Journal of clinical nursing
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This paper describes the participation of critical care nurses in ward rounds, and explores the power relations associated with the ways in which nurses interact with doctors during this oral forum of communication. The study comprised a critical ethnographic study of six registered nurses working in a critical care unit. ⋯ Nurses experienced enormous barriers to participating in decision-making activities during ward round discussions. By challenging the different points of view that doctors and nurses might hold about the ward round process, the opportunity exists for enhanced participation by nurses.
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Patient safety and comfort during general anaesthesia and surgery are to a considerable extent dependent on the capability of anaesthesia personnel to interpret directly monitored as well as indirect clinical signs of pain and/or depth of anaesthesia. The aim of the present study was to evaluate how nurse anaesthetists in their clinical routine work assess and interpret intra-operative responses evoked by pain stimuli and/or insufficient depth of anaesthesia. A questionnaire was designed to assess the perceived relevance and validity of cardiovascular, respiratory, mucocutaneous, eye-associated, and muscular responses for routine assessment of intra-operative pain and/or insufficient depth of anaesthesia in patients undergoing surgery under general anaesthesia. ⋯ Changes in breathing rate/volume, central haemodynamics (BP, HR), lacrimation, and presence of moist and sticky skin were given higher score values as indicators of pain than as indicators of depth of anaesthesia. Occurrence of grimaces, attempted movements, and presence of non-centred pupils were variables considered more indicative of insufficient depth of anaesthesia than intra-operative pain. In conclusion, it is obvious from the present data that indirect physiological signs of intra-operative pain and depth of anaesthesia are still considered of importance by Swedish anaesthesia nurses in the anaesthetic management of surgical patients.