potential for prolonged neuromuscular blockade. The existing variations in practice may affect patients' outcomes.
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The increasing attention to assisted suicide, as evidenced by recent legislation, initiatives, court decisions, and research, propels the issue to a new level of importance and urgency within society and the health professions. Nurses cannot help but be confronted by and struggle with the complex moral and professional quandaries related to assisted suicide. Critical care nurses must continue to evaluate the implications of the possible legalization of assisted suicide and to define the boundaries of morally acceptable professional practice. The challenges to the roles and responsibilities of critical care nurses that might occur if assisted suicide were legalized must be thoughtfully and responsibly explored.
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To formulate a theory of shared decision making in critical care that accounts for both the legal and ethical warrants for informed consent, and the roles of nurses and patients' family members in shaping decision making. ⋯ Informed consent occurs when the patient understands the facts; understanding adheres to meaning, and meaning is achieved through narrative. Thus, a theory of shared decision making that uses narrative resolves the problems of informed consent and substantiates the important roles of nurses and patients' families in critical care.
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More centers are performing lung transplants for a variety of pulmonary conditions. Chronic rejection, manifested as obliterative bronchiolitis, is the most common cause of late death (greater than 6 months after transplant) in this population. ⋯ Obliterative bronchiolitis is a common complication in lung transplant recipients, and future research will focus on treatment and early diagnosis. Efforts are under way to standardize nomenclature and reporting of incidence and mortality rates.