Critical Care (critical + care)

Distribution by Scientific Domains
Distribution within Medical Sciences

Terms modified by Critical Care

  • critical care area
  • critical care environment
  • critical care medicine
  • critical care nurse
  • critical care nursing
  • critical care outreach team
  • critical care physician
  • critical care services
  • critical care setting
  • critical care society
  • critical care unit

  • Selected Abstracts

    American College of Physicians Manual of Critical Care

    David Moxon FRCS, FACEM, FJFICM, Intensivist
    No abstract is available for this article. [source]

    Part two: The core components of legitimate influence and the conditions that constrain or facilitate advanced nursing practice in adult critical care

    Carol Ball RGN MSc PhD
    This paper describes intervening conditions that might constrain or facilitate the exercise of Legitimate Influence: The Key to Advanced Nursing in Adult Critical Care, the foundation of which is credibility and advanced clinical nursing practice. Constraining conditions are conflict, resistance, gender bias, political awareness and established values. Credibility, advanced clinical nursing practice and strategic activity are required to enhance patient stay in hospital and improve patient outcome. Intervening conditions that facilitate these are overcoming resistance, political awareness and established values. In a previous paper, it was indicated that enhanced patient stay and improved patient outcome were achieved primarily through strategic activity that emphasized restoring patients to a former, or improved, health status. This paper portrays how intervening conditions can impinge upon this and the exercise of legitimate influence. [source]

    Civetta, Taylor, & Kirby's Critical Care, Fourth Edition

    Michael D. Burg MD
    No abstract is available for this article. [source]

    Hospitalists and intensivists: Partners in caring for the critically ill,The time has come,

    Michael Heisler MD
    Abstract A report by the Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS), published in 2000, predicted that beginning in 2007 a gap between the demand and availability of intensivists in the United States would become apparent and steadily increase to 22% by 2020 and to 35% by 2030. Subsequent reports have reiterated those projections including a report to congress in 2006 by the U.S. Department of Health and Human Services/Health Resources and Services Administration. This "gap" has been called a health system "crisis" by multiple authors. Two important documents have published specific recommendations for how to resolve this crisis: the Framing Options for Critical Care in the United States (FOCCUS) Task Force Report in 2004 and the Prioritizing the Organization and Management of Intensive Care Services in the Unites States (PrOMIS) Conference Report in 2007. Since the initial COMPACCS report and since these 2 additional reports were published, a new opportunity to take a major step in resolving this crisis has emerged: the growing number of hospitalists providing critical care services at secondary and tertiary care facilities. According to the 2005/2006 Society of Hospital Medicine (SHM) National Survey, that number has increased to 75%. Since the number of intensivists is unlikely to change significantly over the next 25 years, the question is no longer "if" hospitalists should be in the intensive care unit (ICU); rather the question is how to assure quality and improved clinical outcomes through enhanced collaboration between hospital medicine and critical care medicine. Journal of Hospital Medicine 2010;5:1,3. © 2010 Society of Hospital Medicine. [source]

    BSAVA Manual of Canine and Feline Emergency and Critical Care

    Robert Goggs
    BSAVA Manual of Canine and Feline Emergency and Critical Care Edited by Lesley G. King and Amanda K. Boag Published by the British Small Animal Veterinary Association, 2007, 2nd edition, paperback, 380 pages, Price £85.00, ISBN-13: 978-0905214993 [source]

    Price development in important anesthesia and critical care medicine journals in comparison to journals of other disciplines

    J. Boldt
    Background: In today's climate of financial restrictions, libraries and individual subscribers complain about the price increase of scientific journals. The development in prices of anesthesia/critical care journals was analysed over the past 6 years and compared to prices of some journals of other disciplines. Methods: Important journals in the categories Anesthesiology, Emergency Medicine & Critical Care, Surgery, Medicine (General), and Cardiac & Cardiovascular Systems listed in the 1999 Science Citation Index of Journal Citation Report were included and prices for the years 1995 to 2000 were analysed. Results: Increase in prices ranged from +13% to +199%. The mean increase in journal prices was lowest in the category Anesthesiology (+61%), higher in the category Critical Care (+73%), and highest in the category Medicine, General (+101%). Changes in the impact factor (IF) varied widely, ranging from a decrease (Lancet: ,43%; J Neurosurg Anesth: ,44%) to a tremendous increase (e.g. Reg Anesth +165%; Ann Emerg Med +149%). The journals' size (number of articles or pages) did not increase proportionally with the increase in prices. Conclusion: A disproportionate rise in journal prices was seen over the past 6 years. The large increase in cost may have multiple reasons. The rapidly increasing cost of research journals may affect research quality because economic pressure may result in reduction in availibility of information due to cancellation of subscriptions to journals. [source]

    Achieving comprehensive critical care

    Catherine Derham
    Abstract The policy document, Comprehensive Critical Care, suggested that patients with critical care needs should expect the same standard of care wherever they are nursed, be that in a traditional critical care setting or in a general ward area. It is recognized that in order for this to occur, the developmental needs of ward nurses need to be met to enable them to care for patients with level 1 and level 2 needs. A second document, The Nursing Contribution to the Provision of Comprehensive Critical Care for Adults: A strategic Programme of Action, proposed a programme of action and outlined five priority areas to be considered to ensure the success of comprehensive critical care. Education, training and workforce development was one of the areas outlined, and thus, in response, the role of the practice development facilitator was created as a means of developing the critical care knowledge, skills and practice in ward areas. It became apparent that education and training alone were insufficient to ensure that the aims of comprehensive critical care were realized. The way in which the nurses approached and organized their work and the availability of resources had a great impact on the ability of staff to care for these patients. It is argued that achieving comprehensive critical care is complex and that a multi-dimensional approach to the implementation of policy is essential in order to realize its aims. [source]

    Immediate follow-up after ICU discharge: establishment of a service and initial experiences

    Eunice Strahan
    Summary ,Follow-up of patients discharged from the intensive care unit (ICU) is recommended as a means of service evaluation (Department of Health (2000). Comprehensive Critical Care: a Review of Adult Critical Care Services), in order to monitor the quality of the services provided ,Without patient follow-up, ICU staff have only ,death' or ,discharge alive from hospital' as clinical outcomes from which to judge practice performance, and limited evidence exists on which to base decisions about improvements to critical care practice (Audit Commission (1999). Critical to Success , the Place of Efficient and Effective Critical Care Services Within the Acute Hospital ) ,To address these issues the Regional Intensive Care Unit (RICU) obtained information from patient assessment/interview on problems experienced by patients within 8,9 days (mean), following discharge from RICU ,A nurse-administered questionnaire was used to identify functional outcomes, nutrition and psychological issues such as anxiety and sleep disturbances ,Benefits of patient follow-up introduced and planned include: ,patient diaries for long-term patients ,input from clinical psychologist ,review of sedation used in RICU [source]

    Changes in the impact factor of anesthesia/critical care journals within the past 10 years

    J. Boldt
    Background: The impact factor (IF) is published by the Institute for Scientific Information (ISI). There is a tendency to assess quality of scientific journals with the help of the IF. An analysis of the changes in the IF over time in the different specialities may help to further enlighten the worth and problems of the IF. Methods: The IFs listed under the subheadings Anesthesiology and Emergency Medicine & Critical Care in the Science Citation Index , Journal Citation Report were descriptively analysed over the past 10 years. Additionally, IFs of some other important journals (subheadings Surgery, Cardiovascular, General Medicine) were analysed. Results: The IF of most of the journals showed a constant increase over the years (average in Anesthesiology: +65%; average in Emergency Medicine & Critical Care: +145%). IFs of the highest ranked journals of other specialities showed a similar increase over the years (average in surgical journals: +56%; average in cardiac journals: +59%; average in general journals: +40%). More Anesthesiology and Emergency Medicine & Critical Care journals originated from the USA show an IF >2.0 over the past 10 years than do European journals. Conclusion: Although the value of the IF is highly controversial, it is a frequently used tool to assess rating of a medical journal. Anesthesiology and Emergency Medicine & Critical Care journals showed a continuous increase in the IF over the past 10 years. [source]

    Core Topics in Cardiothoracic Critical Care

    ANAESTHESIA, Issue 10 2009
    Michael Spivey
    No abstract is available for this article. [source]

    Critical Care: The Requisites in Anesthesiology

    ANAESTHESIA, Issue 8 2009
    Victoria Cooper
    No abstract is available for this article. [source]

    Receiving: The Use of Web 2.0 to Create a Dynamic Learning Forum to Enrich Resident Education

    Adam Rosh
    Receiving ( is a powerful web-based tool that encompasses web 2.0 technologies. "Web 2.0" is a term used to describe a group of loosely related network technologies that share a user-focused approach to design and functionality. It has a strong bias towards user content creation, syndication, and collaboration (McGee 2008). The use of Web 2.0 technology is rapidly being integrated into undergraduate and graduate education, which dramatically influences the ways learners approach and use information (Sandars 2007). Knowledge transfer has become a two-way process. Users no longer simply consume and download information from the web; they create and interact with it. We created this blog to facilitate resident education, communication, and productivity. Using simple, freely available blog software (, this inter-disciplinary web-based forum integrates faculty-created, case-based learning modules with critical essays and articles related to the practice of emergency medicine (EM). Didactic topics are based on the EM model and include multi-media case presentations. The educational modules include a visual diagnosis section (VizD), United States Medical Licensing Examination (USMLE) board-style cases (quizzER), radiographic interpretation (radER), electrocardiogram interpretation (Tracings), and ultrasound image and video clip interpretation (Morrison's Pouch). After viewing each case, residents can submit their answers to the questions asked in each scenario. At the end of each week, a faculty member posts the answer and facilitates an online discussion of the case. A "Top 10 Leader Board" is updated weekly to reflect resident participation and display a running tally of correct answers submitted by the residents. Feedback by the residents has been very positive. In addition to the weekly interactive cases, Receiving also includes critical essays and articles on an array of topics related to EM. For example, "Law and Medicine" is a monthly essay written by an emergency physician who is also a lawyer. This module explores legal issues related to EM. "The Meeting Room" presents interviews with leading scholars in the field. "Got Public Health?", written by a resident, addresses relevant social, cultural, and political issues commonly encountered in the emergency department. "Mini Me" is dedicated to pediatric pearls and is overseen by a pediatric emergency physician. "Sherwin's Critical Care" focuses on critical care principles relevant to EM and is overseen by a faculty member. As in the didactic portion of the website, residents and faculty members are encouraged to comment on these essays and articles, offering their own expertise and interpretation on the various topics. Receiving is updated weekly. Every post has its own URL and tags allowing for quick and easy searchability and archiving. Users can search for various topics by using a built-in search feature. Receiving is linked to an RSS (Really Simple Syndication) feed, allowing users to get the latest information without having to continually check the website for updates. Residents have access to the website anytime and anywhere that the internet is available (e.g., home computer, hospital computer, IphoneÔ, BlackBerryÔ), bringing the classroom to them. This unique blend of topics and the ability to create a virtual interactive community creates a dynamic learning environment and directly enhances resident education. Receiving serves as a core educational tool for our residency, presenting interesting and relevant EM information in a collaborative and instructional environment. [source]

    Reflection on the relationship between technology and caring

    Christopher Johns
    ABSTRACT Being attached to a piece of medical technology may cause patients physical and emotional distress. Critical care nurses need to empathize and respond to the patient's experience on being attached to all forms of medical equipment. The use of sedation must be carefully considered in response to agitation. Critical care is also palliative care. Compassion is a virtue. [source]

    Critical care bed capacity during the flu pandemic: implications for anaesthetic and critical care departments

    ANAESTHESIA, Issue 9 2009
    J. M. Handy
    No abstract is available for this article. [source]

    Potential use of insulin as an anti-inflammatory drug

    Paresh Dandona
    Abstract Acute hyperglycemia worsens morbidity and mortality in critically ill patients. The control of hyperglycemia with insulin improves clinical outcomes in patients with a stay of more than 3,5 days in the intensive care unit (ICU) and in coronary artery bypass graft (CABG) patients. However, clinical benefits of insulin infusion have not been seen consistently in patients with acute coronary syndromes. Since all previous studies in the ICU have centered on the normalization of glycemia, we still do not know whether insulin exerts beneficial effects over and above those observed with reduction of blood glucose concentrations. The regimens used in acute coronary syndromes infuse fixed doses of insulin with high rates of glucose and are usually associated with hyperglycemia; this may neutralize the beneficial effects of insulin. In this article, we discuss data demonstrating an anti-inflammatory effect of insulin and a pro-inflammatory effect of glucose. We provide a mechanistic justification for the benefits of maintaining euglycemia with insulin infusions in the hospitalized patients. To investigate the clinical benefits of the anti-inflammatory effects of insulin, we also suggest further investigations directed toward optimization of insulin infusion regimens to determine whether restoration of glucose levels toward normal with higher infusion rates and concentrations of insulin will lead to further improvement in outcomes in the critical care and acute coronary syndromes. Drug Dev Res 69:101,110, 2008 © 2008 Wiley-Liss, Inc. [source]

    Review article: Inotrope and vasopressor use in the emergency department

    Ainslie Senz
    Abstract Shock is a common presentation to the ED, with the incidence of septic shock increasing in Australasia over the last decade. The choice of inotropic agent is likely dependent on previous experience and local practices of the emergency and other critical care departments. The relatively short duration of stay in the ED before transfer leaves little room for evaluating the appropriateness of and response to the agent chosen. Delays in transfer to inpatient facilities means that patients receive advanced critical care within the ED for longer, requiring initiation and titration of vasoactive agents in the ED. This article discusses the general concepts of shock and the indicators for inotrope and vasopressor use, revises the various agents available and reviews the current evidence for their use. [source]

    Arterial blood gas parameters of normal foals born at 1500 metres elevation

    Summary Reasons for performing study: Arterial blood gas analysis is widely accepted as a diagnostic tool to assess respiratory function in neonates. To the authors' knowledge, there are no published reports of arterial blood gas parameters in normal neonatal foals at altitude. Objective: To provide information on arterial blood gas parameters of normal foals born at 1500 m elevation (Fort Collins, Colorado) in the first 48 h post partum. Hypothesis: Foals born at 1500 m will have lower PaO2 and PaCO2 than foals born at sea level due to low inspired oxygen and compensatory hyperventilation occurring at altitude. Methods: Sixteen foals were studied. Arterial blood gas analysis was performed within 1 h of foaling and subsequent samples were evaluated at 3, 6, 12, 24 and 48 h post partum. Data were compared to those previously reported in healthy foals born near sea level. Results: Mean PaO2 was 53.0 mmHg (7.06 kPa) within 1 h of foaling, rising to 67.5 mmHg (9.00 kPa) at 48 h post partum. PaCO2 was 44.1 mmHg (5.88 kPa) within one hour of foaling, falling to 38.3 mmHg (5.11 kPa) at 48 h. Both PaO2 and PaCO2 were significantly lower in foals born at 1500 m elevation than those near sea level at several time points during the first 48 h. Conclusions and potential relevance: Foals at 1500 m elevation undergo hypobaric hypoxia and compensatory hyperventilation in the first 48 h. Altitude specific normal arterial blood values are an important reference for veterinarians providing critical care to equine neonates. [source]

    On the Future of Reanimatology,

    Peter Safar MD
    Abstract: This article is adapted from a presentation given at the 1999 SAEM annual meeting by Dr. Peter Safar. Dr. Safar has been involved in resuscitation research for 44 years, and is a distinguished professor and past initiating chairman of the Department of Anesthesiology and Critical Care Medicine at the University of Pittsburgh. He is the founder and director of the Safar Center for Resuscitation Research at the University of Pittsburgh, and has been the research mentor of many critical care and emergency medicine research fellows. Here he presents a brief history of past accomplishments, recent findings, and future potentials for resuscitation research. Additional advances in resuscitation, from acute terminal states and clinical death, will build upon the lessons learned from the history of reanimatology, including optimal delivery by emergency medical services of already documented cardiopulmonary cerebral resuscitation, basic-advanced,prolonged life support, and future scientific breakthroughs. Current controversies, such as how to best educate the public in life-supporting first aid, how to restore normotensive spontaneous circulation after cardiac arrest, how to rapidly induce mild hypothermia for cerebral protection, and how to minimize secondary insult after cerebral ischemia, are discussed, and must be resolved if advances are to be made. Dr. Safar also summarizes future technologies already under preliminary investigation, such as ultra-advanced life support for reversing prolonged cardiac arrest, extending the "golden hour" of shock tolerance, and suspended animation for delayed resuscitation. [source]

    The medical emergency team: does it really make a difference?

    M. Cretikos
    Abstract Hospital systems are failing the critically ill. This has been well documented in many countries around the world, with detailed reports of suboptimal care prior to intensive care and high rates of serious adverse events, including death. These events are potentially preventable, but insufficient attention has been directed towards developing solutions to these important problems to date. The medical emergency team (MET) is a system approach that promotes early and appropriate inter­vention in the care of critically ill hospital patients. The benefits of the MET in terms of absolute in-patient ­mortality and cardiac arrest rates are not yet well-defined, although preliminary studies are promising. The MET does provide a potentially beneficial impact on many other aspects of patient care. These benefits include: (i) facilitating an integrated and coordinated approach to patient care across the hospital, (ii) increasing awareness of at-risk patients, (iii) encouraging early referral of seriously ill patients to clinicians with expertise in critical care and (iv) providing a foundation for quality initiatives for hospital-wide care of the seriously ill. The MET also empowers nursing staff and junior medical staff to call for immediate assistance in cases where they are seriously concerned about a patient, but may not have the experience, knowledge, confidence or skills necessary to manage them appropriately. (Intern Med J 2003; 33: 511,514) [source]

    Part two: The core components of legitimate influence and the conditions that constrain or facilitate advanced nursing practice in adult critical care

    Carol Ball RGN MSc PhD
    This paper describes intervening conditions that might constrain or facilitate the exercise of Legitimate Influence: The Key to Advanced Nursing in Adult Critical Care, the foundation of which is credibility and advanced clinical nursing practice. Constraining conditions are conflict, resistance, gender bias, political awareness and established values. Credibility, advanced clinical nursing practice and strategic activity are required to enhance patient stay in hospital and improve patient outcome. Intervening conditions that facilitate these are overcoming resistance, political awareness and established values. In a previous paper, it was indicated that enhanced patient stay and improved patient outcome were achieved primarily through strategic activity that emphasized restoring patients to a former, or improved, health status. This paper portrays how intervening conditions can impinge upon this and the exercise of legitimate influence. [source]

    Cohesion among nurses: a comparison of bedside vs. charge nurses' perceptions in Australian hospitals

    Wendy Chaboyer PhD RN
    Cohesion among nurses: a comparison of bedside vs. charge nurses' perceptions in Australian hospitals Aim.,This study examines the extent to which hospital nurses view their working environment in a positive sense, working as a cohesive group. Background.,Despite the fact that nursing in Australia is now considered a profession, it has been claimed that nurses are an oppressed group who use horizontal violence, bullying and aggression in their interactions with one and other. Methods.,After ethical approval, a random sample of 666 nurses working directly with patients and all 333 critical care nurses employed in three large tertiary Australian hospitals were invited to participate in the study in the late 1990s. A mailed survey examined the perceptions of interaction nurses had with each other. The hypothesis, that level of employment (either Level I bedside nurses or Level II/III clinical leaders) and area of work (either critical care or noncritical care) would influence perceptions of cohesion, as measured by the cohesion amongst nurses scale (CANS) was tested. Results.,In total 555 (56%) surveys were returned. Of these, 413 were returned by Level I and 142 by Level II/III nurses. Of this sample, 189 were critical care and 355 noncritical care nurses. There was no difference between Level I and II/III nurses in mean CANS scores. It is interesting to note that the item rated most positively was ,nurses on the units worked well together', however, the item rated least positive was ,staff can be really bitchy towards each other' for both Level I and II/III nurses. There was no difference in CANS scores between critical care and noncritical care nurses. Conclusions.,Nurses working in Australian hospitals perceived themselves to be moderately cohesive but, as would be expected in other work settings, some negative perceptions existed. [source]

    Alpha7 cholinergic-agonist prevents systemic inflammation and improves survival during resuscitation

    Bolin Cai
    Abstract Severe haemorrhage is a common cause of death despite the recent advances in critical care. Conventional resuscitation fluids are designed to re-establish tissue perfusion, but they fail to prevent inflammatory responses during resuscitation. Our previous studies indicated that the vagus nerve can modulate systemic inflammation via the alpha7 nicotinic acetylcholine receptor (,7nAchR). Here, we report that the alpha7nAChR-agonist, GTS, restrains systemic inflammation and improves survival during resuscitation. Resuscitation with GTS rescued all the animals from lethal haemorrhage in a concentration-dependent manner. Unlike conventional resuscitation fluids, GTS inhibited the production of characteristic inflammatory and cardiodepressant factors including tumour necrosis factor (TNF) and high mobility group B protein-1 (HMGB1). Resuscitation with GTS was particularly effective in restraining systemic TNF responses and inhibiting its production in the spleen. At the molecular level, GTS inhibited p65RelA but not RelB NF-,B during resuscitation. Unlike non-specific nicotinic agonists, GTS inhibited serum protein TNF levels in both normal and splenectomized, haemorrhagic animals. Resuscitation with GTS inhibited poly(ADP-ribose) polymerase and systemic HMGB1 levels. Our studies suggest that GTS provides significant advantages as compared with non-specific nicotinic agonists, and it could be a promising anti-inflammatory supplement to improve survival during resuscitation. [source]

    Tracheostomy management in Acute Care Facilities , a matter of teamwork

    Vicki Parker
    Aim., Implement and evaluate an inter-disciplinary team approach to tracheostomy management in non-critical care. Background., Trends towards early tracheostomy in intensive care units (ICU) have led to increased numbers of tracheostomy patients. Together with the push for earlier discharge from ICU, this poses challenges across disciplines and wards. Even though tracheostomy is performed across a range of patient groups, tracheostomy care is seen as the domain of specialist clinicians in critical care. It is crucial to ensure quality care regardless of the patient's destination after ICU. Design., A mixed method evaluation incorporating quantitative and qualitative approaches. Method., Data collection included pre-implementation and postimplementation clinical audits and staff surveys and a postimplementation tracheostomy team focus group. Descriptive and inferential analysis was used to identify changes in clinical indicators and staff experiences. Focus group data were analysed using iterative processes of thematic analysis. Results., Findings revealed significant reductions in mean hospital length of stay (LOS) for survivors from 50,27 days (p < 0·0001) and an increase in the number of tracheostomy patients transferred to non-critical care wards in the postgroup (p = 0·006). The number of wards accepting patients from ICU increased from 3,7 and there was increased staff knowledge, confidence and awareness of the team's role. Conclusion., The team approach has led to work practice and patient outcome improvements. Organisational acceptance of the team has led to more wards indicating willingness to accept tracheostomy patients. Improved communication has resulted in more timely referral and better patient outcomes. Relevance to clinical practice., This study highlights the importance of inter-disciplinary teamwork in achieving effective patient outcomes and efficiencies. It offers a model of inter-disciplinary practice, supported by communication and data management that can be replicated across other patient groups. [source]

    An integrative review and meta-synthesis of the scope and impact of intensive care liaison and outreach services

    Ruth Endacott
    Aim., To determine activities and outcomes of intensive care unit Liaison Nurse/Outreach services. The review comprised two stages: (1) integrative review of qualitative and quantitative studies examining intensive care liaison/outreach services in the UK and Australia and (2) meta-synthesis using the Nursing Role Effectiveness Model as an a priori model. Background., Acute ward patients are at risk of adverse events and patients recovering from critical illness are vulnerable to deterioration. Proactive and reactive strategies have been implemented to facilitate timely identification of patients at risk. Design., Systematic review. Methods., A range of data bases was searched from 2000,2008. Studies were eligible for review if they included adults in any setting where intensive care unit Liaison Nurse or Outreach services were provided. From 1423 citations and 65 abstracts, 20 studies met the inclusion criteria. Results., Intensive care liaison/outreach services had a beneficial impact on intensive care mortality, hospital mortality, unplanned intensive care admissions/re-admissions, discharge delay and rates of adverse events. A range of research methods were used; however, it was not possible to conclude unequivocally that the intensive care liaison/outreach service had resulted in improved outcomes. The major unmeasured benefit across all studies was improved communication pathways between critical care and ward staff. Outcomes for nurses in the form of improved confidence, knowledge and critical care skills were identified in qualitative studies but not measured. Conclusion., The varied nature of the intensive care liaison/outreach services reviewed in these studies suggests that they should be treated as bundled interventions, delivering a treatment package of care. Further studies should examine the impact of critical care support on the confidence and skills of ward nurses. Relevance to clinical practice., Advanced nursing roles can improve outcomes for patients who are vulnerable to deterioration. The Nursing Role Effectiveness Model provides a useful framework for evaluating the impact of these roles. [source]

    From critical care to comfort care: the sustaining value of humour

    Ruth Anne Kinsman Dean PhD
    Aims and objectives., To identify commonalities in the findings of two research studies on humour in diverse settings to illustrate the value of humour in team work and patient care, despite differing contexts. Background., Humour research in health care commonly identifies the value of humour for enabling communication, fostering relationships, easing tension and managing emotions. Other studies identify situations involving serious discussion, life-threatening circumstances and high anxiety as places where humour may not be appropriate. Our research demonstrates that humour is significant even where such circumstances are common place. Method., Clinical ethnography was the method for both studies. Each researcher conducted observational fieldwork in the cultural context of a healthcare setting, writing extensive fieldnotes after each period of observation. Additional data sources were informal conversations with patients and families and semi-structured interviews with members of the healthcare team. Data analysis involved line-by-line analysis of transcripts and fieldnotes with identification of codes and eventual collapse into categories and overarching themes. Results., Common themes from both studies included the value of humour for team work, emotion management and maintaining human connections. Humour served to enable co-operation, relieve tensions, develop emotional flexibility and to ,humanise' the healthcare experience for both caregivers and recipients of care. Conclusions., Humour is often considered trivial or unprofessional; this research verifies that it is neither. The value of humour resides, not in its capacity to alter physical reality, but in its capacity for affective or psychological change which enhances the humanity of an experience, for both care providers and recipients of care. Relevance to clinical practice., In the present era which emphasises technology, efficiency and outcomes, humour is crucial for promoting team relationships and for maintaining the human dimension of health care. Nurses should not be reluctant to use humour as a part of compassionate and personalised care, even in critical situations. [source]

    Temperature measurement: comparison of non-invasive methods used in adult critical care

    Sarah Farnell BSc
    Aims and objectives., To assess accuracy and reliability of two non-invasive methods, the chemical (Tempa.DOTTM) and tympanic thermometer (GeniusTM First Temp M3000A), against the gold standard pulmonary artery catheter, and to determine the clinical significance of any temperature discrepancy using an expert panel. Background., There is continued debate surrounding the use of tympanic thermometry in clinical practice. Design., Prospective study. Methods., A total of 160 temperature sets were obtained from 25 adult intensive care patients over a 6-month period. Results., About 75.2% (n = 115) of chemical and 50.9% (n = 78) of tympanic readings were within a ±0.0,0.4 °C range of the pulmonary artery catheter. Both the chemical and tympanic thermometers were significantly correlated with temperatures derived from the pulmonary artery catheter (r = 0.81, P < 0.0001 and r = 0.59, P < 0.0001) and limits of agreement were ,0.5,0.9 °C and ,1.2,1.2 °C respectively. The chemical thermometer was associated with a mean temperature difference of 0.2 °C, which increased 0.4 °C when used in conjunction with a warming blanket. With regard to clinical significance 15.3% (n = 26) of chemical and 21.1% (n = 35) of tympanic readings might have resulted in patients receiving delayed interventions. Conversely 28.8% (n = 44) of chemical and 37.8% (n = 58) of tympanic readings might have resulted in patients receiving unnecessary interventions. Conclusions., The chemical thermometer was more accurate, reliable and associated with fewer clinically significant temperature differences compared with the tympanic thermometer. However, compared with the pulmonary artery catheter both methods were associated with erroneous readings. In the light of these findings and previous research evidence, it is becoming increasingly difficult to defend the continued use of tympanic thermometry in clinical practice. However, as chemical thermometers are not without their limitations, further research needs to be undertaken to evaluate the accuracy and reliability of other non-invasive methods. Relevance to clinical practice., Chemical and tympanic thermometers are used in both adults and children in a wide variety of settings ranging from community to intensive care. As such these findings have significant implications for patients, users and budget holders. [source]

    Use of exogenous erythropoietin in critically ill patients

    R. MacLaren PharmD
    Summary Objective:, Review the literature regarding the use of recombinant human erythropoietin (rHuEPO) to prevent red blood cell (RBC) transfusion in critically ill patients. Data sources:, A computerized search of MEDLINE and EMBASE from 1966 through June 2003 was conducted using the terms erythropoietin, anemia, hemoglobin, critical care, intensive care, surgery, trauma, burn, and transfusion. References of selected articles were reviewed. A manual search of critical care, surgery, trauma, burn, hematology, and pharmacy journals was conducted to identify relevant abstracts. Results:, Six randomized studies have evaluated exogenous administration of erythropoietin to prevent RBC transfusions in critically ill patients. Studies vary with respect to rHuEPO dosage regimens, dose of concurrently administered iron, patient characteristics, and transfusion thresholds. Administration of rHuEPO rapidly produces erythropoiesis to reduce the need for RBC transfusions. The largest study conducted to date used weekly rHuEPO administration and found a modest decrease in transfusion requirements although the time to first transfusion was delayed. Reduced intensive care unit (ICU) length of stay (LOS) was shown in only one study of surgical/trauma patients. Reduced LOS after ICU discharge was found in another study of severely ill patients (APACHE II score >22). Other clinical outcomes were not altered by rHuEPO use. No adverse events were associated with rHuEPO use although studies were not designed to evaluate safety. Conclusions:, rHuEPO reduces the need for transfusions. A cost-effectiveness analysis of rHuEPO for this indication is needed. Defining an optimal dosage regimen, identifying patients most likely to respond to rHuEPO, and determining risk factors for ICU associated anaemia would provide information for appropriate rHuEPO utilization. [source]

    Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approaches

    PG Dip., Renee Adomat BA (Hons)
    Background, A huge range of patient classification systems/tools are used in critical care units to inform workforce planning, however, they are not always applied appropriately. Many of these systems/tools were not originally developed for the purposes of workforce planning and so their use in determining the nurse:patient ratio required in critical care settings raises a number of issues for the organisation and management of these services. Aim, The aim of this paper is to review the three main assessment systems that are commonly used in critical care settings in the UK and evaluate their effectiveness in accurately determining nurse : patient ratios. If the application of these systems/tools is to enhance care, a thorough understanding of their origins and purpose is necessary. If this is lacking, then decisions relating to workload planning, particularly when calculating nurse : patient ratios, may be flawed. Conclusions, Patient dependency/classification systems and patient dependency scoring systems for severity of illness are robust measures for predicting morbidity and mortality. However, they are not accurate if used to calculate nurse : patient ratios because they are not designed to measure nursing input. Nursing intensity measures provide a useful framework for calculating the cost of providing a nursing service in critical care and can serve as a measure of nursing input, albeit a fairly basic one. However, many components of the nursing role are not ,accounted' for in these measures. Implications, The implications of these findings for the organization and management of critical care services are discussed. Careful consideration of these areas is vital if a cost efficient and cost-effective critical care service is to be delivered. [source]

    PROFESSION AND SOCIETY: Recovered Medical Error Inventory

    DNSc, Patricia C. Dykes RN
    Abstract Purpose: To describe the development and psychometric testing of the Recovered Medical Error Inventory (RMEI). Design and Methods: Content analysis of structured interviews with expert critical care registered nurses (CCRNs) was used to empirically derive a 25-item RMEI. The RMEI was pilot tested with 345 CCRNs. The data set was randomly divided to use the first half for reliability testing and the second half for validation. A principal components analysis with Varimax rotation was conducted. Cronbach's alpha values were examined. A t test and Pearson correlation were used to compare scores of the two samples. Findings: The RMEI consists of 25 items and two subscales. Evidence for initial reliability includes a total scale alpha of .9 and subscale alpha coefficients of .88 (mistake) and .75 (poor judgment). Conclusions: The RMEI subscales have satisfactory internal consistency reliability and evidence for construct validity. Additional testing is warranted. Clinical Relevance: A tool to measure CCRNs' experiences with recovering medical errors allows quantification of nurse surveillance in promoting safe care and preventing unreimbursed hospital costs for treating nosocomial events. [source]

    Critical care nurse practitioners and clinical nurse specialists interface patterns with computer-based decision support systems

    APRN (Assistant Professor of Health, Community Systems, Coordinator of the Nursing Education Graduate Program), PhD(c), Scott Weber EdD
    Abstract Purpose: The purposes of this review are to examine the types of clinical decision support systems in use and to identify patterns of how critical care advanced practice nurses (APNs) have integrated these systems into their nursing care patient management practices. The decision-making process itself is analyzed with a focus on how automated systems attempt to capture and reflect human decisional processes in critical care nursing, including how systems actually organize and process information to create outcome estimations based on patient clinical indicators and prognosis logarithms. Characteristics of APN clinicians and implications of these characteristics on decision system use, based on the body of decision system user research, are introduced. Data sources: A review of the Medline, Ovid, CINAHL, and PubMed literature databases was conducted using "clinical decision support systems,""computerized clinical decision making," and "APNs"; an examination of components of several major clinical decision systems was also undertaken. Conclusions: Use patterns among APNs and other clinicians appear to vary; there is a need for original research to examine how APNs actually use these systems in their practices in critical care settings. Because APNs are increasingly responsible for admission to, and transfer from, critical care settings, more understanding is needed on how they interact with this technology and how they see automated decision systems impacting their practices. Implications for practice: APNs who practice in critical care settings vary significantly in how they use the clinical decision systems that are in operation in their practice settings. These APNs must have an understanding of their use patterns with these systems and should critically assess whether their patient care decision making is affected by the technology. [source]