American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Visiting policies have been liberalized in ICUs, but the process and outcome of policy modifications have not been well described. ⋯ Effective implementation of liberalized visiting depends on assessment of the following: nurses' beliefs, attitudes, and satisfaction about a change toward a more open visiting policy; staff involvement in determining the policy; and nurse manager and clinical nurse specialist support.
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The increasing attention to assisted suicide, as evidenced by recent legislation, initiatives, court decisions, and research, propels the issue to a new level of importance and urgency within society and the health professions. Nurses cannot help but be confronted by and struggle with the complex moral and professional quandaries related to assisted suicide. Critical care nurses must continue to evaluate the implications of the possible legalization of assisted suicide and to define the boundaries of morally acceptable professional practice. The challenges to the roles and responsibilities of critical care nurses that might occur if assisted suicide were legalized must be thoughtfully and responsibly explored.
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More centers are performing lung transplants for a variety of pulmonary conditions. Chronic rejection, manifested as obliterative bronchiolitis, is the most common cause of late death (greater than 6 months after transplant) in this population. ⋯ Obliterative bronchiolitis is a common complication in lung transplant recipients, and future research will focus on treatment and early diagnosis. Efforts are under way to standardize nomenclature and reporting of incidence and mortality rates.
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The nature and intensity of a do-not-resuscitate therapeutic plan varies by patient. Some do-not-resuscitate therapeutic plans may include interventions directed at the withdrawal of life-sustaining therapy. ⋯ These results support previous observations that decisions to withdraw life-sustaining therapy are prompted by diminished consciousness. These results may stimulate caregivers to offer withdrawal of life-sustaining therapy as an option in patients with severely decreased consciousness and a poor prognosis for functional recovery.
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Organizational structure and process are thought to affect patient care outcomes beyond the effects of expert clinical care. ⋯ With experienced critical care practitioners, unit-level structure and process factors were better predictors of organizational outcomes than of clinical outcomes.