Intragastric pH monitoring.

Buffering of intragastric pH is an accepted treatment modality for prophylaxis against the development of gastric stress ulcers. This method of prophylaxis is commonly based on the pH value acquired by measurement of gastric aspirate. Recent literature suggests pH measurement techniques that involve gastric aspirate specimens have many flaws. The purpose of this study was to compare gastric pH measurements with the use of a nasogastric sensor, meter system, and pH-sensitive test paper. Fifteen hundred paired serial measurements of intragastric pH were obtained on 19 thermally injured patients (16 men and three women, ages 23 to 79 years, total body surface area burn 25% to 80%). A double-lumen tube containing an antimony/graphite pH sensor incorporated into the tip of the tube was inserted with the use of a standard technique. Each tube was in place an average of 5.7 days (range 1 to 15 days). Patients were randomized into two groups. The first group (six patients) received non-acid-buffering prophylaxis therapy. The second group (13 patients) received standard antacid or antacid/H2 histamine-blocking agent combination prophylaxis therapy. Analysis of the 539 paired measurements for the non-acid-buffering revealed a correlation coefficient of r = 0.532. The 961 measurements from the group receiving gastric acid buffering revealed a correlation coefficient of r = 0.569. Paired t test values for the sample showed a significant difference (18.52, p < 0.0000) between measurement techniques.

When is the burn injury healed?: psychosocial implications of care.

The psychosocial and economic effects of burn trauma are profound, not only for the patients, their families, and the burn unit staff members, but also for society as a whole. Understanding the perception of stresses experienced by patients, families, and staff is discussed, and related strategies to assist in reducing the stress are presented. A comprehensive psychosocial support system can assist the nurse in reducing the psychosocial morbidity of severe burn trauma.

Workload management system for nurses: application to the burn unit.

A patient acuity classification is required by the Joint Commission on Accreditation of Healthcare Organizations, and this is vital in providing safe, cost-effective nursing care. The Workload Management System for Nurses (WMSN), which is based on direct and indirect nursing care research, prospectively classifies patients on the basis of direct care requirements and then establishes staffing levels on the basis of both direct care and indirect care workloads. Application of the Department of Defense WMSN to the military burn research center is feasible and has provided data for objective staffing adjustments and validated staffing requirements. In addition, several other quality assurance implications have been realized as a result of implementation of the system.

Needs of relatives of critically ill patients: a descriptive study.

Relatives of critically ill patients were able to identify their needs during the intensive care phase of hospitalization. The universal need identified as very important was the need for hope. Other important needs were concerned with receiving adequate and honest information and feeling that the hospital staff members were concerned about the patient. Although several of the needs appeared to be of great concern to relatives, all the needs were considered very important by at least one relative. The majority of needs were perceived as being met consistently. Various resources were used by the relatives to meet their needs; however, specific needs were expected to be met by physicians and nurses. Since many relatives have similar needs, the use of a group process to deal with them should be investigated. A group process allows for sharing and support among the relatives and also allows one staff member to work with several relatives. The relatives perceived the role of health care personnel to be patientcentered only. If the patient is a member of a family, then the family and staff should recognize that the health care personnel are helping relatives because it is a crucial part of total patient care. This area in providing total patient care needs to be studied carefully. The relatives of critically ill patients have important needs in this crisis period. By recognizing these needs and evaluating how they are being met, total patient care will involve the family. Such involvement is essential to the care of the critically ill patient.