AACN clinical issues
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AACN clinical issues · Feb 2002
Case ReportsAcute care of the elderly units: a positive outcomes case study.
Acute care of the elderly patient is a specialty area of practice. The elderly have a spectrum of needs including physiologic, psychosocial, functional, and financial needs that will alter their response to physiologic illness and the acute care experience in general. ⋯ This elderly patient manifested a response to the acute care experience that was typical of his age cohort, including confusion and incontinence. Subsequent transfer to an acute care for the elderly unit maximized this patient's recovery and postdischarge placement.
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Pediatric patients are not just "little adults" and elderly patients are not just "old adults." The elderly patient experiences physiologic and anatomic changes that affect all body systems. Providing trauma care for the elderly presents a particular challenge. ⋯ Preexisting health conditions further complicate the picture. This article highlights some of the important differences in caring for an elderly trauma patient from resuscitation to rehabilitation.
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Evidence-based practice means integrating the best available research evidence with information about patient preferences, clinician skill level, and available resources to make decisions about patient care. Barriers to the use of research-based evidence occur when time, access to journal articles, search skills, critical appraisal skills, and understanding of the language used in research are lacking. Resources are available to overcome these barriers and support an evidence-based nursing practice. This article highlights available resources and describes strategies that nurses can use to develop and sustain an evidence-based nursing practice.
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Pediatric nursing is deeply rooted in tradition and ritual. Although many practices remain relevant, others do not stand up to the challenge of an evidence-based nursing practice. ⋯ Although ample evidence to guide the practice of pain assessment and pain management in children exists, children remain undermedicated when compared to adults. This article explores the influence of practice traditions, personal bias, and the persistence of myths regarding pain in children on the practice of pain relief.
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AACN clinical issues · Aug 2001
Medical directors as partners in creating healthy work environments.
Relationships between nurses and physicians in the intensive care unit can range from collegial and supportive to dysfunctional and abusive. When there is trust, open communication, respect, and a sense of camaraderie, the work is still challenging but gets done: priorities are met and people feel good about what they are doing. ⋯ The nurse manager and medical director of the unit, as leaders of this team, are responsible for ensuring not only that quality care is delivered to patients, but also that the environment is supportive to caregivers. Purposefully establishing a collaborative partnership and then modeling these behaviors to the rest of the team, and holding them accountable, are key steps in creating an environment that is healing to patients, families, and caregivers.