Aust Crit Care
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In the emergence of the evidence based practice movement, critical care nurses have struggled to identify scientific evidence on which to base their clinical practice. While the lack of critical care nursing research is a major concern, other important issues have significantly stalled the implementation of evidence even when it is available. A descriptive study of 274 critical care nurses was undertaken to examine nursing research activity in Victorian critical care units. ⋯ The study found that there is a lack of organisational support and management commitment for the development of evidence based nursing. In order to facilitate the implementation of evidence based practice, clinicians must be made aware of the available resources, be educated and mentored when carrying out and using clinical research, and be supported in professional initiatives that promote evidence based practice. It is argued that this will have positive implications for patient outcomes in the critical care environment.
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Review
Non-invasive positive pressure ventilation in acute respiratory failure: providing competent care.
Non-invasive positive pressure ventilation (NPPV) has been used as an alternative strategy to provide ventilatory support for patients with acute respiratory failure. Most studies demonstrate that the use of NPPV in acute respiratory failure results in a reduction in the need for endotracheal intubation and an overall survival advantage. However, current evidence, in the form of randomised controlled trials, suggests that these benefits may be restricted to patients suffering from acute exacerbation of chronic obstructive pulmonary disease (COPD). ⋯ Clinical outcomes and thus valid comparisons with alternate methods of ventilatory support can only be made if attention is paid to the clinical indications for the application of NPPV and patient subgroups it is used to treat and the level of competence of care givers in its application and delivery. One essential element of competence is the establishment of an appropriate knowledge base and the development of clinical practice guidelines. This literature review identifies the current indications for NPPV and the relevant information for developing clinical practice guidelines for the management of this form of ventilatory support.
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Research findings over the last 20 years show that critical care nurses (CCNs) continue to underestimate and under medicate their patients' pain, despite an allegedly strong commitment to pain relief. This literature review investigates the determinants of CCNs' pain assessment and management behaviours. Fishbein and Ajzen's theory of reasoned action' and Ajzen's theory of planned behaviour have been used as models to facilitate understanding of this phenomenon. ⋯ Through an analysis of the behavioural determinants following the models described by Fishbein and Ajzen, strategies can be formulated to address CCN deficiencies, improve patient outcomes and satisfaction with nursing care and CCN fulfilment. Cervantes was quoted as saying "It's a long way from saying to doing". This report aims to improve on this idea.