Flanders, S.A., Harrington, L. & Fowler, R.J. (2009). Falls and patient mobility in critical care: Keeping patients and staff safe. Advanced Critical Care, Vol. 20, No. 3, AACN.
- Abstract Critical care and advanced practice nurses have a significant role in the creation of safe passage for patients in the hospitals in the United States
- Methodology This article written by three registered nurses have investigated the prevention of falls, early mobilization of patients in the intensive care unit and the safe handling of patients. They have conducted a review of relevant articles from Medline and CINAHL databases.
- Participants Relevant articles from the Medline and the CINAHL can be considered as the participants
- Data analysis Safety for patients and nurses can be achieved through various ways which include potential fall risk assessment, clinical judgment of nurses and fall prevention strategies like routine orientation of the patient, call light within reach, low beds, adequate lighting, nonskid footwear, assistive devices in getting out of bed, no dangling tubes and coiled drainage bags. Critically ill patients are to be assessed for physical conditions and implications of moving them with equipment attached. Mechanically ventilated patients are not allowed to move from their bed.
- Results. Engineering controls, administrative controls and behavioral controls are required to handle patients safely in hospitals. The nurse’ judgment is another essential factor.
- Nursing education implications Critical care nurses and advanced practice nurses are in a position to prevent falls, mobilize patients safely and engage in safe patient handling activities. They must be imparted training during their education courses and in the course of their work to allow them to keep abreast of the new situations.
- Final thoughts More nursing research needs to be done in this direction. The techniques employed in institutions always have room for improvement.
Helft, P. R., Bledsoe, P.D., Hancock, M. & Wocial, L.D. (2009). Facilitated ethics conversations: A novel program for managing moral distress in bedside nursing staff. JONA’s Healthcare , Law and Ethics, and Regulation, Vol. 11, No. 1, Wolters Kluwer Health/ Lippincott, Williams and Wilkins.
- Abstract Facilitated unit-based ethics conversations are helpful to overcome moral distress, the major problem for bedside nurses. This research reviews the response of participant nurses.
- Methodology A qualitative study is being done with an attendance survey followed by focus group discussions. The nurses’ satisfaction and their experiences with UEBCs, and how their challenges of issues of ethics have been met by the new program are being investigated
- Participants The 100 hospitals where UEBCs were established formed the participants.
- Data analysis The program has not been fully evaluated yet. However some data have been obtained. The nurses are grateful for the UEBCs. Many experiences have been found.
- Training in the programme has helped the nurses to come out and make their opinions. Nurses who complete the survey will be included in the focal group discussions.
- Results Results have not been obtained yet. A focus group study will elicit the more detailed qualitative experiences of nurses with UEBCs in 100 hospitals. The attendance surveys will provide information on the satisfaction of the UBEC program and whether it helped the nurses to resolve challenging ethical issues in clinical practice.
- Nursing Education implications A special curriculum of training is being planned for facilitators for the UEBCs so that the program can be made extensive and more effective.
- Final thoughts The efficient implementation of the UEBC program would be extremely useful for the nurses globally as their day-to-day experiences keep changing and diverse ethical issues are arising for which there are no immediate or theoretical solutions. They need discussion for resolution.
Lopez, D.P. (2009). Acetaminophen poisoning., AJN, Vol. 109, No. 9, Wolters Kluwer Health Retrieved on 15/10/09
Acetaminophen poisoning is an emergency situation which can be fatal if left undiagnosed. The relevance of the issue in present day society increases alarmingly as acetaminophen is an over-the-counter medicine. Lopez, a clinical educator, has written this thought provoking academic article starting with a case study. A theoretical discussion has been done in this academic article. The stages of acetaminophen poisoning and how hepatic toxicity could complicate matters have been highlighted. The significance of missing a diagnosis and the implications in present day society has been conveyed. The effect of education on statistics has been stressed.
Montague, K.N., Blietz, C.M. and Kacher, M. (2009). Ensuring quieter hospital environments. AJN, Vol. 109, No.9, Wolters Kluwer Health.
The ambient noise levels produced by hospital environments lead to adverse effects like stress, fatigue, exhaustion and burnout to the patients and nurses on duty. Hospital sounds emanating from movement of people, equipment, printers, televisions, public address systems and the ventilation system must be lessened by efficient designing of architecture with the collaboration of hospital staff. This article written by a design consultant and his friends has provided strategies for ensuring quieter hospital environments through special design of the architecture along with behavioral and administrative measures.
The WHO guidelines for acceptable noise have been mentioned: sound levels are not to exceed 35dBA during the day and 30 dBA during the night. The details of the furnishings open our eyes to the small changes that one can make to provide the soothing atmosphere for sound sleep and rest which patients and nurses need. The examples of hospitals which have adopted techniques to quieten their hospital environments have been given.
Winkelman,C. (2009). Bed rest in Health and Critical Illness: A body system approach, AACN, Vol. 20, No. 63, p. 224-266.
- Abstract “Bed rest is a common intervention for critically ill adults”. The benefits and adverse effects or the functional outcomes of bed rest have been exhaustively reviewed of patients in the critical care unit from empirical and anecdotal bed rest studies involving those from different hospital units: cardiovascular, pulmonary, skin, nervous system, immune system, gastro-intestinal and skeletal systems. Functional impairment and poor quality of life are assessed by measures of activity tolerance and ability.
- Methodology Review of classic and current studies which describe the consequences of long term immobility and bed rest has been done.
- Participants The bed rest studies that have been selected for the review
- Data analysis Molecular and systemic changes have been related to reduced quality of life in ICU patients. The physiological effects of bed rest of the ill patients have been obtained. The ICU acquired weakness has been associated with increased mortality. Medications worsen the ill effects of bed rest.
- Results: Changes after bed rest can vary from patient to patient. They influence the recovery. Upright positioning, range of motion and walking are considered useful to shorten the hospital stay of ill patients. After extubation, patients must be mobilized. ICU patients have pain, contractures and social isolation from prolonged rest. Rehabilitation is limited by reduced oxygen capacity, sluggish neurovascular reflexes, tachycardia, muscle weakness and fatigability. Upright position must condition the baroreceptors. The period between the bed rest and interventions must be related to the activity tolerance.
- Nursing education implications Nursing care in ICUs and critical care institutions and homes for the aged must be influenced by the information imparted in this research.
- Final thoughts More research needs to be done as patients with prolonged bed rest due to lengthened critical care are prone to the ill effects. Recovery and ambulation will be affected.