American journal of critical care : an official publication, American Association of Critical-Care Nurses
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In the last 10 years, the American Association of Critical-Care Nurses has twice ranked pain management as a priority issue for research and practice. Recent research findings suggest that undermedication of patients continues both in and out of critical care. Postoperative cardiac surgery patients have reported detailed recollections of pain experiences while in critical care, yet little is known about management of postoperative cardiac surgery pain. ⋯ The finding of small and infrequent analgesic doses is consistent with other studies conducted in and out of critical care. Important inconsistencies, or variations in practice, exist in both the prescription and administration of analgesics for postoperative cardiac surgery patients in the critical care setting.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of tidal volumes obtained by one-handed and two-handed ventilation techniques.
To compare tidal volumes delivered by one- vs two-handed compressions of a manual resuscitation bag and assess the effects of subject characteristics on those tidal volumes. ⋯ Tidal volumes delivered by healthcare providers using one- vs two-handed compressions were found to be significantly different, with those delivered by two hands significantly greater than those delivered by one hand. Strength of hand grip was the best predictor of volume delivered and was more strongly correlated with volumes delivered by one rather than two hands.
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Collaborative practice behavior is a concern for healthcare providers and administrators, because it is associated with positive outcomes for both patients and staff in the intensive care unit. Despite the documented benefits derived from collaborative practice, it remains the exception rather than the dominant pattern for nurse-physician interactions. National concern for quality care and rising healthcare costs mandates that collaborative practice behaviors between nurses and physicians replace competition as the means for resolving differences. The purpose of this article is to describe collaborative practice, propose a theoretical framework for collaborative practice and discuss the development, implementation and evaluation of a collaborative practice model.
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Conventional therapy in the management of adult respiratory distress syndrome is often associated with an increased mortality rate. Several methods to improve survival in patients with severe respiratory insufficiency are under evaluation. One recently developed method of treatment is an implantable intravascular oxygenator, which provides supplemental gas exchange for failing lungs. ⋯ Reduction in ventilator settings such as airway pressure, oxygen concentration, positive end-expiratory pressure and minute volume can be achieved, decreasing the likelihood of oxygen toxicity and barotrauma. Success of the intravascular oxygenator in adult respiratory distress syndrome is dependent in part on critical care staff expertise. Therefore, a thorough understanding of the operation of this device and its role in acute respiratory failure is necessary for optimal care.