Articles: patients.
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The continuing evolution of the highly specialized, technologic manner in which we provide care in critical care units has potentially hazardous effects on the physical and psychological well-being of patients and family members. Although the ICU environment possesses characteristics that make patients and families prone to undesirable sequelae, critical care nurses can employ creative strategies to minimize the impact of bedside technology that is so important for the survival and recovery of the critically ill patient. Strategies to reduce the psychological impact of the ICU environment begin with a psychosocial assessment of the meaning patients and families attach to bedside technology. ⋯ Managing the environment is essential to reduce the physical impact of the ICU environment. Nurses can manipulate the use of equipment to reduce crowding and noise at the bedside, foster familiar activities to stimulate the patient's other senses, and facilitate sleep patterns by structuring nursing activities and providing comfort measures. These nursing interventions will reduce the effects of sensory overload/deprivation and sleep deprivation and, it is hoped, prevent ICU psychosis.
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Although adequate assessment of pain and anxiety during burn wound care serves important clinical and scientific goals (e.g., determination of medication dosage and evaluation of treatment effects), few data are actually available. Studies which compare self-reported pain with observational ratings frequently suffer from small sample sizes or questionable data analysis techniques. This paper presents a study in which 126 burn wound dressing changes were independently rated by patient and nurse(s). ⋯ It is argued that it is not useful to discuss the present and earlier studies only in terms of correctness or incorrectness of observational ratings. Recommendations for future studies include the study of pain-related behaviors, coping mechanisms and effects of treatments. Considering the vast differences in prescription regimes among centers, a multicenter trial would be particularly interesting.