A post hoc descriptive study of patients receiving propofol.

BACKGROUND: Use of propofol has recently gained popularity in intensive care settings for patients receiving mechanical ventilation. This newer intravenous sedative is often preferred over other sedatives because of a rapid onset of action, easy titration that allows neurological assessment during administration, and quick arousability of patients after the drug is discontinued. OBJECTIVES: To determine the time to awakening after discontinuance of propofol in a sample of 100 patients receiving mechanical ventilation who had received propofol for at least 12 hours. In addition, demographics, primary and secondary diagnoses, clinical signs and symptoms, propofol dosage and duration, and concomitant use of analgesics and sedatives were determined. METHODS: A descriptive post hoc design was used. Patients' medical records for an 18-month period in an urban hospital in the southwestern United States were reviewed. Sections used for data collection included each patient's admission sheet, the findings of the history and physical examination done by a physician, physicians' progress notes, nursing notes, critical care flow sheets, and records of medications administered. RESULTS: Although nursing documentation indicated 2 common side effects, decreases in heart rate (18%) and decreases in systolic blood pressure (17%), within the first hour of treatment with propofol, immediate arousability after the drug was discontinued was not observed. Mean Glasgow Coma Scale scores took longer than 30 minutes to return to baseline. CONCLUSIONS: The awakening time of patients receiving propofol for a protracted period, usually in conjunction with other potentiating drugs, may be longer than is commonly cited in the literature.

Self-esteem and self-efficacy as predictors of success in smoking cessation.

The purpose of this study was to compare psychological, biophysical, and socioeconomic variables as predictors of success in smoking cessation adherence among adults who have participated in a smoking cessation program. The purposive sample (N = 75) was selected from participants of 10 smoking cessation programs in Texas who were measured for self-esteem and self-efficacy at the beginning of their program using the Rosenberg Self-Esteem Scale and Stanton's revised Self-Efficacy for Smoking Cessation Questionnaire. Subjects self-reported their smoking/nonsmoking status and use/nonuse of the nicotine patch at the end of their program via postcards and at 3 months later through a phone interview with the researcher. Using discriminant analysis, the psychological variables correctly classified 75% of the subjects at the 3-month follow-up as smoking or nonsmoking (based on their preprogram scores of self-esteem and self-efficacy). With this sample, the biophysical and socioeconomic variables were insignificant in their ability to predict smoking cessation adherence.

Nevada nurses' attitudes regarding physician-assisted suicide.

This descriptive study of Nevada nurses (N = 539) indicates that nurses are evenly divided on the issue of physician-assisted suicide (PAS). Using hypothetical cases, the survey compares nurses' beliefs regarding withdrawal of life-support measures (92% agree, n = 489), double-effect euthanasia (85% agree, n = 447), PAS (53% agree, n = 280), and active euthanasia (44% agree, n = 235). Responses to arguments supporting or rejecting the legalization of PAS are presented. Arguments include: patient autonomy, relief of pain and suffering, death with dignity, decreased quality of life, relief of psychological and financial burdens, sacredness of life, use of adequate comfort measures, unenforceability of safeguards, the professional ethical code, and inappropriate motives. Seventy-five percent (n = 400) of Nevada nurses indicate they personally feel PAS may be justified in selected cases. Only 46% (n = 240) would be willing to participate in PAS if it were legalized. Selected written comments from respondents are included.

Assisted suicide: is there a future? Ethical and nursing considerations.

It is imperative that nurses take a personal and professional stand in the debate regarding physician-assisted suicide. Through case examples, this article defines and illustrates forms of euthanasia, including active and passive, voluntary and involuntary, double-effect, physician-assisted suicide, and physician aid-in-dying. Ethical arguments against assisted suicide based on pain and suffering, quality of life, patient autonomy, and the common good are presented. The anticipated negative effects that legalized physician-assisted death would pose to the health professions and society are discussed. Guidelines and nursing implications conclude the article.