Dimensions of critical care nursing : DCCN
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Dimens Crit Care Nurs · Nov 2013
Using the synergy model of patient care in understanding the lived emergency department experiences of patients, family members and their nurses during critical illness: a phenomenological study.
Despite many studies conducted aimed to understand and improve emergency care, research on the triad of nurses, patients, and family members looking at the lived emergency department experiences and their perspective of each from the other is notably absent. In a hermeneutic phenomenological study using van Manen's method, a sample of 10 patients, 5 family members, and 8 nurses of a nonprofit community hospital was recruited and interviewed in 2010 to 2011 to explore, understand, and describe their lived experiences during critical illness in the emergency department. ⋯ The American Association of Critical-Care Nurses' Synergy Model for Patient Care was applied in conceptualizing the findings and served as a framework in recommending practices and interventions geared toward improving competencies required in caring for critically ill patients and their families in the emergency department. The study supports recognizing the patient and family as active participants in the patient's medical care; encouraging family-member presence and creating institutional policies for patient- and family-centered care, as well as encouraging the development of ongoing programs that will recognize, enhance, and support the psychological and emotional well-being of emergency department nurses.
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Dimens Crit Care Nurs · Sep 2013
Inhaled epoprostenol to support the severely hypoxemic patient with acute respiratory distress syndrome.
This article presents a case study demonstrating various rescue therapies considered in the care of a patient with severe, refractory hypoxemia secondary to acute respiratory distress syndrome. In particular, inhaled epoprostenol (Flolan) is becoming an increasingly common alternative to nitric oxide in the treatment of severe, refractory hypoxemia. Research comparing the 2 inhaled vasodilators suggests that epoprostenol is equally efficacious, easier to administer, less costly, and has fewer adverse effects. This article, using a case study approach, discusses the practical implications of this emerging therapy.
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Dimens Crit Care Nurs · Sep 2013
ReviewAirway pressure release ventilation: improving oxygenation: indications, rationale, and adverse events associated with airway pressure release ventilation in patients with acute respiratory distress syndrome for advance practice nurses.
Airway pressure release ventilation (APRV) is a mode of ventilation that has been around since the 1980s and was originally viewed as a type of continuous positive pressure mode of ventilation. Conceptually, APRV can be thought of as a type of inverse-ratio, pressure-controlled, intermittent mandatory ventilation during which the maintenance of spontaneous breathing and prolonged application of high mean airway pressure contribute to the clinical benefits. The aim of this review article was to familiarize the bedside clinician working in the intensive care unit with the theory and rationale behind this mode of ventilation. The potential advantages and disadvantages of APRV will also be discussed to empower the advance practice clinician and bedside nurse to advocate for their patient diagnosed with the often-high mortality disease of acute respiratory distress syndrome.
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Dimens Crit Care Nurs · Sep 2013
A pilot study on delirium in the intensive care unit: a creative inquiry project with undergraduate nursing students.
Delirium continues to be a major issue in intensive care units (ICUs). Sedation and lack of rapid eye movement (REM) sleep could be important factors in the development of delirium. Improper sedation may interfere with a patient's sleep pattern, specifically time spent in REM sleep, and could be a contributor to the development of delirium. The research team has discovered through this pilot study that there is a possible correlation between sedation, disruptions, and sleep. The goal of our research was to determine the relationship between these variables using a sleep monitor to capture actual sleep activity compared with patient characteristics and real-time activity in the ICU environment. ⋯ Preliminary results show that there is a relationship between lack of REM sleep and delirium. The pilot study was a useful model to demonstrate the need for further investigation in a larger population.