Dynamics (Pembroke, Ont.)
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Dynamics (Pembroke, Ont.) · Jan 2012
ReviewDelirium in the intensive care unit: role of the critical care nurse in early detection and treatment.
Critically ill patients are at increased risk of developing delirium, which has been considered one of the most common complications of intensive care unit (ICU) hospitalization. Despite the high occurrence of delirium in the ICU, researchers have shown it is consistently overlooked and often undiagnosed. An understanding of delirium and the three clinical subtypes of hyperactive, hypoactive and mixed-type delirium that exist are key to early detection and treatment. ⋯ The importance of the use of validated assessment tools, such as the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) to detect key features of delirium development is emphasized. Recommendations to improve the practice of critical care nurses include continuing education regarding the causes, risk factors and treatments of delirium, and education sessions on the use of validated assessment tools. Early prevention strategies, such as modification of the ICU environment to promote normal sleep/wake cycles, including reduction of unit noise and nighttime interruptions, are examined as interventions to avoid the development of delirium.
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Burnout and its development in critical care nurses is a concept that has received extensive study, yet remains a problem in Canada and around the world. Critical care nurses are particularly vulnerable to developing burnout due to the chronic occupational stressors they are exposed to, including high patient acuity, high levels of responsibility, working with advanced technology, caring for families in crisis, and involved in morally distressing situations, particularly prolonging life unnecessarily. The purpose of this article is to explore how the chronic stressors that critical care nurses are exposed to contribute to the development of burnout, and strategies for burnout prevention. ⋯ The results revealed that nurse managers play a crucial role in preventing burnout by creating a supportive work environment for critical care nurses. Strategies for nurse managers to accomplish this include being accessible to critical care nurses, fostering collegial relationships among the different disciplines, and making a counsellor or grief team available to facilitate debriefing after stressful situations, such as a death. In addition, critical care nurses can help prevent burnout by being a support system for each other and implementing self-care strategies.
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Dynamics (Pembroke, Ont.) · Jan 2012
A survey of nurses' perceptions of the intensive care delirium screening checklist.
Delirium in critically ill patients is common and is associated with increased morbidity and mortality. Routine delirium screening is recommended by the Society of Critical Care Medicine. The Intensive Care Delirium Screening Checklist (ICDSC) is one validated and commonly-used tool, but little is known about nurses'perceptions of using the ICDSC, and of barriers to delirium assessment and treatment. ⋯ The ICDSC is viewed favourably by nurses with experience using the tool. Future delirium screening programs should encourage physician engagement early in the planning process to help address perceived barriers to delirium assessment and treatment.
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Dynamics (Pembroke, Ont.) · Jan 2012
Journal club in a critical care unit: an innovative design triggering learning through reading and dialogue.
Journal club has been used for decades to incorporate reading clinical and research articles into professional practice of numerous health care providers to disseminate knowledge and to bridge the gap between research and clinical practice. In this article, the authors describe how such activity was implemented by and for the nursing team of an intensive care unit. ⋯ The authors describe the phases of this project: the co-development of the journal club, the implementation of the activity and its results. The authors detail how this journal club format incorporated additional teaching aids during each session and used narrative pedagogy as a conceptual framework.