Articles: intensive-care-units.
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Information on the role of the intensivist in postoperative cardiovascular patient care was obtained from a national survey of cardiac surgeons. The cardiac surgeon today retains overall responsibility for patient care. ⋯ Intensivists are less likely to practice in nonteaching hospitals and less likely to be present in those cardiac surgical units that are not combined with other services. Because of the preponderance of intensivists in training programs, the surgical resident's role in patient care may be reduced in the future.
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Many critically ill patients suffer pain which can produce by itself undesirable effects. Consequently, pain must be carefully prevented, or at least, treated early and effectively. ⋯ Computer-assisted intravenous "on demand" analgesia with Fentanyl can also be used. When pain coverage is required during transient events such as active physiotherapy or dressing changes, additional intravenous of a narcotic (1-2 mg morphine e.g.) or inhalation of nitrous oxide with oxygen are usually effective.
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Nutritional support is an integral and essential part of the management of 5-10 percent of hospitalized children. Children in the intensive care unit are particularly likely to develop malnutrition because of the nature and duration of their illness, and their inability to eat by mouth. This article reviews the physiology of starvation and the development of malnutrition in children. ⋯ Guidelines are provided for choosing between peripheral and central total parenteral nutrition. A monitoring protocol is suggested and complications of nutritional therapy are reviewed. Safe and effective nutritional support requires considerable investment of time and effort by members of the nutrition team.
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Leadership style has been defined as a two-factor construct composed of "consideration" and "initiating structure." Research has suggested that these factors affect the behavior and attitude of subordinates. This study's purpose was to quantify the relationships of head nurse leadership style with self-reported staff nurse burnout and job satisfaction in Neonatal Intensive Care Units (NICUs). Three instruments--the Minnesota Satisfaction Questionnaire, the Tedium Scale, and the Leadership Opinion Questionnaire--were voluntarily completed by 283 registered nurses employed by 14 level-III NICUs in the United States. ⋯ Satisfaction and burnout of staff nurses in each of the leadership-style groups were then compared. Analysis of variance for satisfaction (F(3,279) = 3.10, p = .03) and burnout (F(3,279) = 3.90, p = .01) were both significant. For both satisfaction and burnout, the head nurse leadership classification of low consideration-high structure was most deviant.(ABSTRACT TRUNCATED AT 250 WORDS)