Articles: critical-care.
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Off J Can Assoc Crit Care Nurs · Jan 1997
ReviewAn innovative approach to pain management in critical care: therapeutic touch.
Nursing research suggests that pain in critically ill patients is inadequately controlled and has deleterious effects. The critical care nurse must depend on the patient's perception of pain and its expression in physiological and behavioural responses. Ventilatory support, fluctuating levels of consciousness, hemodynamic instability and severity of illness are often barriers to the expression and interpretation of pain. ⋯ Therapeutic touch (TT), one innovative approach, is proposed as an adjunct to pharmacological intervention TT is a non-invasive, holistic practice that promotes comfort, relaxation, stress reduction and heating. Clinical studies suggest that TT prolongs the interval between analgesies. The authors highlight the 10-year clinical experience of a critical care nurse practising TT in a 30-bed critical care and trauma centre.
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Off J Can Assoc Crit Care Nurs · Jan 1997
Review Case ReportsThe use of limited critical care resources: an ethical dilemma.
The following article consists of a review of the literature surrounding the issue of persistent vegetative state (PVS) patients and resource allocation. The author attempts to analyze the question: Should limited critical care resources be used on PVS patients at the risk of denying those resources to others? The author explores such factors as: prognosis and recovery in PVS, life expectancy, and quality of life. As well, resource availability and ICU costs involved in sustaining the life of a PVS patient are examined. Finally, principles such as non-maleficence and beneficence; as well as the critical care professionals attitudes toward this issue; and the moral, ethical, and emotional dilemmas are discussed.
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This review describes general principles of quality control and focuses on the issue of process quality in intensive care units. Process quality of a service organisation mostly involves the factors timing and communications. Management tools for improving and enhancing process quality are mainly edition and enforcement of practice guidelines, but also the setting of performance standards and regular audits of process quality by selected indicators. Implementation of these concepts into the practice of Intensive Care is discussed and recommendations are made.
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Dimens Crit Care Nurs · Jan 1997
Review Case ReportsLow cardiac output following cardiac surgery: critical thinking steps.
Patients often experience low cardiac output following cardiac surgery and as many as 90% of patients experience a decreased left ventricular ejection fraction (LVEF) and cardiac index (CI). Causes may vary from volume depletion to global myocardial dysfunction. Critical thinking skills, combined with diligent patient monitoring and a knowledge of cardiovascular physiology and pharmacology are required for prompt recognition and treatment of low cardiac output following cardiac surgery.