Nursing in critical care
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Nursing in critical care · Nov 2011
ReviewPatients' and nurses' experiences of delirium: a review of qualitative studies.
Knowledge of delirium accumulated over the past two decades has focused more on its characteristics, pathophysiology, incidence, aetiology and prognosis as well as interventions for preventing, detecting, evaluating or managing this syndrome and less so on how patients and nurses who care for them experience it. ⋯ The findings suggest that nurses must acknowledge the lived experience of the persons cared for and they must seek out the meaning that patients ascribe to this experience to understand the situation and thus conduct interventions that meet the needs expressed.
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Nursing in critical care · Nov 2011
ReviewChlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates.
Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation after endotracheal intubation. The role of chlorhexidine and tooth-brushing has been considered as a clinical intervention to reduce infection rates, however, evidence to inform this needs appraising. ⋯ The use of chlorhexidine has been proven to be of some value in reducing VAP, although may be more effective when used with a solution which targets gram-negative bacteria. Tooth-brushing is recommended in providing a higher standard of oral care to mechanically ventilated patients and reducing VAP when used with chlorhexidine. However, limitations in study design and inconsistency in results suggest that further research is required into the effects of tooth-brushing.
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Nursing in critical care · Nov 2011
Influence of a dedicated paediatric cardiac intensive care unit on patient outcomes.
The impact of a designated intensive care unit (ICU) for postoperative cardiac care in children is not clear. In our hospital (in the USA), we started a new Paediatric Cardiac Surgery programme 5 years ago, in September 2004. During the first 2 years of the programme, postoperative care was accomplished within the general paediatric ICU (PICU or c-ICU). Subsequently, in September 2006, a dedicated cardiac ICU (d-ICU) was established. We looked at our experience during these two periods to determine whether the designation of a separate ICU affected outcomes for these children. ⋯ We believe the designation of a specific area for postoperative cardiac care was instrumental in the growth and development of our cardiac programme. This rapid change accomplished several crucial elements that lead to accelerated improvement in patient care and a decline in morbidity and mortality.