Dynamics (Pembroke, Ont.)
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Dynamics (Pembroke, Ont.) · Jan 2009
Comparative StudyTotal spinal anesthesia for cardiac surgery: does it make a difference in patient outcomes?
Heart disease is a major cause of morbidity and mortality. While cardiac surgery is a viable treatment option, it is a potent physiological stressor. The surgical stress response may result in patient decompensation and negative patient outcomes. The goal of a novel anesthetic approach, which combines high spinal anesthesia with intrathecal morphine and general anesthesia (TSA), is to attenuate this stress response. ⋯ This evidence highlights the clinical nursing relevance of the type of anesthesia on postoperative care and outcomes. The knowledge gained from these findings will help to enable the multidisciplinary critical care team to anticipate TSA patient outcomes and to facilitate the development of appropriate and effective evidence-based, patient-focused plans of care. This pilot study establishes sound rationale for subsequent larger prospective cohort research of the TSA patient population.
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Dynamics (Pembroke, Ont.) · Jan 2009
Innovations in technology--Novalung iLA: challenges for the field of critical care nursing.
The Novalung interventional lung assist (iLA) device is a new pumpless extracorporeal gas exchange device that imitates the native lung because it allows for protective mechanical ventilation by the reduction of tidal volumes and decreased end expiratory pressures. It is a rescue device for patients with refractory lung failure, as well as a bridge to lung transplantation. While used in Europe for some years, the Novalung iLA has been recently approved by both Health Canada and our facility, as a bridge to lung transplantation. ⋯ Particular attention is paid to the education of the nursing staff. A plan was developed to deliver information, education and training guidelines to prepare for patients requiring a bridge to lung transplantation with this device within the medical surgical intensive care unit in our hospital. Subsequently, these initiatives have expanded to include a workshop and a simulation experience.
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Dynamics (Pembroke, Ont.) · Jan 2009
The Oxygen Supply and Demand Framework: a tool to support integrative learning.
Critically ill patients are at high risk for inadequate oxygen supply, increased oxygen demand and inadequate cellular oxygenation. Understanding and managing the physiological consequences of critical illness requires nurses to integrate knowledge of patient assessment, physiology and pathophysiology, and critical care interventions into their clinical decision-making. The Oxygen Supply and Demand Framework incorporates interrelated physiological concepts that influence balance between oxygen supply and demand and, consequently, supports an integrated understanding of critically ill patient situations. In this article, we present the Oxygen Supply and Demand Framework as an integrative tool for use by educators, students and critical care nurses to guide the process of patient assessment, interpret data, inform selection of appropriate interventions, and understand the rationale for all aspects of patient management.
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Dynamics (Pembroke, Ont.) · Jan 2008
Glycemic control in diabetic and non-diabetic cardiac surgical patients and length of hospital stay.
Maintaining blood glucose levels (BGL) within normoglycemic range has been shown to reduce morbidity and mortality in critically ill patients. However, there is little evidence that maintenance of normoglycemic BGL is beneficial for diabetic and non-diabetic patients who undergo cardiac surgery. ⋯ In this cohort of cardiac surgical patients, pre- and postoperative BGL did not affect LOS.
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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.