[Physiological changes and related nursing care issues during hunger strike].

The use of hunger strike as a tool to assert grievances has been around for ages and has occasionally happened in the world. Hunger strikers' motives may differ, but their tool is the same--the voluntary refusal of food. Fasting not only results in body weight loss, but also in physiological and neurological function changes, and, of course, it may even threaten life. The health care of hunger strikers is complex. It involves medical staff, medical ethics and guidance for the management of the hunger strikers. Improper medical management may not only undermine the hunger striker's dignity but also risk further damage to his or her health. By understanding hunger strikers' physiological changes and related ethical issues, therefore, we aim to identify appropriate forms of nursing care management and guidance for the care of hunger strikers.

ICU nurses' knowledge of, and attitudes towards, the APACHE II scoring system.

AIMS AND OBJECTIVES: This study was undertaken to determine whether intensive care unit nurses possess adequate knowledge to implement the Acute Physiological and Chronic Health Evaluation (APACHE) II scoring system and to understand nurses' attitudes towards this scoring system. DESIGN: A questionnaire, which contained 20 multiple-choice questions to test knowledge of the scoring system and 27 statements with a five-points Likert type scale to assess attitude, was developed by researchers for this study. METHODS: The participants consisted of 102 intensive care unit nurses working in adult, emergency, or coronary intensive care units in a large teaching hospital (Veterans General Hospital) in Taiwan, where the APACHE II scoring system is used routinely by nurses. RESULTS: On the knowledge section of the questionnaire, 76% of the questions were answered correctly. However, more than 50% of the nurses were uncertain about how to score a patient's chronic history status, only 44.1% of the nurses knew that APACHE II total scores range from 0 to 71, and only 37.3% understood that the value for bicarbonate in venous samples could replace the arterial pH value. The results of the attitude questionnaire revealed that nurses believed APACHE II was useful mainly for statistical purposes by the administration rather than for patient care, but acknowledged that the scores could provide a reference for more aggressive treatment. CONCLUSIONS: The questionnaire answers indicated that greater knowledge concerning the APACHE II is needed. RELEVANCE TO CLINICAL PRACTICE: Information and training concerning the proper use and purpose of APACHE II needs to be provided, especially for those intensive care unit nurses using this evaluation tool to score patients' conditions routinely.