La enfermería en cuidados intensivos / The infirmary in intensive critical care

Formación continua de enfermería en el área de cuidados intensivos. Organización de un Servicio de Terapia Intensiva. Oxigenoterapia. Ventilación no invasiva BIPAP. Asistencia respiratoria invasiva. Monitoreo hemodinámico. Atención al paciente con falla multiorgánica. Muerte digna en terapia intensiva?

La enfermería en cuidados intensivos / The infirmary in intensive critical care

Formación continua de enfermería en el área de cuidados intensivos. Organización de un Servicio de Terapia Intensiva. Oxigenoterapia. Ventilación no invasiva BIPAP. Asistencia respiratoria invasiva. Monitoreo hemodinámico. Atención al paciente con falla multiorgánica. Muerte digna en terapia intensiva?

Nursing diagnosis. Powerlessness in critical care patients.

The critical care environment, with its fast-paced tempo, its vast technology, and its many invasive procedures, carries the potential for creating feelings of powerlessness within patients, their families, and even in the nurses who work there. This article examines the nursing diagnosis of powerlessness and its etiologic factors. The authors present a challenging case in which creative nursing techniques decrease powerlessness for a partially paralyzed and intubated patient.

Reducing complications of thoracic gunshot wounds.

With the persistent presence of violence in our urban areas and the availability of guns, penetrating injuries as a result of firearm use continue to be a challenge for the emergency, surgery, and operating room nurse. Because gunshot wounds may be rapidly fatal, an understanding of firearms and the injuries they produce, as well as their possible complications, can assist the critical care nurse in caring for patients with gunshot wounds to the chest. Thoracic trauma is present in 50% of all trauma patients and is the cause of death in 25% of these victims. Penetrating trauma from violent episodes accounts for approximately 50% of cases of chest trauma in the urban setting.

Ethical considerations in conducting clinical research.

Each step of the research process has specific ethical considerations. This article presents the ethical aspects that the nurse researcher needs to incorporate into a clinical research project and that the critical care staff nurse can use to identify potential unethical research practices involving critical care patients.

Re-evaluating the role of the charge nurse.

Charge nurses are used in most critical care units to facilitate quality patient care by serving as resources to the nursing staff. These authors suggest strategies for initiating or evaluating the charge nurse role in critical care. Interviews with critical care charge nurses show how different viewpoints remain regarding this key role of the charge nurse.

Multimethod teaching modules.

The information in this article is for a wide variety of nurses who find themselves in a teaching role: the critical care nurse orienting another nurse (experienced or new graduate); the critical care manager who needs to present an inservice program; and the educator or clinical specialist looking for a new way to present the same information. The author describes how self-paced modules for inservice education offer variety to learners since learners choose the teaching strategy that best suits their learning styles.

Supervising unlicensed technicians in critical care.

As the nursing shortage continues and there is an increased demand for technicians and other nurse extenders, critical care nurses may be asked to supervise numerous types of other health care workers. This nurse-attorney author describes the legal aspects of the situation for the licensed nurse who supervises registered or unregistered, unlicensed technicians.

Thermal gradients and shivering following open heart surgery.

Critical care nurses caring for postoperative cardiac surgery patients are confronted, on a regular basis, with care issues related to thermal gradients and shivering. Thermal gradients are defined as temperature differences between two body parts. Monitoring the central and peripheral temperatures, evaluating the thermal gradients, and measuring shivering with reliable means are the prerequisites for the prediction of shivering. The detrimental physiologic effect of shivering necessitates additional clinical research to further define causative factors of shivering.

Aortic valvuloplasty: medical and critical care nursing perspectives.

Aortic valvuloplasty, an investigational alternative to valve replacement, is explained from the perspectives of a nurse in a cardiac catheterization laboratory, a nurse in a coronary care unit, and a cardiologist. A case study is presented along with a plan of care developed around three nursing diagnoses. A prevalvuloplasty nursing diagnosis includes a teaching plan to assist nurses in preparing patients for aortic valvuloplasty.

Tissue-plasminogen activator: nursing implications.

Coronary thrombolysis has been proved to be beneficial in the treatment of myocardial infarction. Much attention has been focused on tissue-type plasminogen activator (t-PA) as a fibrinolytic agent. This article will discuss the unique properties of t-PA and the role of the critical care nurse in providing the safe delivery of t-PA.

The decision-making process in critical care of the aged.

Nurses in a critical care setting are challenged daily to provide safe, effective quality care for elderly patients. The decision process underlying this care is complex because of the amount, diversity, and uncertainty of information that must be processed. Some variables associated with the client, the nurse, and the critical care environment are irrelevant to the decision process, yet continue to influence nurses' decision making. Suboptimal and erroneous diagnoses and interventions may result. Awareness of factors that adversely affect decision making should assist nurses in enhancing their information processing. Use of objective and systematic decision-making techniques also can improve the efficiency and quality of decision making in the critical care of aging people.

Ration or rescue: the elderly patient in critical care.

1. Persons who require the intensive interventions of critical care units enter with a contract of trust. They place their well-being, and often their lives in the hand of caregivers. To respect that trust by the most vigorous effort is a moral responsibility. 2. It is not the task of the practitioner in critical care to evaluate the social worth of the patient. Judgments as to the quality of life of individual patients are inappropriate and unsupportable and should never be used as a rationale for withholding or withdrawing essential care. 3. The decisions for introducing treatments should be based (as they have been historically) on the physician's evaluation of the patient's condition and the consequent appropriate interventions. The interference of third party payers in this clinical relation in which therapeutic decisions are dictated by cost or any other extraneous factors is morally repugnant. 4. Life or death decisions are not properly those of caregivers and should never be left to those whose mission is to protect life and relieve suffering. Decisions to use extraordinary means of sustaining life processes should be made in advance of the actual events by the informed wisdom of the physician whenever possible. The caregivers--physicians and nurses-should bring all their skills to bear to alleviate suffering, but that does not include hastening the death of another human being.

A review of the literature relating to touch and its use in intensive care.

This literature review is an exploration of the available literature on and surrounding the subject of touch in order to help nurses to understand this subject and use touch effectively in nursing care. The study is focused particularly on the use of touch in intensive care as this is the area of interest of the author, and several writers have suggested touch is of great importance in this area. The literature on communication in all its forms and particularly in intensive care is discussed first as this explains the framework in which touch occurs and how it fits into nursing care. Theories about touch and studies of the use of touch are linked to try to show the human need, and taboos about touch. This is related to the use of touch by nurses and other health care workers particularly in intensive care. Recommendations are made, from the information gained from the literature, about how nurses' use of touch as part of nursing care can be improved.