Dynamics (Pembroke, Ont.)
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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.
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Dynamics (Pembroke, Ont.) · Jan 2008
Comparative StudyFamily presence during resuscitation: a survey of Canadian critical care nurses' practices and perceptions.
The practice of allowing family members to be present at the bedside during cardiopulmonary resuscitation is a controversial one and represents a paradigm shift among health care providers. To date, no research has examined this issue from the perspective of Canadian critical care nurses. ⋯ Although guidelines or policies for FPDR are not available in most hospitals where respondents worked, the majority of critical care nurses support FPDR and either had taken or would be willing to take family members to the bedside during CPR. The willingness of nurses in critical care to support FPDR suggests the need for more formal policies in hospitals and the development of algorithms to facilitate this process.
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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.