International journal of trauma nursing
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This article provides an overview of the history and current practice of trauma nursing in the German health care system. A description of nursing education, skills, duties, and responsibilities of the nursing workforce is complemented by a brief description of the trauma system. As current demographic developments, structural changes, and medical progress result in a rapidly changing health care environment, tasks for nurses are becoming increasingly complex. The development of academic programs and extended nursing tasks are expected to help manage the upcoming changes and challenges in the manifold processes of patient-centered-nursing-care delivery.
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A prospective, concurrent study was conducted of all patients who self-extubated in a mixed critical care setting during a 14-month period. The purpose of the study was to identify the incidence and common factors associated with spontaneous self-extubation (SSE). A total of 75 cases of SSE occurred in 68 patients who had an incidence of 38.5 SSEs per 100 intubated days. ⋯ Of the 56 cases of SSE that were witnessed, 43 cases (73% of those observed) were considered deliberate rather than accidental. The practice of using intravenous boluses on an "as needed" dosing frequency for administering sedation and analgesia was a common factor in SSE. Adequate doses of sedation and analgesia delivered by continuous infusion may prevent SSE in alert, intubated patients.