Nursing in critical care
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The aim of the review was to consider the relationship between delirium and aspects of sedative and analgesic drug use in mechanically ventilated intensive care patients. The basis for routine delirium screening and the implications for nurses are discussed along with a brief outline of the treatment of delirium. ⋯ Sedative and analgesic drugs have an important role in the prevention and treatment of delirium in intensive care patients. Routine delirium screening should be included as part of sedation monitoring practice. When detected, treatment is focused on the prompt correction of precipitating factors, non-pharmacological interventions and appropriate drug therapy for symptom control.
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Nursing in critical care · Jul 2008
ReviewManaging a good death in critical care: can health policy help?
This paper discusses end-of-life care (EoLC) in critical care through exploration of what is known from the international literature and what is currently presented within UK policy. ⋯ A key issue for EoLC in critical care is a lack of robust systems to prospectively identify individuals who are most at risk of dying. A further challenge is divergent perspectives within and across clinical teams on treatment withdrawal and limitation practices. To streamline patient management and underpin a hospice approach to care, EoLC policies are currently being used within the UK. While this provides a national framework to address some key critical care clinical issues in the UK, there is a need for further refinement of the tool to reflect the reality of EoLC for the critically ill. It is important that international best practice exemplars are examined and clinicians actively engage and contribute to ensure that any local EoLC frameworks are fit for purpose.
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Nursing in critical care · Jul 2008
Implementing a ventilator care bundle in an adult intensive care unit.
Ventilator-associated pneumonia (VAP), in addition to causing distress to patients, is associated with increased length of stay in intensive care, higher rates of morbidity and mortality and pressure on critical care capacity and costs. A care bundle approach for the management of ventilated patients can reduce the risk of VAP. ⋯ Daily care bundle audits showed a positive impact on compliance. However, without a robust method to collect data on prevalence of VAP, the impact of the care bundles on improving outcomes for this aspect of care is unknown.
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Nursing in critical care · Jul 2008
Experiences of intensive care nurses assessing sedation/agitation in critically ill patients.
Patients admitted to the intensive care unit (ICU) will more often than not require sedative and analgesic drugs to enable them to tolerate the invasive procedures and therapies caused as a result of their underlying condition and/or necessary medical interventions. ⋯ This paper reinforces the potential benefits to patients as a direct result of implementing the SAS scoring tool and clinical guidelines. Furthermore, it highlights the reluctance of a number of staff to adhere to such guidelines and discusses the concerns regarding less experienced nurses administering sedative agents. Attention was also drawn to the educational requirements of nursing and medical staff when using the SAS scoring tool.