Critical care medicine
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Critical care medicine · Feb 2007
Multicenter StudyNurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate.
To explore registered nurses' and attending physicians' perspectives on caring for dying patients in intensive care units (ICUs), with particular attention to the relationships among moral distress, ethical climate, physician/nurse collaboration, and satisfaction with quality of care. ⋯ Registered nurses experienced more moral distress and lower collaboration than physicians, they perceived their ethical environment as more negative, and they were less satisfied with the quality of care provided on their units than were physicians. Provider assessments of quality of care were strongly related to perception of collaboration. Improving the ethical climate in ICUs through explicit discussions of moral distress, recognition of differences in nurse/physician values, and improving collaboration may mitigate frustration arising from differences in perspective.
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Critical care medicine · Feb 2007
Multicenter StudyPrognostication during physician-family discussions about limiting life support in intensive care units.
Prognostic information is important to the family members of incapacitated, critically ill patients, yet little is known about what prognostic information physicians provide. Our objectives were to determine the types of prognostic information provided to families of critically ill patients when making major end-of-life treatment decisions and to identify factors associated with more physician prognostication. ⋯ Prognostication occurred frequently during physician-family deliberations about whether to forego life support, but physicians did not discuss the patient's prognosis for survival in more than one third of conferences. Less educated families received less information about prognosis. Future studies should address whether these observations partially explain the high prevalence of family misunderstandings about prognosis in intensive care units.
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Critical care medicine · Feb 2007
Multicenter StudyVisiting hours policies in New England intensive care units: strategies for improvement.
Dying patients often feel isolated and alone, and restricted visiting hours in the intensive care unit (ICU) has been shown to increase anxiety and dissatisfaction in both critically ill patients and their families. Unrestricted visiting has been identified as a top-ten need by families of patients in the ICU. Because emotional distress experienced by patients and families may persist well beyond the ICU stay, an open visiting policy, by meeting the needs of patients and families, may improve the quality of end-of-life care in the ICU. This two-part study included a survey to determine the visiting hours policies of New England-area hospital ICUs, and nursing focus groups to describe challenges and barriers that nursing staff working in an open ICU have experienced and to provide solutions that will facilitate implementation of an open visiting hours policy. ⋯ The majority of ICUs in New England have restricted visiting hours. Only one third of ICUs have open visiting policies. Nursing concerns with an unrestricted ICU were identified and solutions were offered that may provide guidance for other ICUs considering adopting an open visiting hours policy.
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Critical care medicine · Feb 2007
Multicenter Study Comparative StudyCircadian rhythm of blood glucose values in critically ill patients.
To test whether there is a circadian rhythm of blood glucose control in critically ill patients and whether morning blood glucose is an accurate surrogate of overall blood glucose control. ⋯ Blood glucose values and the incidence of hyperglycemia have a circadian rhythm in critically ill patients. Morning blood glucose may not be an accurate surrogate of blood glucose control over the daily cycle.