Articles: intensive-care-units.
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Working on an intensive care unit is perceived as stressful. This study investigated occupational stress in staff working on an intensive care unit using the occupational stress indicator. Questionnaires were given to all intensive care staff; the replies were then analysed and compared with normative data. ⋯ Their coping strategies differ but the only significantly different measure of adverse outcome was related to personal relationships at work. The job itself was not found to be a significant source of stress. Nursing staff have different sources of stress from medical staff and individuals with partners or children are relatively protected from stress.
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Continuous renal replacement therapy (CRRT) is performed in critical care units around the world with various levels of involvement from critical care and nephrology nurses. In this article, factors affecting the delivery of nursing care and the particular expertise nephrology and critical care nurses have in the area of CRRT are examined. ⋯ Based on related research findings and a comparison of the models, the Collaborative Model is the preferred one, as it brings the highest level of expertise directly to the patient. For the Collaborative Model to work, a framework for collaboration and a high degree of commitment from both specialties must be maintained.
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The arrival of continuous renal replacement therapy (CRRT) has given the intensivist and the intensive care nurse the opportunity to treat acute renal failure (ARF) independently by giving them the necessary technology and taking CRRT away from absolute nephrological control. This structural shift has created a controversy between those countries where control of CRRT has completely shifted to the intensivist and those countries where nephrological input is still dominant. The argument in favor of intensivist-driven CRRT rests upon several observations, including the fact that therapy is continuous, as is the presence of the intensivist in the intensive care unit (ICU). ⋯ Intensivists are successfully performing more and more procedures that were previously seen as part of other specialties and, last but not least, "closed" models of ICU care appear to work best. Australian intensivists have taken up CRRT from the start and now control it. Patient outcomes under such a system, as reported here, are above average, and confirm the effectiveness of such an approach.
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AACN clinical issues · Nov 1997
A collaborative approach to fetal assessment in the adult intensive care unit.
When a pregnant woman is admitted to the adult intensive care unit (ICU), responsibility for fetal assessment must be assumed by a nurse who is competent in interpreting data obtained by auscultation of the fetal heart rate or by the electronic fetal monitor. The fetus is a distinct patient requiring assessments, interventions, and evaluation, including documentation of nursing care provided, similar to any patient in the ICU setting. ⋯ Therefore, in institutions in which critically ill pregnant women are transferred to the adult ICU, a formal plan should be in place that includes care provided by nurses who are competent in fetal assessment. This article describes a collaborative approach to ensure that fetal assessments are performed by nurses who have the experience and education to do so and includes common terminology used to describe fetal status so that ICU nurses are familiar with the language and appropriate nursing intervention.