Nursing in critical care
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Nursing in critical care · Mar 2007
Stressful experiences in relation to depth of sedation in mechanically ventilated patients.
In mechanically ventilated patients, sedatives and analgesics are commonly used to ensure comfort, but there is no documented knowledge about the impact of depth of sedation on patients' perception of discomfort. The aim of this study was, therefore, to investigate the relationship between stressful experiences and intensive care sedation, including the depth of sedation. During 18 months, 313 intubated mechanically ventilated adults admitted to two general intensive care units (ICU) for more than 24 h were included. ⋯ Multivariate analyses showed that higher proportion of MAAS score 3 (indicating more periods of wakefulness), longer ICU stay and being admitted emergent were factors associated with remembering stressful experiences of the ICU as more bothersome. The findings indicate that the depth of sedation has an impact on patients' perception of stressful experiences and that light sedation compared with heavy seems to increase the risk of perceiving experiences in the ICU as more bothersome. In reducing discomfort, depth of sedation and patient comfort should be assessed regularly, non-pharmacological interventions taken into account and the use of sedatives and analgesics adapted to the individual requirements of the patient.
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Many of the patients with sepsis admitted to intensive care and high dependency units develop severe sepsis/septic shock in general hospital wards. If the Surviving Sepsis Campaign's aim of a 25% reduction in mortality from sepsis is to be achieved by 2009, then it is essential that registered nurses are aware of the standard definitions of sepsis, and the recommendations for its initial management. The aim of this study was to audit ward nurses' knowledge of sepsis against standard definitions and evidence-based management guidelines. ⋯ The results showed that some ward nurses appeared to have a poor knowledge of the signs and symptoms of sepsis, severe sepsis/septic shock and some aspects of its initial management. Following the results of the audit, a variety of educational initiatives were introduced to raise awareness of the standard definitions and the surviving sepsis management guidelines. In conclusion, targeted education must be provided for nurses working in general wards if the Surviving Sepsis Campaign is to achieve its aim of a 25% reduction in mortality by 2009.
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Nursing in critical care · Mar 2007
CommentCommentary: Numata Y, Schultzer M, et al. (2006). Nurse staffing levels and hospital mortality in critical care settings: literature review and meta-analysis.
This paper reports a review of the literature on the association between critical care nurse staffing levels and patient mortality. Statistically significant inverse associations between levels of nurse staffing and hospital mortality have not been consistently found in the literature. Critical care settings are ideal to address this relationship due to high patient acuity and mortality, high intensity of the nursing care required and availability of individual risk adjustment methods. ⋯ Methodological challenges that might have impeded correct assessment of the association include measurement problems in exposure status and confounding factors, often uncontrolled. The lack of association also indicates that hospital mortality may not be sensitive enough to detect the consequences of low nurse staffing levels in critical care settings. Abstract reprinted from the Journal of Advanced Nursing volume 55, Numata Y et al., 'Nurse staffing levels and hospital mortality in critical care settings: literature review and meta-analysis.', pages 435-448. (c) 2006, with permission from Blackwell Publishing Ltd.
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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.