Articles: intensive-care-units.
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The circumstances surrounding the admission of a patient to a critical care unit have a particularly negative effect on both the quantity and quality of sleep. Critical care nurses play an important and challenging role in the promotion of effective sleep and rest. Developing a plan of care that not only addresses the acute, life-threatening needs of patients but also promotes sleep and rest may seem impossible. This article provides a brief review of normal sleep, discusses barriers to sleep and rest in the critical care setting, and presents research-based interventions to promote sleep.
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This article examines the impact of greater management involvement by the medical director on efficiency of bed allocation in the intensive care unit (ICU) or critical care unit. Managerial involvement is modeled using a principal components approach in terms of perceived supervision, conflict resolution regarding bed allocation at critical times, extent of control over treatment, and employment status. ⋯ It was found that greater involvement by medical directors in the day-to-day management of the ICU significantly reduces the average occupancy rate in ICUs and also the probability of patients misallocated to the ICU, suggesting superior resource allocation in ICUs as a result. These results also suggest that the managerial impact of the medical director is greater in ICUs in high-occupancy hospitals.
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The literature on outcomes of intensive care for the elderly with regard to intensive care unit utilization, mortality, hospital costs and charges, and quality of life after intensive care were reviewed. Publications in the English literature, which evaluated intensive care and included elderly populations, were obtained from review of Index Medicus and MEDLINE. ⋯ A therapeutic trial and appropriately discontinuing life support may lead to better utilization of intensive care. Additional data are needed on long-term mortality and quality of life after hospital discharge.