1,721,008 research outputs found
Notes on critical care—–review of seminal management and leadership papers in the United Kingdom
No full textCocaine-induced myocardial infarction
No full textTo date, cocaine-induced myocardial infarction (MI) remains an infrequent reason for admission into hospital. However, reports identify rising cocaine usage in the UK. With 7–10% of all patients presenting chest pain having traces of cocaine in their urine, there is an increasing incidence of cardiovascular disease in the under 30s age group. The potential impact on health care resources must cause concern. This report describes the case of a young man admitted to the emergency department after an 18-h cocaine session. With evidence of an anterolateral MI, left heart studies and thrombectomy were undertaken in cardiac catheters. Admission to critical care was required for ongoing respiratory and cardiac support therapies. Although there are many aspects of patient management that can be explored, specific issues to be discussed in this paper include evidence-based treatment options, nursing management of inotrope administration and caring for family and friends.<br/
Guest editorial. Using 'soft solutions' to meet today's hard challenges in critical care
No full textNew roles, new teams ... crossing the frontiers. [In: RCN Critical Care Forum: Outreach Services in Scotland, Bernadette O’Riordan (ed) pp.187-195]
No full textThe current role of the consultant nurse in critical care: consolidation or consternation?
No full textSummary:
Background
The consultant nurse role emerged into the National Health Service in 1999, presented against a backdrop of practice and service modernisation. As with any innovative development, the role was originally subject to much scrutiny with regards to impact and outcome. However, six years after its initial introduction, continued focus and support on this role is less visible. This paper presents a follow-up review of the role and function of consultant nurses in critical care, using an original survey tool that underpinned Dawson and McEwen's work in 2003. From the results of the current study, key changes in role are identified and areas for further development are highlighted.Aims• To provide a contemporary profile of the consultant nurse in critical care.• To identify changes in the consultant nurse role from 2003 to 2006.Method
A national email survey of all known critical care nurse consultants in post in the United Kingdom was undertaken in October 2006. Using a validated survey tool originally used in 2003, a return rate of 73% (n = 47) was yielded.Results
Biographics of this survey reveal a static consultant nurse population with increasing length of tenure in post (mean = 60.2 months). There is no substantial increase in the size of the cohort since 2003. Postholders demonstrate advanced academic skills through higher degrees (94%) and carry a national and international profile through presentation and publication portfolios (92% national and 53% international presentation, 62% multi-authored publication, 47% single authored publication). The core role that consultant nurses in critical care engaged in is practice and service development (mean involvement score = 3.65), with expert practice holding least mean involvement scores (mean involvement score = 2.67). There is evidence of increasing use by these posts for strategic input at organisational/trust level.Conclusions
This paper has identified ongoing strengths and limited developments of the consultant nurse in critical care role. Whilst it is clear that core role functions have not dramatically changed, there are demonstrable shifts towards more strategic engagement within Acute Care Trusts. This has brought about concerns regarding overall management of the role, and sustainability of postholders to balance this ever-increasing portfolio. It is also clear that there has been little new investment in this key leadership role, and this raises concerns as to the perceived contribution that experienced clinical nurses bring to a currently financially and operationally driven health service agenda.<br/
Managing a good death in critical care: can health policy help?
No full textAim: This paper discusses end-of-life care (EoLC) in critical care through exploration of what is known from the international literature and what is currently presented within UK policy.Background and context: EoLC is an important international critical care issue, and currently provides a key focus for health care policy in the UK. While society holds that critical care is delivered in a highly technical area with a strong focus on cure and recovery, mortality rates in this speciality remain at approximately 20%. When patient recovery is not an outcome, discussions with patient, family and extended care teams turn towards futility of treatment and end-of-life management. However, there arespecific barriers to overcome in EoLC for the critically ill.Conclusion: A key issue for EoLC in critical care is a lack of robust systems to prospectively identify individuals who are most at risk of dying. A further challenge is divergent perspectives within and across clinical teams on treatment withdrawal and limitation practices. To streamline patient management and underpin a hospice approach to care, EoLC policies are currently being used within the UK. While this provides a national framework to address some key critical care clinical issues in the UK, there is a need for further refinement of the tool to reflect the reality of EoLC for the critically ill. It is important that international best practice exemplars are examined and clinicians actively engage and contribute to ensure that any local EoLC frameworks are fit for purpose
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