Nursing in critical care
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Critically ill patients are at high risk for the development of delirium and agitation, resulting in non-compliance with life-saving treatment. The use of physical restraint appears to be a useful and simple solution to prevent this treatment interference. In reality, restraint is a complex topic, encompassing physical, psychological, legal and ethical issues. ⋯ Studies into the use of physical restraint are analysed, and in particular the physical effects on patients discussed. The use of physical restraint raises many legal, ethical and moral questions for all health care professionals; therefore, this study aims to address these questions. This article concludes by emphasizing areas of future practice development in intensive care units throughout the UK.
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Nursing in critical care · Jan 2007
ReviewFluid management and diuretic therapy in acute renal failure.
Acute renal failure (ARF) is a common problem in critical care; therefore, nurses should consider it to be a potential issue for all of their patients. Fluid management and diuretic therapy are important in these patients. ⋯ This will be followed by a critical examination of the evidence surrounding the use of crystalloids and colloids for fluid resuscitation, as well as the role of diuretics in patients with acute renal failure. The paper concludes by identifying approaches for developing future practice in this area.
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Nursing in critical care · Jan 2007
Patient severity as an indicator of nursing workload in the intensive care unit.
The importance of measuring nursing workload in the intensive care unit (ICU) has been supported by both an increasing demand for nursing personnel and the relationship of nursing workload with patient safety. According to previous studies, the correlation between clinical severity of ICU patients and nursing workload measured by Therapeutic Intervention Scoring System has been estimated to be particularly high. The aim of this study was to investigate whether clinical severity of ICU patients can be used for the prediction of nursing workload on a daily basis. ⋯ Regarding categories of PRN Réa, respiration, communication, diagnostic methods and treatments were significantly predicted by APACHE II. APACHE II explained higher proportions of PRN Réa in medical male patients aged >60 years. Clinical severity of the ICU patients measured by APACHE II is an important early indicator of daily nursing workload, especially of care demands associated with respiration, diagnostic methods and treatments.
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Nursing in critical care · Jan 2007
Comparative StudyPressure ulcer risk assessment immediately after cardiac surgery--does it make a difference? A comparison of three pressure ulcer risk assessment instruments within a cardiac surgery population.
The intensive care unit (ICU) population has a high risk of developing pressure ulcers. According to several national expert guidelines for pressure ulcer prevention, a risk assessment for every situation in which the patient's condition is changing should be performed using a standardized risk assessment instrument. The aims of this study were to (a) assess the number of patients who are 'at risk' for the development of pressure ulcer according to three commonly used risk assessment instruments in the intermediate period after cardiac surgery procedures, (b) assess which instrument best fits the situation of the ICU patients and c) decide if 'static' risk assessment with an instrument should be recommended. ⋯ Only 1.9% (n= 1) of the pressure ulcers were stage 2. The study concluded that the patients in the cardiac surgery ICU can be identified as at risk during the first 5 days after surgical procedure without continuously using a standardized risk assessment instrument in every changing condition. Individual risk assessment by a standardized risk assessment instrument is only recommended to enable initiation of preventive measures based on patient-specific risk factors.
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Nursing in critical care · Jan 2007
Visits to intensive care unit patients--frequency, duration and impact on outcome.
The issue of the presence of patients' loved ones during their intensive care unit (ICU) stay is a frequently discussed topic among ICU staff. Today, ICU patients' loved ones are seen as important for the care of the patient. There is a gap in knowledge and research concerning the frequency and duration of visits by loved ones and the effect of such visits on patient outcome. ⋯ There were no significant differences in mortality and length of hospital stay over time. We could not establish that patients who had no visitors had a poorer outcome. Most of the older patients had no visitors, which indicates that elderly people may have a poorer social network; thus, there may be a greater need for professional caring relationships and care planning.