The constitution of space in intensive care: Power, knowledge and the othering of people experiencing mental illness.

A sociological conceptualisation of space moves beyond the material to the relational, to consider space as a social process. This paper draws on research that explored the reproduction of legitimated knowledge and power structures in intensive care units during encounters, between patients, who were experiencing mental illness, and their nurses. Semi-structured telephone interviews with 17 intensive care nurses from eight Australian intensive care units were conducted in 2017. Data were analysed through iterative cycling between participants' responses, the literature and the theoretical framework. The material and relational aspects of space in this context constitute a dynamic process that is concerned with the reproduction of everyday life, the preservation of the biomedical authority of intensive care, and the social othering of people experiencing mental illness. The work of theorists such as Löw, Harvey and Foucault underpins the exploration of space as a multi-dimensional, malleable social process that both produces and is the product of social interaction and the social world. In this paper, we argue that the performative work of knowledge and power production and reproduction, considered here in relation to intensive care spaces, enables ongoing othering and disenfranchisement of people experiencing mental illness.

Alcohol withdrawal in the critical care unit.

Managing acute alcohol withdrawal in critical care presents a unique challenge to the critical care nurse. The prominence of alcohol use within the Australian community means that many critical care admissions involve acute alcohol withdrawal, an alcohol induced illness, or indeed an unrelated admission with underlying heavy alcohol intake. Current statistics suggest 1 in 5 Australians drink to 'risky' levels each month. This suggests that most critical care nurses will encounter a patient who is experiencing active withdrawal from alcohol, often without clear physiological symptomatology. Acute alcohol withdrawal delirium can be difficult to distinguish from other forms of delirium and in the absence of a comprehensive history, alcohol withdrawal and its sequelae may go untreated. Contemporary management guidelines for alcohol withdrawal suggest a common framework of first line benzodiazepine usage, with emerging research focusing on adjunctive therapy aimed at reducing benzodiazepine doses, and therefore reducing length of stay in the critical care unit. The controversial therapy of ethanol infusion and common assessment and withdrawal scales are examined in relation to their usefulness in critical care. Alcohol withdrawal management in critical care necessitates careful nursing assessment, including alcohol usage history, delirium management, withdrawal assessment and symptomatic relief using an evidence-based protocol.