Articles: intensive-care-units.
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Meeting the challenges of allocating critical care resources in the fairest way possible depends upon the development of a standardized strategy for apportioning ICU services in times of limited supply. Two main approaches are emerging to handle these challenges. ⋯ The second approach involves improving the efficiencies of the care giving system itself. Either approach requires the establishment of a standard of care that reduces the potential for personal biases into the decision making process.
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Little research was found to indicate that pain is managed well in hospitalized patients and few studies were found regarding pain management for critical care patients. ⋯ Results from this study suggest that nurses in both intensive care and surgical units do not appropriately assess, manage or evaluate pain and pain-related side effects. Patients who experience pain expect to have their pain controlled. Efforts must be made to change nurses' pain management behaviors.
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Critical care clinics · Jan 1994
ReviewObjective data and quality assurance programs. Current and future trends.
As CCM has grown, the diversity of ICU patients, as well as that of ICU organization and structure, has grown. This growth has led to numerous questions regarding health care delivery in the ICU. These questions contributed to the development of systems that objectively evaluate the quality of health care delivery in ICUs. ⋯ The SCCM data suggest two possible alternatives, not necessarily exclusive of each other: (1) A large percentage of ICUs may be obligated to undergo structural changes in the near future. (2) Regionalization of critical care, already present, may continue. Certain rural areas may find it more expedient to send the most critically ill patients to tertiary centers in nearby cities, as opposed to a wholesale upgrading of the delivery of care in their own ICUs. Ultimately, all hospitals will be obligated to provide patients access to the highest quality of critical care.
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Advancements in techniques of medical technology have made it possible to postpone death, which, in many situations, amounts to nothing more than a protracted process of dying rather than a prolonging of life. This, together with the fact that these techniques are prohibitively expensive has brought to the fore difficult and extremely uncomfortable problems in medical ethics, especially with regard to who should have and who should not have high technology medical treatment. ⋯ Normally it is imperative that individuals make their own autonomous decisions in respect of medical treatment but there are times when consent is of secondary importance and when autonomy must of necessity be limited. However, information concerning medical decisions in intensive care should always be freely available to patients and their surrogates.