Contemp Nurse
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This paper describes a four-month preparatory training program for mental health nurses to provide an Emergency Mental Health Triage and Consultancy Service in the emergency department. The emergency department is an important gateway for patients presenting with psychiatric/psychosocial problems and mental health professionals need to provide prompt and effective care to this group of patients. Prior to the implementation of the service, it was acknowledged that occupational stress and burnout could affect the turnover of mental health nurses in the department. ⋯ The results demonstrated that providing mental health nurses with a structured program was instrumental in facilitating their movement to an advanced practitioner level. The nurses were able to apply advanced knowledge and skills to assess and manage clients with complex mental health /psychosocial problems. Furthermore, on leaving the emergency department these nurses were able to utilise the advanced skills in other areas of mental health nursing practice.
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Evidence based practice is seen to be a vehicle through which nurses can deliver more cost-effective care and improve patient outcomes. Despite this, however, 'evidence' does not always appear to influence policy and practice. Routine and traditional practices such as pre-operative fasting protocols seem particulary resistant to change. ⋯ Despite this evidence, however, pre-operative fasting for clear fluids, even for healthy young adults undergoing elective surgery, still persist for periods of up to twelve hours' duration. 'Evidence' was used in a surgical unit in a private hospital in Sydney to reduce pre-operative clear fluid fasting periods for patients requiring elective bowel surgery. This paper will describe the process of implementation of the reduced fasting guidelines. More specifiically, it will detail what was done and how it was done; it will also demonstrate the crucial role of strong nursing leadership in this evidence based change to existing practice.
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Review Case Reports
Withdrawal of treatment in the intensive care unit: the ethical and legal issues.
Many articles have been written and studies conducted into why our patients' pain is not being managed more effectively. The myths and fears still persist, yet the solution is known. Why, then, can't our profession help those we care most about--our clients? Intensive care units (ICUs) have, over the last 30 years, become places of life-saving miracles, and as such, moral dilemmas have also been created. ⋯ The emotional, and other, stakes are also high in this area for patient, family and care team. This paper discusses ethical and legal issues highlighting the principles, doctrines, legislation and precedents especially important in the making of the decisions to withdraw treatment. An ethical framework grid is suggested to assist with the decision-making process.
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Nurses have the responsibility of adequately managing patients' post-operative pain. This literature review assesses whether nurses' management of post-operative pain is adequate or not, according to the literature findings. The findings reveal that nurses' management of patients' post-operative pain is not adequate and implies the concurrent need for improved nurse education and practice. The findings also indicate a need for ongoing research of this phenomenon.
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Caring for patients with prolonged persistent pain remains one of nursing's greatest challenges. Increased knowledge and understanding of pain pathways, however, has enabled new treatments to be incorporated into pain management regimes. ⋯ This review will explore the physiological processes associated with these phenomena, and the use of NMDA receptor antagonists such as ketamine and dextromethorphan to prevent and treat persistent pain. The importance of nurses understanding the modes of action of these drugs will be illustrated through presentation of two case histories.