American journal of critical care : an official publication, American Association of Critical-Care Nurses
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To examine structural and organizational characteristics at two ICUs with marked differences in risk-adjusted survival. ⋯ The methods used in this study can identify organizational problems and potential means for improvement. The best practices and suggestions for improvement at these units provide examples of methods for improving ICU management.
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Many critically ill patients undergo endotracheal suctioning and chest tube removal procedures, yet little documentation of associated pain exists. Therefore, a study was conducted to (1) compare the magnitude and dimensions of pain associated with endotracheal suctioning and chest tube removal in intubated and nonintubated patients and (2) correlate preprocedural analgesic administration and pain magnitude. ⋯ Patients were able to communicate extensive information about procedural pain, even when intubated. Endotracheal suctioning and chest tube removal were both painful; yet, there was little preparatory analgesic management of the pain. Research is needed to investigate a variety of pharmacological and nonpharmacological interventions for pain related to endotracheal suctioning and chest tube removal.
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We describe an algorithm to aid clinicians in making ethical decisions regarding interventions. Logically sequenced questions about competency, advance directives, treatment benefit, and patient and family preferences guide the decision maker to nine specific scenarios. Each scenario includes guidelines for action based on legal and ethical consensus.
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To describe psychological reactions, neurological sequelae, and family adjustment following sudden cardiac arrest during the first year of recovery. ⋯ To develop intervention programs to aid adjustment, healthcare providers need to take into account psychological reactions, neurological deficits, and family coping of sudden cardiac arrest survivors and their family members.
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Postoperative pain is one of the major obstacles in the prevention of complications during patient recovery. Pain and its management have gained great interest among researchers, clinicians and policy-makers. ⋯ Certain patient conditions such as length of time after surgery and ventilator status affected nurses' assessment and management of pain. Nurses' knowledge about pain assessment and management may affect patient care and outcomes.