Abstract This paper discusses the progression of amendments to the criticalcare guidelines from 2001 to 2004. The author includes adult and pediatric criticalcare. The paper suggests for whom these guidelines would be appropriate and how they would be used.
From the Paper "The critical care guidelines discussed here were found on the website of the Society of Critical Care Medicine (SCCM) www.sccm.org. They were found by going to the search engine Google and typing in 'guidelines for critical care'. The guidelines were developed for the care of patients needing critical care. The guidelines were published in Critical Care Medicine between ... . The guidelines were developed to set standards of critical care for admission and discharge for triage."
Abstract This paper reviews how criticalcare practitioners in the United Kingdom can find information on new research in their area of specialty, how this can be communicated and how it can be implemented into their patient care. The author investigates clinical audits. The paper urges the establishment of a baseline audit before implementing new practices and monitoring their effects on patient well-being.
From the Paper "Since there is great variety between institutions and between individual nurses and patients, there is no simple practice of critical care, which will suit call cases. Managers of clinical areas need to work with providers of education to make sure that ..."
Abstract This paper discusses criticalcare nursing and the role of the criticalcare nurse. It describes the nurse's role from the point of view of the writer, who is a nurse, and presents some of her experiences in this position. The paper presents a case study of an elderly patient in a criticalcare setting and discusses both the patient's needs and experiences, as well as the nurse's.
Table of Contents:
Introduction
A Personal Point Of View Of My Nursing Experience
Comprehensive Discussion Of Critically Ill Patient And Their Experience Of Critical Illness
Personal Reflection About Visit To The CSICU
How This May Influence My Own Vision Of Myself As A CriticalCare Nurse
From the Paper "Knowing the patient's family and social environment would have given me a better idea about her outlook, whether she was optimistic or pessimistic about getting well, how she felt about her state of health in general, and what acts of daily life and independence were most important to her. It would also have helped me assess the family's ability to facilitate the patient's self-care, and their awareness of the seriousness of monitoring her health condition. Also, I would have liked to have known the patient's attitude, and her family's attitude regarding her other ailments, such as her diabetes, her adherence to a special diet, her ability to monitor her blood sugar and cholesterol, as well as her history in observing a medication regime with religiosity and diligence."
Abstract This paper looks at the reasons that the writer has chosen to work in criticalcare nursing and the importance that it has on the writer's life. The rationale for choosing this career is discussed along with these reasons. Following this, the background of the career is dealt with as the necessary preparation, the typical professional responsibilities and the personality traits that are best suited for this kind of career are important not only to a better understanding of the career and the writer, but also to those that might be considering this type of career for themselves in the future.
From the Paper "Why someone chooses a particular career path has much to do with the personality that the individual has and what type of work appeals to that person. This is very important in many different types of jobs, as some people are just not 'cut out' to work in a particular field, and some do not have the desire to perform the functions of a particular job. This is very apparent in nursing, as it takes a certain kind of person to do the work of caring for others and deal with the lack of recognition and lack of high pay that many nurses must face. For those that work in critical care, witnessing the deaths and dying of others are also a part of the job and the individual that chooses this occupation must be able to accept this issue and have empathy for the patient and the patient's family without becoming so emotionally attached that he or she is unable to do the job competently and correctly."
Abstract This paper proposes a study in the form of a qualitative examination of the effects of the implementation of an outreach service and modified early warning system on re-admissions to criticalcare. An enormous body of literature suggests a need for outreach services in the medical community, particularly in large hospitals. Re-admissions are generally considered a measure of criticalcare quality in the field of medicine. The paper shows that, generally, outreach teams are considered a mechanism for improving the overall criticalcare delivery system and quality of medical care service. Thus, the researcher proposes that the implementation of an outreach service and modified early warning system will improve the overall quality of medical care services within hospitals and potentially reduce the re-admissions rates.
From the Paper "Bristow et. al (2000) finds in a study conducted of patients at a hospital utilizing an outreach program that fewer patients were unexpectedly admitted to the ICU and there were fewer non-DNR deaths in a hospital using this type of approach than in other hospitals. Further the study suggests that outreach programs and other critical care teams may have important "implications for patient care in hospitals." Bristow et. al (2000) suggests a need exists for further large scale studies of outreach programs in hospital institutions large and small."
Abstract This paper offers a literature review of ten documents regarding the open visitation in the criticalcare/intensive care unit. The paper discusses the concepts of open visitation in various areas of care and explores nursing concerns about the practice. The paper also includes research studies that have measured the practice, the present day situation regarding the topic and the future of open visitation.
From the Paper "Open visitation in critical care units is a topic that is consistently debated within the medical community. Since the inception of hospital visitation practices in the 1960s medical professionals have been struggling to implement policies that benefit both the critically ill patient and the medical teams that provide their health care needs. Multiple factors are taken into consideration when studying open visitation in the health care arena. Factors affecting open visitation policies may include the lack of nursing training to handle psychological effects on the family unit; the benefits of open visitation for the patient; the benefits of open visitation for the family members; and the effects on the hospital and nursing staff of allowing open visitation. (Cullen, Titler, & Drahozal, 2003)."
Abstract This paper, written from the perspective of a nursing practitioner, examines the issue of open versus closed visiting hours in the intensive care unit. The author explores these questions from the perspective of a quality care issue as well as a culturally competent care issue. The author summizes that open visiting hours in the intensive care unit can cause more strain on the patient and the staff than is good for either to experience.
From the Paper "Confounding and complicating factors in the study include the relative selectivity of the patients, and the fact it was a single center trial, which reduces the degree of generalization of the results. What should be noted in the authors favor however is that the study was indeed a pilot and used more scientific methods than had previously been done to examine the true effect on the patient. What cannot be judged from this survey is what the effect of the rotating sequences had on the staff. It is noted that the staff were not allowed to know which sequence was being used until the new period began. It is also interesting to note that the ICU did not accept any new patients in the last week of the two month period in order to prevent overlap of patients in different visiting cycles, and that the ICU was closed for 4 days between each cycle to allow a cleaning and disinfecting. This unusual procedure may have had a confounding effect on the rate of infection as well."
Tags:critical, care, nursing, intensive, care, units, (ICU), hospitals, patients
Abstract In this article the writer explains that the legal definition of a nurse practitioner differs between states and that the scope of practice of a nurse practitioner also varies considerably from one state to another. The writer also points out that as all nurse practitioners in every state perform physician services in criticalcare, they must conform to their particular state's requirements. The writer then points out that while Medicare requires that a nurse practitioner be authorized, under state law, to perform any service that is billed, state laws governing nurse practitioners' scope of practice differ to a significant degree. The writer maintains that numerous hospitals and other facilities are uninformed about the rules and procedures related to billing for nurse practitioners' services. The writer concludes that while research has indicated that nurse practitioners provide the same quality of care in acute care settings as do physicians, the same demands are made on them with the potential for legal problems.
From the Paper "The nurse practitioner's services are reimbursed through the facility fee or Diagnostic Related Group payment to the hospital. The main opportunities for billing nurse practitioner services are located in evaluation and management procedure codes. While the patient pays 20 percent of the physician fee schedule rate, Medicare pays 85 percent of 80 percent of the Physician Fee Schedule rate for physician services billed under a nurse practitioner's provider number. The American College of Nurse Practitioners maintains that this problem is the result of a problematic annual update formula so that Medicare payments to all providers of services are threatened with reductions each year. Since nurse practitioners receive just 85 percent of the reimbursement that physicians obtain, the reductions are substantial. Within the current system, payment updates for providers are linked with the U.S. Gross Domestic Product (GDP) growth."
Abstract This paper presents a detailed examination of Dorothy Johnson's behavioral system model. The writer explores the model itself and then uses case study examples to apply the theory to real life situations in a criticalcare nursing role. It presents the positive outcomes for nurses and family members, of using the model in criticalcare nursing.
Table of Contents:
Introduction
Johnson's Life
The Model
Case Study
Conclusion
From the Paper "One of the most well known nursing theorists in modern history was Dorothy Johnson. Johnson ideas about the field of nursing and how that field relates to the care of individual patients, including her well known Behavior Model theory (Fruschwirth, 2000). The theory encompasses many of the medical systems in the human body and how they relate to behaviors of individuals to provide a measurable blueprint as to how to apply those functions and behaviors to the everyday practice of nursing. To understand how the Behavioral System Model was conceived and developed and how it pertains to today's nursing profession it is important to have a basic understanding of nursing itself and the life of Johnson."
Abstract This paper discusses the book, "Welfare and Rational Care" by Stephen Darwall, and its argument that intervening in the welfare of an individual is morally justifiable. The paper critically reviews the book and discusses the major points Darwall makes.
From the Paper In "Welfare and Rational Care", Stephen Darwall examines the ethical nature of welfare. Darwall states, "I shall be claiming that a person' good is constituted, not by what that person values, prefers, or wants (or should value), but by what one (perhaps she) should want insofar as one cares about her (Darwall 4)."What this means is that an individual's welfare is essentially determined by what other individuals and society as a whole determine should be in their best interest."
Abstract This paper discusses the concept of caring, specifically as it manifests between a nurse and his/her patient. The paper discusses five aspects of caring, which are caring and competency; caring and connectedness; caring and critical thinking; caring and healing; and caring and professionalism. The writer mentions his own experiences following surgery.
From the Paper "Caring is a complex issue. Dowling (2004) mentions that there are 35 different definitions of caring, but one of the most useful is caring as an interpersonal interaction. "For caring to occur, both the nurse and the patient must communicate openly with trust and respect for each other" (Dowling, 2004, p. 1291). There are five aspects of caring which consist of: caring and competency; caring and connectedness; caring and critical thinking; caring and healing; and caring and professionalism. These aspects will be discussed. My own experience of surgery was marked by deep anxiety and feelings of loss."
Abstract This paper discusses the use of a strategic business plan. The author includes in the plan for a day care center: Executive Summary, Company Background, Vision Statement, Mission Statement, Values Statement,
Environmental Analysis, Internal Environment, External Environment, Long Term Objectives, Strategic Analysis and Choice, Plan Goals and Implementation, Financial Projections, Critical success Factors, Controls and Evaluation.
From the Paper "Strategic planning is a comprehensive process for determining what a business should become and how it can best achieve that goal. The planning appraises the full potential of a business and links the business' objectives to the actions and resources required to achieve them. Strategic planning involves a systematic process to address the critical issues confronting a company or organization. Strategic Planning processes are often implemented to change the direction and performance of a business, set a proper context for budget decisions and performance evaluations."
Tags: strategic plan, day care, child care, Executive Summary, Company Background, Vision Statement, Mission Statement, Values Statement.
Abstract This paper provides a detailed account of the Music therapy method of treatment especially in the criticalcare units. It shows how modern scientists agree that many different kinds of music can be therapeutic. Some people respond well to reggae or jazz. Others are uplifted or in fact healed, when they listen to Gregorian chant, or heavy metal.
From the paper:
"Music Therapy is a form of sound wave therapy which includes several other different tools and methods. The music therapists or the sound therapists in general work with tuning forks, song pods, toning, and music. Tuning Forks produce pure sounds when tapped. The human bodies in actual acts like a resonating board to the pulses of the universe as the major part of the human body is water. The human cells resound with the vibrations of the sounds by which they are surrounded in the daily life. When tuning forks are being used the energy blocks can be released and the physical system can be brought back into alignment. The sounds can also balance the spiritual, emotional and mental bodies by creating sounds through the tuning fork that the nervous system and the whole body can harmonize to. The other tool is the song pods."
Abstract This paper is a concept analysis of grief behaviors in families, as witnessed in the pediatric criticalcare setting. The writer explains how grief is a concept surrounded by ambiguity despite nurses' frequent encounters with grieving persons. This paper clarifies this concept and explains how it allows nurses to gain insight into managing grieving families in a therapeutic manner. A concept analysis is described using antecedents, attributes and referents, and principal variables of grief are identified. In addition, model, contrary, borderline, related and illegitimate cases are described. It shows how this analysis can contribute to the establishment of nursing practices with grieving persons.
From the Paper "Grief fills the room up of my absent child, lies in his bed, walks up and down with me"? (Bartlett, 1919). The death of a child, sudden or otherwise, has a profound, life changing effect on the family infrastructure. As nurses, it is important to develop skills of compassion so that we can support these families in their time of need. In order to support a family through the initial stages of grief, one must look at their own belief systems. One must keep an open mind and realize that every family has a different belief system related to death, dying and the grieving process. Our responsibility is not to get families to believe as we believe, rather we must fill the role that the family defines for us during their time of need.
Abstract This paper studies how medical professionals diagnose and treat thrombolysis during criticalcare for patients experiencing chest pain. The paper provides a detailed analysis of scientific and clinical evidence indicating that patients experiencing acute myocardial infarction benefit from the early administration of thrombolytic therapy. The paper then discusses the challenge for multidisciplinary providers in ensuring that patients give true informed consent for all procedures, from administration of medication to invasive procedures. The paper explains that the setting can be chaotic, however, it maintains that effective communication between patients and providers is imperative.
From the Paper "The definitive diagnosis of AMI is best obtained by following a standard chest pain protocol. Most accident and emergency wards have these in place. It is standard to initially obtain a 12 lead electrocardiogram (ECG) and begin cardiac monitoring. Patient's routine laboratory studies include electrolytes, blood urea nitrogen (BUN), complete blood count (CBC) and markers for myocardial injury (Creatinine Kinase isoenzyme-myocardial (CK-MB) or troponin). Normal serial CK values rule out an acute infarction but are negative in the setting of acute unstable angina. A slight rise in CK-MB or troponin indicates myocardial injury but is not specific for ischemic syndromes. Troponin assay is highly sensitive for identifying acute coronary syndromes. Troponin has longer half life in the system than CK-MB but is less specific for the identification of infarction as opposed to repeated episodes of myocardial ischemia. As the total CK greater than two times the upper ranges of normal is indicative of infarction it can be used as an adjunct in diagnosis ischemia versus infarction and also in determining the relative efficacy of reperfusion. Serum troponin may take up to six hours to become diagnostically sensitive enough (Dougan, 2001)."
