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Am J Crit Care 2003 Jan;12(1):47-53
School of Nursing, Family and Community Health, University of Western Sydney, St. George Hospital, Sydney, Australia.
Nurses lack a comprehensive body of scientific knowledge to guide the palliative care of patients with nonmalignant conditions. Current knowledge and practice reveal that nurses in many instances are not well prepared to deal with death and dying. Focus groups were used in an exploratory study to examine the perceptions of palliative care among cardiorespiratory nurses (n = 35). Content analysis was used to reveal themes in the data. Four major themes were found: (1) searching for structure and meaning in the dying experience of patients with chronic disease, (2) lack of a treatment plan and a lack of planning and negotiation, (3) discomfort in dealing with death and dying, and (4) lack of awareness of palliative care philosophies and resources. The information derived from this sample of cardiorespiratory nurses represents a complex interplay between personal, professional, and organizational perspectives on the role of palliative care in cardiorespiratory disease. The results of the study suggest a need for nurses to be equipped on both an intellectual and a practical level about the concept of palliative care in nonmalignant disease.
PMID: 12526237, UI: 22414035
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Am J Crit Care 2003 Jan;12(1):41-6
Catholic University of America, Washington, DC, USA. toth@cua.edu or www.cua.edu
BACKGROUND: No previous research was found that compared basic knowledge in critical care nursing among nurses from different nations. Nurses from outside the United States were invited to participate during reliability testing of the Basic Knowledge Assessment Tool, Version 5. PURPOSE: To compare basic knowledge in critical care between nurses from the United States and nurses from other countries and to measure the reliability of the Basic Knowledge Assessment Tool, Version 5. SAMPLE: Data were collected for 16 months from 682 critical care nurses: 528 from the United States and 154 from other countries. RESULTS: The Basic Knowledge Assessment Tool, Version 5, was a reliable test for all nurses studied, regardless of country of origin. The level of knowledge of nurses from English-speaking countries other than the United States did not differ from that of nurses from the United States. Scores for nurses from non-English-speaking nations were lower than scores for nurses from the United States. The largest source of variance in scores among all subjects was the length of experience in critical care nursing. CONCLUSIONS: The Basic Knowledge Assessment Tool, Version 5, is a valid and reliable tool for assessing critical care nurses from the United States and the other countries studied. Critical care nurses from English-speaking countries scored higher than nurses from countries where the primary language is not English.
PMID: 12526236, UI: 22414034
Am J Crit Care 2003 Jan;12(1):19-27
Ohio State University College of Nursing, Columbus, Ohio, USA.
BACKGROUND: Anxiety is associated with increased morbidity and mortality. Critical care nurses are uniquely positioned to reduce anxiety in their patients. Critical care nurses' beliefs about and frequency of use of strategies to reduce anxiety have not been studied. OBJECTIVES: To explore critical care nurses' beliefs about the importance of anxiety management and to describe nurses' reported use of strategies to manage anxiety in their patients. METHODS: A random sample (N = 2500) of members of the American Association of Critical-Care Nurses was asked to complete the Critical Care Nurse Anxiety Identification and Management Survey. RESULTS: Respondents (n = 783) were primarily female (92%), white (88.5%) staff nurses (74.1%) who thought that anxiety is potentially harmful (mean, 4.1; SD, 0.8; range, 1 = no harm to 5 = life-threatening harm), that anxiety management is important (mean, 4.8; SD, 0.6; range, 1 = not important to 5 = very important), and that effective anxiety management is beneficial (mean, 4.6; SD, 0.6; range, 1 = no benefit to 5 = profound benefit). A majority commonly used pharmacological management; most also used information and communication interventions. Fewer subjects used the presence of patients' family members to alleviate patients' anxiety; few reported using stress-reduction techniques. CONCLUSION: Most respondents thought that treating anxiety is important and beneficial. Commonly used strategies included pharmacological relief of anxiety and pain and information and communication interventions. Although these strategies are useful, they may not effectively reduce anxiety in all patients.
PMID: 12526233, UI: 22414031
Am J Crit Care 2003 Jan;12(1):9-16; quiz 17-8
University of California, San Francisco, Calif., USA.
An important factor to consider when using findings on electrocardiograms for clinical decision making is that the waveforms are influenced by normal physiological and technical factors as well as by pathophysiological factors. Traditionally, the focus of bedside monitoring is detection of arrhythmia. However, continuous ST-segment monitoring for the detection of myocardial ischemia is now readily available. Many factors affect electrocardiographic waveforms and may interfere with diagnosis of myocardial ischemia based on electrocardiographic findings. Accordingly, a principal leadership role for clinical nurse specialists and nurse practitioners is to become knowledgeable about interpretation of 12-lead electrocardiograms and to share this knowledge with staff nurses who care for patients with acute coronary syndromes. The factors that alter electrocardiographic findings are reviewed, and the alterations that interfere with electrocardiogram-based diagnosis of myocardial ischemia are discussed.
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PMID: 12526232, UI: 22414030
Am J Crit Care 2003 Jan;12(1):6-8
PMID: 12526231, UI: 22414029
Anaesthesia 2003 May;58(5):448-454
Clinical Research Fellow, University Department of Anaesthesia and Academic Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK Clinical Research Fellow and Specialist Registrar in Anaesthesia, University Department of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK Statistician, Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK Director of Neurosurgical Physics, Academic Neurosurgery, Addenbrooke's Hospital, Cambridge, UK Professor of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
[Record supplied by publisher]
Intra-arterial measurement is considered the gold standard for continuous, beat-to-beat arterial blood pressure monitoring. However, arterial cannulation can be difficult and may cause complications such as thrombosis and ischaemia. Recently, a tonometric system, the Colin CBM-7000 has been developed for noninvasive beat-to-beat measurement of arterial blood pressure from the radial artery. We assessed the level of agreement between the CBM-7000 and invasive radial artery measurements in 15 patients on a neuro-intensive care unit. Agreement of systolic, diastolic and mean arterial pressure values was limited, with approximately 34% of mean arterial pressures differing by over 10 mmHg. In many cases, this was due to a downward drift of the noninvasive measurements over time. Furthermore, there was a tendency to underestimate low pressures and overestimate high pressures. In our opinion, the Colin CBM-7000 cannot be recommended for continuous blood pressure monitoring in the intensive care setting.
PMID: 12694001
Crit Care Clin 2003 Apr;19(2):185-207
U.T.M.D. Anderson Cancer Center, Box 112, 1515 Holcombe Blvd., Houston, TX 77030, USA. micwilliams@mdanderson.org
Most ICU patients have a significant number of risk factors for VTE. The high incidence of DVT in the ICU population and the recognition of a high incidence of PE at autopsy confirm this. We have alluded to the difficulty of clinical diagnosis of VTE and the need for diagnostic investigations. We have reviewed currently available diagnostic investigations with regard to their sensitivity and specificity and their practicability in ICU patients, and have formulated recommended diagnostic algorithms (Figs. 4 and 5). The most important factor in the management of VTE is prevention. In the ICU, all patients are at high risk for VTE, and therefore, at a minimum should receive subcutaneous prophylactic heparin unless it is contraindicated. Alternative methods of prophylaxis are available, and should be considered for patients who have contraindications to heparin.
PMID: 12699319, UI: 22585062