Dynamics (Pembroke, Ont.)最新文献

Aims: The purpose of the study was to examine the relationship between (1) critical care nurses' information-seeking behaviour and the non-routineness of tasks; and (2) the extent to which nurses' perception of their problem-solving abilities when completing patient care tasks, moderate the relationship between information-seeking behaviour and non-routineness of tasks.

Methods: A cross-sectional survey design was used. A random sample (n = 177) of critical care nurses working in hospital settings was selected from the College of Nurses of Ontario (CNO) database. Descriptive statistics and multiple regression were used to analyze the data.

Results: Previous information-seeking training (p = 0.008), non-routineness of the task (p = 0.018), and the perception of the problem-solving ability domain of personal control (p = 0.040) had positive relationships with information-seeking behaviour.

Conclusions: The development of problem-solving skills such as personal control, in addition to information-seeking training is essential so critical care nurses will have the skills to aid their information needs when faced with the completion of non-routine tasks.

A case report, focused on vasopressor use and presented in this article, is likely to resonate with many critical care nurses. In this article the authors describe opportunities to enhance safety with vasopressor therapy. Specifically, the goal of improving communication among physicians, nurses, and pharmacists around desired endpoints for vasopressor therapy, triggers for reassessment of the therapeutic strategy and cause of the patient's shock was identified as an area for improvement. A form piloted within an organization for use during multidisciplinary rounds and key findings is shared. Vasopressors constitute the mainstay of therapy for nearly every hemodynamically unstable patient in critical care. It is hoped that the lessons and information shared help empower critical care nurses to facilitate vasopressor stewardship within their facilities and, ultimately, enhance patient safety.

Objectives: Removal of secretions from the subglottic space, which is the larynx cavity below the glottis that contains the vocal cords, reduces the risk for ventilator associated pneumonia. Relationships between factors associated with subglottic secretion volume and viscosity have not been investigated. Subglottic secretions may have a possible link with systemic volume status and oral cavity hydration. The purpose of this study was to examine the relationships among systemic volume, oral cavity hydration, and subglottic secretion (SS) volume and viscosity in mechanically ventilated adults.

Design: Seventy daily oral and SS samples were obtained over a 24-hour collection period from 15 mechanically ventilated adults. Markers of systemic volume and oral cavity hydration and measurements of SS volume and viscosity were collected and analyzed.

Results: The daily volume of oral secretions ranged from 0 to 1.0 mL (SD 0.180 mL), and SS ranged from 0 to 15 mL (SD 22.9 mL). BUN/creatinine ratio (marker of systemic volume status) was moderately correlated with oral secretion volume (r = -0.43). Weak correlations were identified between SS volume and oral volume (r = 0.29) and SS viscosity and oral viscosity (r = 0.22). No other linear relationships were identified among the variables.

Conclusions: This study confirmed that SS accumulation occurs, the amount varies widely, and the secretions are highly viscous. SS volume and viscosity were not found to have a very strong relationship with the variables measured. Nevertheless, clinical implications for practice are present. Further research is needed to understand secretion dynamics in ventilated adults to prevent complications and promote positive patient outcomes.

Background: The decision to donate organs and tissues has the potential to save and improve the quality of life of the transplant recipient. Previous studies suggest lack of information, fears, and prejudices have prevented some cultural minorities from participating in organ and tissue donation (OTD). There is scarce information about the views of those who might be approached for potential donation in the Haitian community. In fact, Haitians are the largest Black ethno-cultural community in Montreal and are at higher risk for needing a kidney transplant (Desilets & Sodjinou, 2006).

Purpose: To learn what Haitians know and believe about OTD in order to enable registered nurses to develop culturally appropriate approaches and interventions.

Design: A qualitative descriptive design was used to explore the knowledge, beliefs, and attitudes toward OTD among the adult Haitian population in the Montreal area. Focus groups were held with 24 members of the Haitian community and moderated by Haitian registered nurses who spoke French and Creole.

Data analysis: Group interviews were transcribed verbatim and analyzed for themes. Adult participants represented younger and older members of the community. They were from different socioeconomic backgrounds.

Findings: Knowledge about donation was influenced by the media, personal beliefs and experience, and level of trust in the health care system. Participants' recommendations on how to address OTD issues within the Haitian community were shaped by beliefs about wholeness, perceived need for donation and key persons who could influence decision-making behaviour.

Conclusion: The level of distrust with the health care system and the study consent process used with participants might have affected the degree of participation and disclosure in discussions.

Background: Emerging evidence indicates that critically ill children are particularly at risk for incurring significant psychological harm. Little is known about these children's actual experiences.

Aim: The aim of the study was to examine children's experience of critical illness. The research question was: What are a critically ill child's sources of discomfort and comfort?

Design: Interpretive phenomenology was selected as the study's method. Children's accounts were examined to identify what they considered meaningful, in terms of their experienced discomfort and comfort. Data sources included formal and informal interviews with child-participants, drawings provided by some participants, and field-notes documenting observed non-verbal data.

Sample: Twelve children were enrolled in the study, ranging from 3 to 17years of age; including four girls and eight boys.

Findings: Although all participants were able to discuss the discomfort and comfort they experienced, they reported difficulties in remembering part or most of their experience. Some participants characterized their Pediatric Intensive Care Unit stay quite favourably or as "not that bad", while some described their experience unfavourably. Diverse types of discomforts were reported, including fears and worries, hurt and pain, invasive interventions, missing significant people, noise, food or eating problems, boredom, physical symptoms, as well as four additional discomforts reported by individual participants. Several sources of comfort were described, including parents, visitors and friends, hospital staff (principally nurses), stuffed animal/favourite blanket, entertainment and play, food, selected medical interventions, thinking of going home, being able to walk or run, sleep, waking up, gifts, along with two other comforts reported by individual participants. Embodiment and a tension between aloneness and being with were identified as the principal phenomena underlying these children's experiences.

Conclusion: The findings complement existing knowledge regarding the psychological impact of critical illness by highlighting how children regard specific phenomena as discomforting or comforting. This sheds light on future directions for practice and research development in pediatric critical care.

Background: Fatigue associated with shiftwork can threaten the safety and health of nurses and the patients in their care. Napping during night shift breaks has been shown to be an effective strategy to decrease fatigue and enhance performance in a variety of work environments, but appears to have mixed support within health care.

Purpose: The purpose of this study was to explore critical care unit managers'perceptions of and experiences with their nursing staff's napping practices on night shift, including their perceptions of the benefits and barriers to napping/not napping in terms of patient safety and nurses'personal health and safety.

Methods: A survey design was used. Forty-seven Canadian critical care unit managers who were members of the Canadian Association of Critical Care Nurses responded to the web-based survey. Data analysis involved calculation of frequencies and percentages for demographic data, use of the Friedman rank test for comparison of managers' perceptions, and content analysis for responses to open-ended questions.

Results: The findings of this study offer valuable insights into the complexities and conflicts perceived by managers with respect to napping on night shift breaks by nursing staff Staff and patient health and safety issues, work and break expectations and experiences, and strengths and deficits related to organizational napping resources and policy are considerations that will be instrumental in the development of effective napping strategies and guidelines.

Background: Novice nurses are increasingly beginning their career paths in critical care areas, where they are expected to care for patients whose lives are potentially threatened. They are unable to benefit from years of experience to facilitate their clinical decisions. Reflection after simulation could possibly improve nurses' clinical judgment in complex situations.

Design: An educational project was conducted to pilot-test a teaching intervention, which combined reflective debriefing with a simulated critical care experience.

Method: Five nurses beginning in an intensive care unit participated in the pilot test. Their perception of their learning and satisfaction with the reflective debriefing and the simulation were collected using open-ended questionnaires. A clinical nurse educator, a faculty member and the first author participated in a group discussion to review the time plan and the affective components of the teaching intervention.

Results: Participants reported that the reflective debriefing helped them understand their cognitive processes during the simulation and contributed to clinical judgment development and to their care prioritization and assessment capacities. Observers reported the time plan was adequate and that attention to participants' negative feelings was necessary.

Conclusion: The results of this pilot test provide preliminary information that reflective debriefing may be a safe and potentially effective way for novice critical care nurses to learn from a clinical experience and enhance clinical judgment.