American journal of critical care : an official publication, American Association of Critical-Care Nurses
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To investigate the knowledge, beliefs, and ethical concerns of nurses caring for patients dying in intensive care units. ⋯ Intensive care unit nurses strongly support good pain management for dying patients and withholding or withdrawing life-sustaining therapies to allow unavoidable death. The vast majority oppose assisted suicide and euthanasia. Wider professional and public dialogue on end-of-life care in intensive care units is warranted.
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Results from several research studies combined with increasing public tensions surrounding physician-assisted suicide have fueled a growing awareness of the inadequacies of end-of-life care. Investigators also suggest that intensive care unit nurses have a limited role in end-of-life decision making and care planning. ⋯ Recommendations for changing nursing practice include a model of end-of-life care that incorporates the goals of both cure and comfort care, as well as a shared decision-making process. Nurses are essential to improving end-of-life care in today's intensive care units.
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Removal of internal jugular and subclavian central venous catheters is a common nursing intervention. Venous air embolism is a serious complication of catheter removal. Although some procedures have been recommended to prevent venous air embolism, whether nurses use these procedures and what complications patients experience are unknown. ⋯ None of the nurses sampled had venous air embolism diagnosed in their patients. They reported observing dyspnea, pain, bleeding from the insertion site, and arrhythmias. Many of the nurses reported that they did not always use all the recommended procedures; only 9 nurses (31%) reported always using all the recommended procedures.
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Multicenter Study
Sedating critically ill patients: factors affecting nurses' delivery of sedative therapy.
Critical care nurses often have wide discretion in managing the sedative therapy of patients receiving mechanical ventilation. Little is known about the factors and processes that influence sedative practice. ⋯ Social, personal, and professional factors influence sedative therapy. Future research should establish the relative importance of these factors and determine whether their impact is attenuated when sedation protocols are implemented.