ABSTRACT
Advanced practice roles are gaining attention nationwide as health care reform becomes a reality. Through the actions of its advanced practice councils and Congress of Nursing Practice, the American Nurses' Association has been instrumental in merging the roles of clinical nurse specialists and nurse practitioners into an advanced clinical practice role. This paper examines issues related to advanced clinical practice in critical care.
Subject(s)
Critical Care , Job Description , Nurse Practitioners , Role , Certification , Humans , Nurse Practitioners/education , Nurse Practitioners/standardsABSTRACT
An acute injury in which a family member requires critical care creates a period of intense stress for families. During such time, family members are often faced with decisions about the patient or the family. The ability of families to make decisions during this stressful period is not addressed in the literature. The purpose of this study was to determine what decisions families made in the one-month period after a patient's admission. Families of patients with severe head injury were chosen because these families are often forced to make decisions quickly and to act as proxy decision-makers for the injured person. Nurses can make important contributions to assist family members in making decisions about the patient or the family. Nurses need to understand what decisions family members need to make and the circumstances surrounding the decision-making process to intervene appropriately.
Subject(s)
Craniocerebral Trauma/therapy , Critical Care , Decision Making , Family/psychology , Adult , Craniocerebral Trauma/nursing , Humans , Middle Aged , Surveys and Questionnaires , Time FactorsABSTRACT
An exploratory descriptive study was conducted to determine factors affecting decisions made by families of patients with severe head injury during the first two stages of recovery. Nineteen family members of 11 patients participated in this study. Five interviews of each family member were conducted over a 1-month period after the injury. Sixty decisions were identified by family members. Six factors: personal functioning, relationships, information, uncertain outcomes, environment, and emotions, were found to affect these decisions. The six factors identified by family members have specific implications for nursing.
Subject(s)
Craniocerebral Trauma , Decision Making , Family/psychology , Adult , Brain Injuries/nursing , Communication , Craniocerebral Trauma/nursing , Emotions , Female , Humans , Male , Middle Aged , Nurse-Patient Relations , Prospective StudiesABSTRACT
Barbiturate therapy is a controversial mode of therapy instituted in patients with acute head injuries after conventional means of treatment to decrease intracranial hypertension have been unsuccessful. Thiopental is a fast-acting central nervous system depressant and is one of the agents used for barbiturate therapy. Baseline laboratory values and access to four IV sites, including a Swan-Ganz catheterization site, should be obtained prior to institution of barbiturate therapy. While a patient is on barbiturate therapy, it is difficult to assess his clinical status. Nursing care for a patient on barbiturate therapy is an exciting challenge. It is the nurse's responsibility to continuously assess the patient's pressure readings, laboratory values, fluid balance, and pulmonary status to accurately interpret his clinical status.
