Nursing in critical care
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Nursing in critical care · Jul 2006
ReviewA critical discourse analysis of provision of end-of-life care in key UK critical care documents.
This article highlights certain practical and professional difficulties in providing end-of-life (EOL) care for patients in critical care units and explores discourses arising from guidelines for critical care services. ⋯ The key documents give little clear guidance about how to provide EOL care in critical care. Discourses include the power dynamic in critical care between professions, families and patients, and how this impacts on provision of EOL care. Difficulties encountered include dilemmas at discharge and paternalism in decision-making. The technological environment can act as a barrier to good EOL care, and critical care nurses are at risk of assuming the dominant medical model of care. Nurses, however, are in a prime position to ensure that decision-making is an inclusive process, patient needs are paramount, the practical aspects of withdrawal lead to a smooth transition in goals of care and that comfort measures are implemented.
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Nursing in critical care · Jul 2006
Hospital emergency care teams: our solution to out of hours emergency care.
The implementation of the European Working Time Directive and the compulsory reduction in junior doctors hours provided the main driver and background for this project. The project aim was to implement Hospital Emergency Care Teams (HECT) on three District General Hospitals (DGHs) to provide emergency out-of-hours care. The project strategy centred on the recruitment, training and preparation of critical care nurses to undertake advanced assessment roles. ⋯ Experiences gained provide valuable learning that could be used to influence similar projects. Implications for practice include the development of a national framework to inform areas such as multidisciplinary competency-based education and training. Scientific evidence is required to evaluate the effect of HECT on hospital mortality and morbidity and quantify the staff, inpatient experiences.