British journal of nursing (Mark Allen Publishing)
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Admission to critical care can have far-reaching psychological effects because of the distinct environment. Critical care services are being re-shaped to address long-term sequelae, including post-traumatic stress disorder, anxiety and depression. The long-term consequences of critical illness not only cost the individual, but also have implications for society, such as diminished areas of health-related quality-of-life in sleep, reduced ability to return to work and enjoy recreational activities (Audit Commission, 1999; Hayes et al, 2000). ⋯ Facilitating communication, explaining care and rationalizing interventions, ensuring patients are oriented as to time and place, reassuring patients about transfer, providing patients,where possible, with information about critical care before admission and considering anxiolytic use, are all practices that have a beneficial effect on patient care. Follow-up services can help patients come to terms with their experiences of critical illness and provide the opportunity for them to access further intervention if desired. Working towards providing optimal psychological care will have a positive effect on patients' psychological recovery and may also help physical recuperation after critical care.
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Mortality from cardiac disease is decreasing, yet the prevalence of ischemic heart disease, diabetes and hypertension is increasing. This, combined with an aging population, affects the characteristics of the surgical population. Survival in this subgroup of the non-cardiac surgical population has not been studied in a UK setting. ⋯ Patients with angina had nearly a 60% greater risk of death compared with asymptomatic patients. In the hospital setting, nurses with the appropriate pre-assessment and critical care competencies are pivotal to the successful management of this group of patients. In the long term, careful follow-up by the primary care team can help modify cardiac risk factors and potentially reduce cardiac-related mortality.
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Following the introduction of a new nurse-led telephone referral service to a dedicated paediatric emergency assessment unit (PEAU), a study was conducted to determine the views of general practitioners (GPs) who use the service. The PEAU operates between 10 am and 10 pm on weekdays and between 10 am and 6 pm at weekends. The unit has four beds and treatment and stabilization areas, plus associated services in a dedicated area of a regional child health unit. ⋯ Of the 25 GP respondents to the follow-up postal survey, the majority (17) agreed that the follow-up morning after discharge telephone call to parents by the PEAU nurses was helpful. Four GPs indicated that the 24-hour open access system, offered by the nursing staff, in which a parent may attend PEAU with a discharged child causing concern without a previous appointment, does not always work. This study has shown that a nurse-led telephone referral system to a PEAU for GPs and the subsequent management of the children has been favourably received.
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Patients undergoing total laryngectomy/glossectomy are left without a voice at least temporarily in the early postoperative stage, since their larynx and/or tongue has been removed. Those patients rendered permanently speechless usually acquire a form of mechanical speech through electronic devices. However, the life-changing nature of this surgery should not be underrated as effectively these people have lost their normal voice. ⋯ Such change has been driven by patient comment such as: 'But then when you wake up after that operation that's the pits when you are laying there and you think "I'm dead". And then when you wake up properly that's the bit I always say you wish you were dead. That's when you wish you had died.'
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With an increasing elderly population, estimated to rise to 26% of the UK's total population by 2020 (World Health Organization (WHO), 2004), this demographic represents a large area of potential referrals for hospital-based palliative care services. In planning service provision for this group, all nurses must examine current levels of access for older people to specialist palliative care services. ⋯ The article analyses the benefits of palliative care involvement in a group who have multiple comorbidities and whose concerns, including adequate symptom control and assistance in making end-of-life decisions, reflect the philosophies inherent in the palliative care movement. Political- and clinical-based strategies in overcoming these barriers involving multidisciplinary working and education are necessary to ensure that the older person is being treated with dignity and fairness throughout his/her hospital journey.