Contemp Nurse
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Evidence based practice is seen to be a vehicle through which nurses can deliver more cost-effective care and improve patient outcomes. Despite this, however, 'evidence' does not always appear to influence policy and practice. Routine and traditional practices such as pre-operative fasting protocols seem particulary resistant to change. ⋯ Despite this evidence, however, pre-operative fasting for clear fluids, even for healthy young adults undergoing elective surgery, still persist for periods of up to twelve hours' duration. 'Evidence' was used in a surgical unit in a private hospital in Sydney to reduce pre-operative clear fluid fasting periods for patients requiring elective bowel surgery. This paper will describe the process of implementation of the reduced fasting guidelines. More specifiically, it will detail what was done and how it was done; it will also demonstrate the crucial role of strong nursing leadership in this evidence based change to existing practice.
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Review Case Reports
Withdrawal of treatment in the intensive care unit: the ethical and legal issues.
Many articles have been written and studies conducted into why our patients' pain is not being managed more effectively. The myths and fears still persist, yet the solution is known. Why, then, can't our profession help those we care most about--our clients? Intensive care units (ICUs) have, over the last 30 years, become places of life-saving miracles, and as such, moral dilemmas have also been created. ⋯ The emotional, and other, stakes are also high in this area for patient, family and care team. This paper discusses ethical and legal issues highlighting the principles, doctrines, legislation and precedents especially important in the making of the decisions to withdraw treatment. An ethical framework grid is suggested to assist with the decision-making process.
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Nurses have the responsibility of adequately managing patients' post-operative pain. This literature review assesses whether nurses' management of post-operative pain is adequate or not, according to the literature findings. The findings reveal that nurses' management of patients' post-operative pain is not adequate and implies the concurrent need for improved nurse education and practice. The findings also indicate a need for ongoing research of this phenomenon.
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The authors examine the topic of humour and argue that humour is needed as one of many skills within the nurse patient relationship. We advance the view that humour has been well researched as an agent of therapeutic value and as a communication tool which helps to relieve stress, but, to date is not used to its fullest potential and tends therefore to be underestimated in both general and psychiatric nursing areas. Humour has benefits for both the nurse and the patient having psychological benefits and a vast array of physiological advantages and is regarded by those who use it as a social lubricant acting as a positive in nurse patient relationships. ⋯ Furthermore, it helps to facilitate and promote mutual health and well being for both the patient and the nurse. The usage of humour in psychiatric nurse settings is discussed and the benefits to both the patients and their staff are outlined as being of immense therapeutic value. The literature perhaps tends to skirt around these benefits somewhat, as psychiatry and laughter in partnership are not really considered important discursive topics.
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The purpose of this paper is to examine trends in the global healthcare environment, especially the developed countries. The developed countries are examined in detail as they have influenced the changes that have occurred in the delivery of healthcare in Australia. The countries discussed include the United States, Canada, Europe and Australia. ⋯ There has been a marked rise in the cost of hospital and other institutionalised care and health insurance. The ageing population and the increased use of sophisticated and expensive equipment have also increased costs. Other issues identified are, the declining number of hospitals beds, the shift from care in the hospitals or institutions to care in the home or community, the increase in continuum of care programs, the establishment of health care networks, focus on service quality, the lack of security about gaining health insurance and the focus on treatment rather than prevention.