British journal of nursing (Mark Allen Publishing)
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This article, the second in a two-part series, outlines the role of the nurse in assessing and implementing aspects of care of the mechanically ventilated patient in the intensive care unit, including sedation, communication, safety, nutrition, and the needs of patients' visitors. The ultimate goal (Where possible) is to help the patient manage without the ventilator. This process is referred to as 'weaning' and often involves the nurse participating in intricate patient assessment and the implementation of specialized care. The need for a multidisciplinary approach to patient care is emphasized.
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The mechanically ventilated patient often represents the ultimate in vulnerability and demands the highest standards of nursing care. Not only may the patient be unconscious but also the artificial airway is an unnatural invasion of the most innate physiological mechanism--breathing, and the nurse must safeguard this during all aspects of care. ⋯ It ranges from caring for the patient's activities of daily living to carrying out the highly technical and invasive monitoring and interventions which require specialist knowledge and skills. This article, the first in a two-part series, covers the types of ventilation, suction therapy, oral and eye care, elimination, body position, physiotherapy and the physiological effects of mechanical ventilation.
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Managed care is a system of coordinating and structuring health care for use by all members of the multidisciplinary team. It is intended to provide quality, cost-effective care that is research- or evidence-based. ⋯ This article describes the concept of managed care and some of the tools used in managed care programmes. The benefits of adopting such a system are discussed and the issues that should be considered before its implementation examined.
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This article explores issues related to the health of people with learning disabilities, with particular reference to the Department of Health (1995a) document The Health of the Nation: A Strategy for People with Learning Disabilities. This publication has stimulated care staff across all agencies to take a fresh look at this client group and their health needs in the five key areas: coronary heart disease and stroke; cancers; HIV/AIDS and sexual health; accidents; and mental health.