The needs of relatives during the patient's stay in intensive care following routine cardiac surgery

The review outlines and discusses the original study carried out by Molter (1979) which explored the needs of relatives in the intensive care setting. It explores studies which have replicated and developed the knowledge generated by Molter's study in both USA and UK. The needs of relative are endless and individual and must be set within the context of the family. There appears to be some dissonance between relatives' perceptions of their needs and nurses understanding and ability to meet their needs. Communication and creation of a therapeutic relationship between nurses and relatives is fundamental to the provision of holistic care. There are few studies which have focused on relatives within the cardiothoracic intensive care setting.     

Stressors in ICU: patients' evaluation

OBJECTIVE: To study the physical and psychological stressors in the intensive care unit (ICU) and to correlate stressors with different demographic variables. DESIGN: Cross-sectional analytical survey. SETTING: Intensive care unit of a private hospital. PATIENTS AND PARTICIPANTS: 50 randomly selected ICU patients during the first week of their ICU stay. MEASUREMENTS AND RESULTS: The Intensive Care Unit Environmental Stressor Scale was administered to 50 patients. Pain and the impossibility of sleeping due to noise and having tubes in the nose and mouth were considered the most important physical stressors. Loss of self control and lack of understanding about the attitudes and procedures were the main psychological stressors. CONCLUSIONS: Interventions should be aimed at relieving the patient's pain and at controlling the level of noise to make sleep possible. From the psychological standpoint, the independence of the patient should be encouraged, thus stimulating the recovery of self-control. The team should also inform the patient about the procedures which will be carried out.     

Does HIV status influence the outcome of patients admitted to a surgical intensive care unit? A prospective double blind study

OBJECTIVES: (a) To assess the impact of HIV status (HIV negative, HIV positive, AIDS) on the outcome of patients admitted to intensive care units for diseases unrelated to HIV; (b) to decide whether a positive test result for HIV should be a criterion for excluding patients from intensive care for diseases unrelated to HIV. DESIGN: A prospective double blind study of all admissions over six months. HIV status was determined in all patients by enzyme linked immunosorbent assay (ELISA), immunofluorescence assay, western blotting, and flow cytometry. The ethics committee considered the clinical implications of the study important enough to waive patients' right to informed consent. Staff and patients were blinded to HIV results. On discharge patients could be advised of their HIV status if they wished. SETTING: A 16 bed surgical intensive care unit. SUBJECTS: All 267 men and 135 women admitted to the unit during the study period. INTERVENTIONS: None. MAIN OUTCOME MEASURES: APACHE II score (acute physiological, age, and chronic health evaluation), organ failure, septic shock, durations of intensive care unit and hospital stay, and intensive care unit and hospital mortality. RESULTS: No patient had AIDS. 52 patients were tested positive for HIV and 350 patients were tested negative. The two groups were similar in sex distribution but differed significantly in age, incidence of organ failure (37 (71%) v 171 (49%) patients), and incidence of septic shock (20 (38%) v 54 (15%)). After adjustment for age there were no differences in intensive care unit or hospital mortality or in the durations of stay in the intensive care unit or hospital. CONCLUSIONS: Morbidity was higher in HIV positive patients but there was no difference in mortality. In this patient population a positive HIV test result should not be a criterion for excluding a patient from intensive care.     

Hematologic emergencies in the intensive care unit

Hematologic emergencies in the oncology population may require an admission to the intensive care unit (ICU). Syndrome of inappropriate antidiuretic hormone, hypercalcemia, tumor lysis syndrome, and disseminated intravascular coagulation are diseases defined in this article. These are common conditions in oncology patients that are reduced or prevented with close monitoring and accurate assessments. The purpose of this article is to introduce intensive care nurses to these disease entities so they will have a better understanding of the care involved with an oncology patient in the ICU unit.     

Retention of advanced cardiopulmonary resuscitation knowledge by intensive care trained nurses

The teaching and reinforcing of advanced cardiopulmonary resuscitation (ACPR) is an important part of the role of an intensive care nurse manager. This study highlights the need for a structured training programme, as well as regular updates in ACPR. Current research shows poor retention of CPR skills amongst nursing staff. A small study was undertaken amongst intensive care trained nurses at The Middlesex Hospital intensive care unit (ICU). 18 nurses took part in the study, and were each interviewed with regard to their knowledge of ACPR in December 1990. The period of time since last trained in ACPR ranged from 2 months-4 years. Those who had been recently updated in ACPR (up to 4 months prior to interview) scored higher than those who were updated more than 2 years ago. The results showed that most nurses interviewed were only able to answer correctly half the questions asked. These results indicate that the nurses in the study generally demonstrated a severe lack of knowledge of ACPR. This indicates the need for a structured training package in ACPR, followed by frequent reinforcement of ACPR knowledge and skills for nurses practising in an ICU environment.     

Fine needle tissue aspiration for accurate localization of histological specimens from complex structures

There is little information available regarding quality of life following critical illness. The consequences of a stay in an intensive care unit (ICU) can result in considerable psychological and physical morbidity. At the Homerton Hospital, London, UK an intensive care follow-up outpatient clinic was established to ascertain patients' experiences after discharge from the ICU. This exploratory study examines narrative data collected from 26 patients by means of unstructured client-led interviews. Themes are derived that have implications for staff, patients and relatives. The findings suggest that patients experience a variety of psychological and physical symptoms. Patients experienced vivid dreams, flashbacks, relocation and convalescent stress as well as profound tiredness and weakness. These are consistent with previous research findings. New themes were identified which suggest that mood changes, inability to cope, the need to talk about their ICU experience and indistinct memories of the ICU made recovery at home difficult for both the patients and their families. As a result of these findings, the role of a clinical nurse specialist has developed in order to improve liaison between and within departments, the hospital and the community. Future research will aim to focus on the role of the critical care/community liaison clinical nurse specialist and in improving outcomes through the use of action research.     

Characterization of human IgG1 monoclonal antibody against gangliosides expressed on tumor cells

In this study, our intention was to describe the decision making of nurses practicing in intensive care, and the differences of nurses' decision making in Canada, Finland, Northern Ireland, Switzerland, and the United States. The instrument used in the study was a 56-item Likert-type questionnaire that has been used in previous studies and has proved to be a reliable tool. The target group comprised a nonrandom sample of nurses (N = 314) from five countries. The samples are not representative; therefore, the results in these cases cannot be generalized. The results showed that the decision making of nurses practicing in intensive care was broadly based, and that there were some country differences in data collection, problem definition, and planning. In contrast, decision making related to the implementation and evaluation of nursing is quite similar in the different countries. Canada and the United States on the one hand, and Finland, Northern Ireland, and Switzerland on the other, showed more similarities with each other in data collection, problem definition, and nursing planning related to decision making. Neither experience nor nurse's knowledge structure was associated with different decision-making approaches.     

Preoperative management of patients with major trauma injuries

Traumatic injuries require rapid, efficient, and precise diagnose and immediate treatment. Patients with major trauma injuries place special demands on emergency department, OR, and intensive care unit health care providers. Cost-effective and time-efficient management of these patients results in improved patient care and optimal outcomes in this era of shrinking health care dollars. Perioperative nurses need to be aware of the many evolving changes in the preoperative management of patients with major trauma injuries to provide quality care to these patients.     

A quality review of high-dependency patient care

In order to develop strategies to improve high-dependency (HD) patient care, a continuous quality improvement (CQI) study was initiated in August 1994. It sought to establish a system for the collection and evaluation of relevant information concerning medical and nursing management of HD patients. This CQI study followed a high-dependency areas needs analysis undertaken in January, 1994. Conducted over a 12-week period (August-October, 1994) the CQI study involved 92 HD patients who required cardiac and/or respiratory monitoring. The study revealed a low HD bed occupancy rate, inadequate documentation by medical staff of the need for monitoring, and insufficient numbers of nursing personnel specifically educated to care for HD patients. Recommendations include increased consultants surveillance, immediate assessment of HD patients by a medical officer on the ward, a documented plan for monitoring, avoidance of after-hours discharge from operating theatres or intensive care, and the implementation of an education program for HD area nurses.     

Computer based nursing documentation means to achieve the goal

New functions have been integrated in the Giessen Hospital Information System WING to support the classification of all intensive care patients into the Therapeutic Intervention Scoring System (TISS). The use of those functions has been pushed when health insurance bodies demanded evidence for the correct classification of ICU beds. This article presents an overview on this development from the start in just one intensive care unit to the complete coverage of six intensive care units and three intensive monitoring units with a total of 109 beds. For those units complete TISS data has been documented for more than a year now at a detailed level. On average 14 interventions have been recorded per patient and day, accumulating to a database with more than a million entries. We describe the experiences made during introduction and the different front-end applications we used to achieve the goal. Results gained from the huge database and their implications for our future work are discussed. TISS documentation is now an established routine on every intensive care unit of our University hospital. It has been implemented without major financial or manpower investments and no specific intensive care information system has been needed. Establishing this type of basic care documentation made nurses aware of their activities, so that now they consider electronic care documentation to be in their very own interest. The next goal has been set by nurses themselves, they want to establish intervention based care documentation on normal wards as well. We think that step by step we will thus be able to achieve a more complete electronic patient record.     

Barbiturates, neuroleptics, and propofol for sedation

In a modern, hectic, and stressful intensive care unit, sedation is an important aspect of care, and every nurse and physician in a critical care setting must be familiar with it. This article describes older modalities of sedation, including barbiturates and neuroleptics, and compares them to a more recently developed drug, propofol.     

An introduction to music therapy: helping the oncology patient in the ICU

Oncology and critical care patients have unique and complex problems. With the explosion of technology and advances in medicine, many intensive care units are seeing an increase in oncology patients. Intensive care units are stressful and frightening; music therapy is a noninvasive holistic approach to bridging the gap between oncology patients and intensive care units.     

Influence of immediate post-therapy bone scintigraphy in the assessment of response to therapy in a case of nasopharyngeal carcinoma

We have conducted a retrospective study of deaths on a paediatric medical intensive care unit over a two-year period and reviewed similar series from outside the UK. There were 89 deaths out of 651 admission (13.7% mortality). In almost two-thirds of the cases death occurred with a decision to limit medical treatment or withdraw mechanical ventilation, implying that additional or further therapy was considered futile. We highlight this as a crucially important issue in the practice of intensive care. More comprehensive studies are needed to help clinicians derive consensus on what constitutes a futile intervention, and therefore when such an intervention should be withheld. This will help families and society better understand the limitations of intensive care.     

Head and neck patients. An innovative, cost-effective approach

An otolaryngology (OTO) acute care unit was developed to provide nursing care for head and neck patients who required intensive respiratory monitoring but did not need to be in an intensive care unit because they were hemodynamically stable. This unit allowed better utilization of intensive care unit beds and contributed to a more cost-effective system for all patients while meeting the special needs of these patients and their families.     

Consequences of the ambivalence about openness and transparency]

Personnel at the general intensive care unit at the University of Heidelberg Children's Hospital aim for a maximum of openness and transparency for parents regarding everything relevant to their own child. In this context ward nurses were interviewed about diverse aspects of their work. Aside from technical-medical activities, nurses regarded the relationship to the parents to be a central point in their work. The recognize that the relationship to the parents influences the relationship to the child and partially even the nursing of the child. Nurses are in favor of openness and transparency in relating to parents, however, reality reveals contradictions. Nurses differentiated attitude and the consequences for physicians, psychologists and parents are discussed. A case example is presented.     

Evaluation of nursing care in patients with myasthenia gravis

A retrospective study was made of 35 periods of hospital admission between January 1985 and September 1995, of 17 patients diagnosed in the Hospital Josep Trueta, Girona, as having myasthenia gravis. These were all the patients diagnosed as having myasthenia gravis in this ten year period. We studied the characteristics of their stay in hospital and evaluated the planning and practice of nursing care during these 35 periods. Nursing problems or diagnostic difficulties were found on 15 occasions, probably due to lack of knowledge of myasthenia gravis. When a patient had dysphagia, nursing care was increased and any problems identified. 29.4% of the patients were admitted to the intensive care unit. Since this disorder may be very serious, we consider that special training should be given to the nurses attending these patients. An understanding of this disorder and the possible treatments, complications, drugs, etc. would make it possible to give specific, individualized attention which would result in a higher standard of care.