Dynamics (Pembroke, Ont.)
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Dynamics (Pembroke, Ont.) · Jan 2011
Clinical TrialCerebrospinal fluid collection: a comparison of different collection sites on the external ventricular drain.
Intracranial pressure monitoring using an external ventricular drainage (EVD) system is the most commonly used technology to monitor intracranial pressure or drain cerebrospinal fluid (CSF) in neurological and neurosurgical patients. CSF samples are collected routinely from the EVD system for laboratory tests. No study has been conducted to identify where the most appropriate site for CSF collection is in order to reduce the disruption of the closed EVD system and reduce the risk of infection. ⋯ The distal port of the EVD system is safe and easy for CSF collection. It also provides accurate results for CSF samples. When the CSF sample is collected from the distal port, the entire volume of CSF in the drip chamber should be collected and tested to obtain an accurate WBC count per unit of volume.
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Dynamics (Pembroke, Ont.) · Jan 2011
Caring for patients and families at end of life: the experiences of nurses during withdrawal of life-sustaining treatment.
Withdrawal of life-sustaining treatment is a process in which active treatment and the accompanying technology are removed, ending in the death of the patient. ⋯ The essence of this experience was described by these nurses as "trying to do the right thing". Three major themes emerged: A journey--creating comfort along the way, working in professional angst, and providing memories.
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Dynamics (Pembroke, Ont.) · Jan 2011
Conversations about challenging end-of-life cases: ethics debriefing in the medical surgical intensive care unit.
Clinicians frequently encounter and grapple with complex ethical issues and perplexing moral dilemmas in critical care settings. Intensive care unit (ICU) clinicians often experience moral distress in situations in which the ethically right course of action is intuitively known, but cannot be acted on. Most challenging cases pertain to end-of-life issues. ⋯ Process changes were implemented based on the group's suggestions. The process changes resulted in increased awareness of the benefits, increased frequency of sessions and demonstrated utility. Lessons learned from the MSICU experience will inform the development of education curricula to help critical care nurses with challenging end-of-life situations.
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Dynamics (Pembroke, Ont.) · Jan 2011
Increased mortality among the critically ill patients admitted on weekends: a global trend.
Critical illness and injury have no concept of time and do not always occur within regular business hours or at times conducive to optimal hospital function. In fact, it is a global trend that critically ill patients admitted to hospitals on weekends suffer higher mortality rates than those admitted during the week. ⋯ Possible solutions include moving to a "closed" ICU system, increasing nurse staffing, intensivist coverage and diagnostic accessibility, and creating a true seven-day hospital system. Finally, it is unclear exactly how to solve the nurse staffing portion of this problem, as it appears internally linked to the nursing profession and externally to hospital management, recruiting difficulties and financial restraints, and a problem that will take more than change in nursing management strategy to resolve.