scholarly journals Time-limited trials: A qualitative study exploring the role of time in decision-making on the Intensive Care Unit

2019 ◽  
Vol 15 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Bradley Lonergan ◽  
Alexandra Wright ◽  
Rachel Markham ◽  
Laura Machin
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Qualitative Study ◽  
Intensive Care Units ◽  
Treatment Withdrawal ◽  
Structured Interviews ◽  
Open Communication ◽  
North West

Background Withholding and withdrawing treatment are deemed ethically equivalent by most Bioethicists, but intensivists often find withdrawing more difficult in practice. This can lead to futile treatment being prolonged. Time-limited trials have been proposed as a way of promoting timely treatment withdrawal whilst giving the patient the greatest chance of recovery. Despite being in UK guidelines, time-limited trials have been infrequently implemented on Intensive Care Units. We will explore the role of time in Intensive Care Unit decision-making and provide a UK perspective on debates surrounding time-limited trials. Methods This qualitative study recruited 18 participants (nine doctors, nine nurses) from two Intensive Care Units in North West England for in-depth, one-to-one semi-structured interviews. A thematic analysis was performed of the data. Results Our findings show time is utilised by Intensive Care Unit staff in a variety of ways including managing uncertainty when making decisions about a patient’s prognosis or the reversibility of a disease, constructing relationships with patients’ relatives, communicating difficult messages to patients’ relatives, justifying resource allocation decisions to colleagues, and demonstrating compassion towards patients and their families. Conclusions Time shifts the balance towards greater certainty in Intensive Care Unit decision-making, by demonstrating futility, and can ease the difficult transition for staff and families from active treatment to palliation. However, this requires clear and open communication, both within the Intensive Care Unit team and with the family, being prioritised when time is used in decision-making.

Factors Nurses in the Intensive Care Unit Consider When Making Decisions About Patient Mobility

2019 ◽  
Vol 28 (4) ◽  
pp. 281-289 ◽  
Author(s):  
Anna E. Krupp ◽  
William J. Ehlenbach ◽  
Barbara King
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Content Analysis ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Program Implementation ◽  
Structured Interviews ◽  
Patient Mobility ◽  
Related Factors ◽  
Directed Content Analysis

Background Early mobility interventions in the intensive care unit can improve patients’ outcomes, yet they are not routinely implemented in many intensive care units. In an effort to identify opportunities to implement and sustain evidence-based practice, prior work has demonstrated that understanding the decision-making process of health professionals is critical for identifying opportunities to improve program implementation. Nurses are often responsible for mobilizing patients, but how they overcome barriers and make decisions to mobilize patients in the intensive care unit is not understood. Objective To describe processes that nurses in intensive care units use to make decisions and barriers that influence their decision-making about patient mobility. Methods An exploratory descriptive approach using semi-structured interviews of a purposive sample of registered nurses in 2 intensive care units at 2 hospitals was used. Interviews were transcribed and analyzed by using directed content analysis to identify categories that describe nurses’ decision-making about patient mobility. Results Semistructured interviews were conducted with 20 nurses in a 1-on-1 setting. Four main categories that influenced nurses’ decision-making about mobility were identified in the directed content analysis: purpose of mobility, gathering information, establishing and activating the plan, and barriers to progressing the plan. Conclusions Deciding to mobilize patients in the intensive care unit is a multifaceted, individualized decision made by nurses, and numerous patient-, nurse-, and unit-related factors influence that decision. Future studies that target unit culture and interprofessional perspectives are needed.

scholarly journals Continuous EEG Monitoring in the Intensive Care Unit

1998 ◽  
Vol 25 (S1) ◽  
pp. S12-S15 ◽  
Author(s):  
John Kay
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Eeg Monitoring ◽  
General Icus ◽  
Continuous Eeg ◽  
Nonconvulsive Seizures ◽  
Continuous Eeg Monitoring ◽  
Clinical Problems

AbstractBackground:Electroencephalography (EEG) is playing an increasingly important role in the management of comatose patients in the intensive care unit.Methods:The techniques of EEG monitoring are reviewed. Initially, standard, discontinuous recordings were performed in intensive care units (ICUs). Later, continuous displays of “raw EEG” (CEEG) were used. More recently, the addition of quantitative techniques allowed for more effective reading.Results and Conclusions:Applications of continuous EEG to clinical problems are discussed. The most useful role of CEEG appears to be the detection and management of nonconvulsive seizures. There is a need for controlled studies to assess the role for CEEG in neuro-ICUs and general ICUs.

scholarly journals The challenges of using physical restraint in intensive care units in Iran: A qualitative study

2020 ◽  
pp. 175114371989278
Author(s):  
Zahra Salehi ◽  
Soodabeh Joolaee ◽  
Fatemeh Hajibabaee ◽  
Tahereh Najafi Ghezeljeh
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Qualitative Study ◽  
Intensive Care Units ◽  
Physical Restraint ◽  
Critical Care Nurses ◽  
Structured Interviews ◽  
Standard Equipment ◽  
Restraint Use ◽  
Ensure Patient Safety

Background Physical restraint is widely used in intensive care units to ensure patient safety, manage agitated patients, and prevent the removal of medical equipment connected to them. However, physical restraint use is a major healthcare challenge worldwide. Aim This study aimed to explore nurses' experiences of the challenges of physical restraint use in intensive care units. Methods This qualitative study was conducted in 2018–2019. Twenty critical care nurses were purposively recruited from the intensive care units of four hospitals in Tehran, Iran. Data were collected via in-depth semi-structured interviews, concurrently analyzed via Graneheim and Lundman's conventional content analysis approach, and managed via MAXQDA software (v. 10.0). Findings Three main themes were identified (i) organizational barriers to effective physical restraint use (lack of quality educations for nurses about physical restraint use, lack of standard guidelines for physical restraint use, lack of standard physical restraint equipment), (ii) ignoring patients' wholeness (their health and rights), and (iii) distress over physical restraint use (emotional and mental distress, moral conflict, and inability to find an appropriate alternative for physical restraint). Conclusion Critical care nurses face different organizational, ethical, and emotional challenges in using physical restraint. Healthcare managers and authorities can reduce these challenges by developing standard evidence-based guidelines, equipping hospital wards with standard equipment, implementing in-service educational programs, supervising nurses' practice, and empowering them for finding and using alternatives to physical restraint. Nurses can also reduce these challenges through careful patient assessment, using appropriate alternatives to physical restraint, and consulting with their expert colleagues.

scholarly journals The Role of C-Reactive Protein and the SOFA Score as Parameter for Clinical Decision Making in Surgical Patients during the Intensive Care Unit Course

PLoS ONE ◽  
2013 ◽  
Vol 8 (2) ◽  
pp. e55964 ◽  
Author(s):  
Zainna C. Meyer ◽  
Jennifer M. J. Schreinemakers ◽  
Paul G. H. Mulder ◽  
Ruud A. L. de Waal ◽  
Antonius A. M. Ermens ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Sofa Score ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surgical Patients ◽  
C Reactive Protein ◽  
Reactive Protein

scholarly journals The Healthcare Staffs’ Perception of Parents’ Participation in Critical Incidents at the PICU, a Qualitative Study

2021 ◽  
Vol 11 (3) ◽  
pp. 680-689
Author(s):  
Julia Hansson ◽  
Amanda Hörnfeldt ◽  
Gunilla Björling ◽  
Janet Mattsson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study ◽  
Health Professionals ◽  
Qualitative Method ◽  
Structured Interviews ◽  
Parental Presence ◽  
Lower Priority ◽  
Positive Effects ◽  
Critical Situations

Background: Internationally, there are very few guidelines regarding how near relations can be taken care of on a children’s intensive care unit. Despite knowledge about the positive effects of parental presence, staff frequently reject parents out of insecurity. This study aimed to investigate health professionals’ understanding of letting parents be present throughout critical situations. A qualitative method with semi-structured interviews was used to answer the aim of his study. Nine persons participated in the study, both physicians and nurses. The result showed that health professionals’ main view is that parents’ presence is positive. However, their presence often has lower priority than the medical focus of the child and the health professionals’ concern of failure. Conclusion: Health professionals have the power to decide if parents can be present in critical situations. Only when a parent demands to be present does that demand beat the decisions made by health professionals. Lack of resources within the team and fear of parents becoming a disturbance or a distraction are cited as the primary reasons not to let parents be present.

Sign in / Sign up

Export Citation Format

Share Document