American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Nurses experience stress and suffering when they care for critically ill and dying patients. Moral distress occurs when nurses are unable to translate their moral choices into moral action. In response to this stress, nurses may experience burnout. ⋯ (1) Suffering among caregivers occurs and must be recognized, (2) measures must be taken to reduce the stress and distress of healthcare professionals as they provide care to patients who cannot recover, and (3) in addition to these measures, society must provide guidance to healthcare professionals, especially concerning the care of patients who are permanently unconscious.
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Long-term ICU patients who require prolonged mechanical ventilation are a growing segment of the in-hospital population. Despite recognition that this population is costly to care for no systematic research has been done on the characteristics, outcomes, and disposition of these patients after they leave the hospital. ⋯ A large percentage of ICU patients who require 5 days or more of mechanical ventilation die in the hospital, and many of those who live spend considerable time in an extended-care facility before they are discharged to their homes. These likely outcomes of patients who require long-term ventilation should be discussed with patients and their families to assist them in making informed decisions.
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Recently, a change in anticoagulation therapy occurred that is still partially ignored by the healthcare community. Understanding the controversy over the use of the internal normalized ratio in monitoring patients receiving warfarin therapy is important for nurses who provide care to these patients. ⋯ The international normalized ratio is the most appropriate way to evaluate the effects of warfarin therapy. All healthcare providers should use this ratio as the standard in evaluating the effects of anticoagulation therapy.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Psychological factors and survival in the cardiac arrhythmia suppression trial (CAST): a reexamination.
Evaluating the independent effects of psychosocial and physiological factors on survival of cardiac patients is difficult because it requires obtaining extensive physiological and psychosocial data and long-term follow-up of high-risk patients. ⋯ Among patients who had asymptomatic ventricular arrhythmias after myocardial infarction, psychological status during the period after infarction contributed to mortality beyond the effect of physiological status. The results reaffirm the critical interrelationship between mind and body for cardiovascular health.