Aust Crit Care
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In this study we aimed to identify the cues that ward nurses and doctors use to identify patient deterioration and, secondly, examine the assessment and communication of deterioration in patients on acute wards of a regional hospital. ⋯ This study highlights inadequate communication between clinicians and lack of process for ensuring timely management when patients deteriorate in a regional hospital. The use of casual or locum staff who are less familiar with the clinical culture of regional hospitals may influence the recognition of, and response to, deteriorating ward patients.
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Aggression and violence are common in the emergency setting, with nurses out-ranking police and prison officers in exposure to workplace violence. This paper examines the current literature to identify the incidence of violence within the ED, precipitators of violence and aggression and the government policy directive of 'zero tolerance'. Methods of managing violence and aggression are explored, including environmental management, de-escalation, pharmacological and physical restraint and seclusion and these are linked to course content recommended for staff training.
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To assess the incidence of diarrhoea in intensive care patients with a length of stay (LOS) greater than 3 days who were receiving any type of enteral tube feeding, and to measure the effect of implementing a bowel management protocol. ⋯ Use of an evidence-based protocol, and improved monitoring and reporting of bowel activity, can decrease the incidence of diarrhoea in ICU patients.
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Comparative Study
Comparison of dynamic measurements of pulse contour with pulsed heat continuous cardiac output in postoperative cardiac surgical patients.
Cardiac output (CO) can be measured using bolus thermodilution via a pulmonary artery catheter (PAC) and as continuous cardiac output (CCO), using pulsed heat thermoditution. Pulse contour cardiac output (PCCO) measures continuous CO by analysis of the arterial waveform after calibration with thermodilution CO. The Pulsion Medical Systems (PiCCO system) achieves this by transpulmonary aortic thermodilution (TDtpa). ⋯ Whilst PCCO responded to rapid change, it developed significant error during haemodynmamic instability and requires frequent recalibration. CCO on the other hand has a considerable time lag in responding to changes in CO. The way a monitor measures CO must be taken into account when using the data in clinical management.
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Pulse oximetry has become one of the most commonly used tools in the clinical environment for assessing patients' oxygenation status. It is employed almost continuously in critical care areas and frequently in the general ward environment. Although it is a much better tool for determining hypoxia than the human eye, its use is limited if clinicians do not understand relevant physiological principles, such as the oxyhaemoglobin dissociation curve and the inherent limitations of the device. ⋯ The studies were limited by their use of convenience sampling and small sample sizes. Further research is needed to better understand the significance of this problem and to examine how principles of pulse oximetry are taught to nurses and other health professionals at the undergraduate and postgraduate levels. Educators and clinicians alike must ensure that a safe level of knowledge for the use of pulse oximetry is maintained in order to ensure that patient outcomes are not compromised.