Aust Crit Care
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Observational Study
Expert clinical reasoning and pain assessment in mechanically ventilated patients: A descriptive study.
Pain assessment in mechanically ventilated patients is challenging, because nurses need to decode pain behaviour, interpret pain scores, and make appropriate decisions. This clinical reasoning process is inherent to advanced nursing practice, but is poorly understood. A better understanding of this process could contribute to improved pain assessment and management. ⋯ Patient's clinical condition is important for making decision about pain in critically ill nonverbal patients. The concept of pain cannot be assessed in isolation and its assessment should take the patient's clinical stability and sedation into account. Further research is warranted to confirm these results.
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Extracorporeal membrane oxygenation (ECMO) is one of the most invasive rescue therapies for acute heart and/or lung failure. Survivors have high rates of adverse mental health outcomes, such as post-traumatic stress symptoms (PTSS) and manifest post-traumatic stress disorder (PTSD). Yet no study to date has identified and explored PTSD risk factors in these patients. ⋯ ECMO patients are exposed to PTSD risk factors such as young age, mechanical ventilation, drug administration, delirium and agitation. Younger age, heterogeneous conditions, profound illness severity and prolonged ICU stay describe the case complexity of patients and may explain these findings. Patients in ICU are increasingly conscious during active treatment and this may have positive or negative psychological effects. "Awake" ECMO in which patients are conscious while on active life support may represent a unique PTSD risk factor in this perspective.
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Observational Study
Measurement of the frequency and source of interruptions occurring during bedside nursing handover in the intensive care unit: An observational study.
Effective clinical handover involves the communication of relevant patient information from one care provider to another and is critical in ensuring patient safety. Interruptions may contribute to errors and are potentially a significant barrier to the delivery of effective handovers. ⋯ Nurses, doctors and alarming intravenous pumps frequently interrupt ICU bedside handovers, which may lead to loss of critical information and result in adverse patient events. Increased knowledge in this area will ensure appropriate strategies are developed and implemented in healthcare areas to manage interruptions effectively and improve patient safety.
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The cardiovascular risk profile and postoperative morbidity outcomes of anxiety disorder patients undergoing coronary artery bypass surgery is not known. ⋯ A differential cardiovascular risk profile and postoperative outcome was observed dependent on anxiety and depression disorder status. There were few modifiable cardiovascular risk factors at the time of surgery other than psychiatric status, perioperative management of depression and anxiety may have promise to reduce further cardiac morbidity after coronary artery bypass surgery.