Dynamics (Pembroke, Ont.)
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Dynamics (Pembroke, Ont.) · Jan 2008
ReviewBuilding a successful DCD program: planning and leading change.
In Canada, there is a growing gap between the number of organs donated each year and the number of organs needed for transplant. This gap is forcing health care professionals to re-examine end-of-life care and donation practices. ⋯ Clinical nurse specialist leadership, ethics consultation, partnerships with key physician colleagues and administrators, as well as comprehensive workshops are described as essential for success. Lessons learned throughout are shared.
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Dynamics (Pembroke, Ont.) · Jan 2008
ReviewThe importance of routine QT interval measurement in rhythm interpretation.
When monitoring a patient's cardiac rhythm, the QT interval should be routinely measured. A variety of factors can prolong the QT interval such as drug effects, electrolyte imbalances, acute myocardial infarction, and congenital factors. ⋯ One obstacle to the routine measurement of the QT interval is the lack of a standardized and simple approach. The purpose of this article is to detail factors that prolong the QT interval and describe methods used to measure the QT interval.
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There is an increasing need for critical care expertise outside of the intensive care unit (ICU). This is particularly related to high acuity levels and limited nursing resources. Teams of critical care health care providers have been formed to meet this need. ⋯ In this article, the process of establishing an ICU outreach team without additional resources, in a 200-bed tertiary care hospital in central Saskatchewan is presented. The team responds to calls from within the hospital to provide critical care expertise to patients about whom the professional caregiver is concerned, or patients who have early warning signs of physiological distress. Implementation of the team has been successful in improving timely patient care, providing a resource for nurses to access for their patients, and providing an opportunity for education and support for nurses on inpatient units.
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Managing anxiety, pain and delirium in critically ill patients is an ongoing challenge. Differences in physician practice, variations of pharmacological agents, as well as concentrations and units can increase the risk of medication error Personal preferences, subjectivity, and nurses' level of expertise are variables when titrating analgesic and sedation infusions. ⋯ We believe that the implementation of the sedation protocol has been beneficial in our adult ICU. Findings indicate that with experience and resources nurses can manage anxiety, pain and delirium more confidently than without such a protocol. Critical care nurses, given the right tools, education, and support can make decisions that promote positive outcomes for patients receiving sedation and analgesia in the ICU.
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Patient- and family-centred care (PFCC) concepts are increasingly cited in the critical care literature and are a welcome addition to the vernacular of the intensive care unit (ICU). The implementation and maintenance of a supportive PFCC environment is challenging, however, and usual strategies for knowledge translation using guidelines and policies, no matter how articulate, have not yet resulted in sustained practice change at the point of care delivery. In this article, co-authored by community partners, the physician director and nurse leader of one tertiary care ICU, we describe an initiative in which patient and family representatives were included in the ICU interdisciplinary team membership. After two years and now, at the conclusion of the assignment, options for community partner participation in various activities related to unit governance are shared.