Aust Crit Care
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Randomized Controlled Trial
The effect of family-authored diaries on posttraumatic stress disorder in intensive care unit patients and their relatives: A randomised controlled trial (DRIP-study).
Critical illness and mechanical ventilation may cause patients and their relatives to experience symptoms of posttraumatic stress, anxiety, and depression due to fragmentation of memories of their intensive care unit (ICU) stay. Intensive care diaries authored by nurses may help patients and relatives process the experience and reduce psychological problems after hospital discharge; however, as patients particularly appreciate diary entries made by their relatives, involving relatives in authoring the diary could prove beneficial. ⋯ A diary written by relatives for the ICU patient reduced the risk of posttraumatic stress symptoms in relatives. The diary had no effect on depression, anxiety, or health-related life quality. However, as the diary was well received by relatives and proved safe, the diary may be offered to relatives of critically ill patients during their stay in the ICU.
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Management of gut function in the intensive care unit (ICU) is often protocol-driven. Protocols for enteral feeding or bowel management are based on assumptions about what is 'normal' gastrointestinal motility during critical illness or in the early postoperative period, although 'normal' has not been well described in this group. ⋯ Alteration of upper and lower gastrointestinal motility is common in critically ill and early postoperative patients. Care should be taken in interpreting protocols that relate to gut function to avoid unnecessary interventions or interruptions to nutritional therapy.
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Despite the widespread implementation of medical emergency teams (METs) in hospitals to provide immediate interventions to deteriorating ward patients, little is known about how junior doctors and nurses escalate care for deteriorating ward patients in hospitals with established MET services. ⋯ The decision to call a MET or the primary team doctors is a complex judgement that is greatly influenced by the dynamics of perceived hierarchy between the medicine and nursing professions and within the medicine profession. Educational and organisational changes that enhance doctor-nurse interprofessional and intraprofessional collaboration among all levels of doctors may improve the process of the escalation of care for deteriorating patients and thus improve patient safety for hospitalised patients.
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Critically ill patients are often transferred from the intensive care unit (ICU) to other locations around the hospital during which adverse events, some life threatening, are common. An intercollegiate guideline covering the transport of critically ill patients exists in Australasia; however, compliance with this guideline has previously been shown to be poor, and its role in improving safety in transportation of patients in the ICU is unknown. We performed a pre-post interventional study in a tertiary metropolitan ICU, assessing the impact of the introduction of a transport checklist on guideline compliance. ⋯ We conclude that a checklist is useful in improving safety in the transport of a critically ill patient population.
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Various critical care outreach services have been developed and evaluated worldwide; however, the conflicting findings indicate the need to strengthen the outreach service research. This study aimed to evaluate the effects of a nurse-led critical care follow-up program on intensive care unit (ICU) readmission and hospital mortality in patients with respiratory problems discharged from the ICU in Hong Kong. ⋯ The findings demonstrated that a nurse-led multidisciplinary ICU follow-up program was a beneficial and cost-saving strategy to avert ICU readmission in patients with respiratory problems after ICU discharge. It also highlighted the competent role of ICU nurses in planning and leading the implementation of a multidisciplinary program. The results contributed to the database of an innovative follow-up program to inform the practice worldwide.