Aust Crit Care
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End-of-life care is a significant component of work in intensive care. Limited research has been undertaken on the provision of end-of-life care by nurses in the intensive care setting. The purpose of this study was to explore the end-of-life care beliefs and practices of intensive care nurses. ⋯ Despite the uncertainty and ambiguity surrounding end-of-life care in this practice context, the intensive care setting presents unique opportunities for nurses to facilitate positive end-of-life experiences and nurses valued their participation in the provision of end-of-life care. Care of the family was at the core of nurses' end-of-life care work and nurses play a pivotal role in supporting the patient and their family to have positive and meaningful experiences at the end-of-life. Variation in personal beliefs and organisational support may influence nurses' experiences and the care provided to patients and their families. Strategies to promote an organisational culture supportive of quality end-of-life care practices, and to mentor and support nurses in the provision of this care are needed.
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The high numbers of patients suffering from adverse incidents has resulted in wide spread commitment to improving patient safety. While a lack of technical skill can play a part, there is growing evidence that poor non-technical skills can be a major cause of error in healthcare. Non-technical skills, or human factors, play an important role in improving team function and improving these skills can drive improvements in patient safety and outcome. This editorial challenges traditional role stereo-types, and argues that fundamental changes in the behaviour of professionals need to be made, and sustained, in order that the whole team can make a valuable contribution to the patient safety agenda.
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The use of the sepsis bundles in patients with severe sepsis and septic shock has been controversial in the last decade. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate survival effects. ⋯ The Resuscitation 6 hour bundle in the context of the patient population at hand is unlikely to do harm and is yet to be established in primary research in Australia. The Management 24 hour Bundle could not establish a strong enough survival benefit above current routine practice. The sepsis guidelines and bundles have demanded more credible process measurements and debate to induce positive changes in the intervention and treatment care of patients with severe sepsis.
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Elements of evidence based practice (EBP) are well described in the literature and achievement of EBP is frequently being cited as an organisational goal. Despite this, the practical processes and resources for achieving EBP are often not readily apparent, available or successful. ⋯ A multi-dimensional program of practice change has been implemented in one setting and is providing a forum for discussion of practice-related issues and improvements. Adaptation of these strategies to multiple different health care settings is possible, with the potential for sustained practice change and improvement.
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Falling among adults in acute care is an important problem with falls rates in tertiary hospitals ranging from 2% to 5%. Factors that increase the risk of falling, such as advanced age, altered mental status, medications that act on the central nervous system and poor mobility, often characterise individuals who survive a prolonged intensive care unit (ICU) admission. ⋯ Falling during hospitalisation is common in intensive care survivors. Compared with non-fallers, fallers were younger and required inotropes for a shorter duration. Those who survive a prolonged admission to an ICU may benefit from specific assessment of balance and falls risk by the multidisciplinary team.