Heart & lung : the journal of critical care
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Comparative Study
Needs of family members of critically ill patients: a comparison of nurse and family perceptions.
Critical illness often occurs without warning. leaving families feeling vulnerable and helpless with no clear knowledge of what to expect from health care professionals or patient outcome. The challenge for critical care nurses (Registered Nurses [RNs]) is to provide care for aggressively managed, critically ill patients while attending to the needs of stressed family members. ⋯ Family needs were categorized according to Leske's dimensions of assurance, proximity, information, comfort, and support. By implementing specific cost-effective strategies to increase family access to the patient, to improve communication with the physician and the health care team, and to create a family-friendly environment, critical care RNs can meet family member needs and improve the quality of nursing care.
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We know little about long-term exercise behavior and adherence in patients with chronic obstructive pulmonary disease (COPD). ⋯ This investigation provides a description of long-term exercise behavior and adherence in a sample of patients with COPD. The categories suggest that physical benefits are related to consistent adherence, whereas mental health improvements are related to regular exercise with some flexibility in the schedule. Future research should test interventions to improve exercise adherence in patients with COPD and identify characteristics of patients who are most likely and least likely to adhere over time.
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The study assessed attitudes of intensive care unit (ICU) staff members toward practice guidelines in general and toward a specific guideline, The Centers for Disease Control and Prevention's Guideline for Hand Hygiene in Healthcare Settings; correlated these attitudes with staff and hospital characteristics; and examined the impact of staff attitudes toward the Hand Hygiene Guideline on self-reported implementation of the Guideline. ⋯ The majority of staff members were familiar with the Centers for Disease Control and Prevention Hand Hygiene Guideline. Staff attitudes toward practice guidelines varied by type of ICU and by profession, and more positive attitudes were associated with significantly better self-reported guideline implementation. Because differences in staff attitudes might hinder or facilitate their acceptance and adoption of evidence-based practice guidelines, these results may have important implications for the education and/or socialization of ICU staff.
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Unplanned endotracheal extubation (UE) is recognized as the most common airway adverse event in the intensive care unit (ICU). ⋯ This study does not confirm the highest rates of UE previously reported in orally intubated medical patients in the ICU or the association with mortality in this scenario. However, UE increased the need for MV and ICU care. We found a moderate to high prevalence of potentially modifiable risk factors for UE, suggesting unsatisfactory ICU practices.
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Comparative Study
Comparison of forehead and digit oximetry in surgical/trauma patients at risk for decreased peripheral perfusion.
Measurement of pulse oximetry (Spo(2)) is often impaired in critically ill patients. Forehead reflectance oximetry, the Max-Fast (Nellcor, Pleasanton, CA), may be less susceptible to poor tissue perfusion and could improve accuracy of oxygen saturation measurement. The objective of this study was to evaluate the use of forehead oximetry measures in critically ill surgical/trauma patients. ⋯ Forehead sensors improve measurement of oxygen saturation in critically ill surgical/trauma patients at risk for decreased peripheral perfusion.