Managing Cancer-Related Pain in Critical Care Settings

2011 ◽  
Vol 22 (4) ◽  
pp. 365-378
Author(s):  
Elisabeth A. Dolan ◽  
Judith A. Paice ◽  
Sally Wile
Keyword(s):  
Critical Care ◽  
Spiritual Care ◽  
Critical Care Nurses ◽  
Treatment Modalities ◽  
Common Symptom ◽  
Challenging Problem ◽  
Team Members ◽  
Care Intervention ◽  
Advanced Stages ◽  
Selection Of

Pain is a common symptom experienced by individuals who are in treatment for cancer and becomes more prevalent for those with more advanced stages of malignancy. Critical care nurses are essential in the management of cancer-related pain, which is a challenging problem when individuals who have a cancer diagnosis are admitted to the intensive care unit for emergent conditions. Regular, thorough, and patient-appropriate assessments by experienced critical care nurses guide selection of treatment modalities, including pharmacologic and nonpharmacologic techniques. In addition, existential pain necessitates spiritual care intervention, and involvement of other appropriate interdisciplinary team members can result in improved management of all types of pain experienced by critically ill individuals with cancer.

Naloxone infusion and drainage of cerebrospinal fluid as adjuncts to postoperative care after repair of thoracoabdominal aneurysms

1999 ◽  
Vol 19 (5) ◽  
pp. 37-47
Author(s):  
LA Iacono
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Critical Care ◽  
Postoperative Care ◽  
Regional Blood Flow ◽  
Neurological Complications ◽  
Critical Care Nurses ◽  
Treatment Modalities ◽  
Assessment Skills ◽  
New Treatment

The mechanisms that produce paraplegia in patients after TAA repair are complex and involve alterations in regional blood flow to the spinal cord, CSF dynamics, and reperfusion. Although neither the minimal level of blood flow nor the maximal spinal cord pressure that can be tolerated by the spinal cord is known, adjuncts such as CSF drainage and naloxone infusions may allow longer durations of aortic cross-clamping before irreversible ischemia occurs. Because paraplegia is multifactorial and none of the recommended adjuncts alone provides complete protection of the spinal cord, a combination of treatments may be necessary to reduce the prevalence of neurological complications after thoracoabdominal aortic reconstruction. Critical care nurses thus must be acquainted with the advanced monitoring techniques and the pathophysiology behind these new treatment modalities. Advanced assessment skills are also essential to recognize the potential neurological complications that may occur in these patients. Care of patients with TAA is a challenge. Critical care nurses must use multidimensional skills in the areas of hemodynamic monitoring, physical assessment, and psychological counseling to effectively manage postoperative care of these patients.

Understanding the oxyhemoglobin dissociation curve

1995 ◽  
Vol 15 (5) ◽  
pp. 54-58 ◽  
Author(s):  
SL Dickson
Keyword(s):  
Critical Care ◽  
Oxygen Affinity ◽  
Critical Care Nurses ◽  
Treatment Modalities ◽  
Dissociation Curve ◽  
Patient Assessment ◽  
Oxyhemoglobin Dissociation Curve ◽  
Hemoglobin Oxygen Affinity ◽  
Oxygenation Status ◽  
Oxyhemoglobin Dissociation

The oxyhemoglobin dissociation curve helps critical care nurses to better understand how various factors affect the oxygenation status of patients. Disease processes or treatment modalities that may cause shifts in the curve should be identified and the effects of the increased or decreased affinity assessed. Knowledge of conditions that affect hemoglobin-oxygen affinity, results of careful patient assessment, and oxygenation monitor readings allow critical care nurses to intervene and attempt to correct tissue hypoxia of critically ill patients.

scholarly journals Spiritual wellbeing, Attitude toward Spiritual Care and its Relationship with Spiritual Care Competence among Critical Care Nurses

2015 ◽  
Vol 4 (4) ◽  
pp. 309-320 ◽  
Author(s):  
Tagie Azarsa ◽  
Arefeh Davoodi ◽  
Abdolah Khorami Markani ◽  
Akram Gahramanian ◽  
Afkham Vargaeei
Keyword(s):  
Critical Care ◽  
Spiritual Care ◽  
Critical Care Nurses ◽  
Spiritual Wellbeing

Critical Care Nurses’ Perceived Need for Guidance in Addressing Spirituality in Critically Ill Patients

2016 ◽  
Vol 25 (3) ◽  
pp. 206-211 ◽  
Author(s):  
Christina Canfield ◽  
Debi Taylor ◽  
Kimberly Nagy ◽  
Claire Strauser ◽  
Karen VanKerkhove ◽  
...  
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Spiritual Care ◽  
Critically Ill Patients ◽  
Further Education ◽  
Critical Care Nurses ◽  
Spiritual Needs ◽  
Individual Interviews ◽  
Perceived Need ◽  
Working Definition

Background The term spirituality is highly subjective. No common or universally accepted definition for the term exists. Without a clear definition, each nurse must reconcile his or her own beliefs within a framework mutually suitable for both nurse and patient. Objectives To examine individual critical care nurses’ definition of spirituality, their comfort in providing spiritual care to patients, and their perceived need for education in providing this care. Methods Individual interviews with 30 nurses who worked in a critical care unit at a large Midwestern teaching hospital. Results Nurses generally feel comfortable providing spiritual care to critically ill patients but need further education about multicultural considerations. Nurses identified opportunities to address spiritual needs throughout a patient’s stay but noted that these needs are usually not addressed until the end of life. Conclusions A working definition for spirituality in health care was developed: That part of person that gives meaning and purpose to the person’s life. Belief in a higher power that may inspire hope, seek resolution, and transcend physical and conscious constraints.

scholarly journals The Correlation between Spiritual Care Giving and Nurses’ Competences at Critical Care Units

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Muhammad Deri Ramadhan ◽  
Destiya Dwi Pangestika ◽  
Nurul Fatwati Fitriana
Keyword(s):  
Critical Care ◽  
Spiritual Care ◽  
Strong Correlation ◽  
Critical Care Nurses ◽  
Main Task ◽  
Cross Sectional ◽  
Critical Care Units ◽  
Care Giving ◽  
Competence Scale ◽  
Nurses Perceptions

 ABSTRACTPatients’ complex and critical conditions may influence humans to fulfill their basic daily needs. One nurses’ main task is giving the nursing care based on the patients’ daily needs including spiritual care. However, the critical care nurses only focused on the patients’ physical needs, without paying more attentions to the spiritual care. Many factors may influence the nurses’ competences in giving the spiritual care, including nurses’ perceptions, involvements with the other health workers, spiritual care input as a part of nursing curriculum. Thus, it is greatly important to r reveal the correlation between spiritual care giving and nurses’ competences in developing the spiritual care to the patients. This study aims at revealing the correlation between spiritual care giving and nurses’’ competences at critical care units. This quantitative non experimental research employed a cross sectional design. Seventy seven critical care nurses at the intensive care units participated in this research and two research instruments consisting of Spiritual Care Giving Scale (SCGS) and Spiritual Care Competence Scale (SCCS) were employed. The data were then bivariately analyzed to reveal the nurses’ perceptions on spiritual care. The research results showed that spiritual care giving and nurses’ competences had a strong correlation. Each domain in spiritual care giving scale had a strong correlation with nurses’ competences.   ABSTRAK Kondisi pasien kritis yang komplek dapat menganggu terpenuhinya kebutuhan dasar manusia. Fokus perawat dalam merawat pasien adalah dengan memberikan asuhan keperawatan yang berdasar pada kebutuhan dasar manusia dimana salah satu kebutuhan dasar manusia yang juga harus dipenuhi adalah kebutuhan spiritual. Namun, kenyataannya perawat dalam memberikan perawatan kepada pasien hanya berfokus kepada perawatan medis dan fisik saja, tanpa melakukan pendekatan secara spiritual. Beberapa faktor dapat mempengaruhi kompetensi perawat dalam memenuhi kebutuhan spiritual pasien seperti persepsi perawat, keterlibatan dengan multidisiplin lain, melibatkan materi spiritual dalam kurikulum keperawatan. Berdasarkan paparan di atas, maka penting untuk dilakukan kajian mengenai hubungan kompetensi perawat dengan pemberian perawatan spiritual. Jika hal tersebut sudah dapat diketahui, maka ruangan intensif akan lebih mudah dalam mengembangkan bentuk pemberian kebutuhan spiritual pada pasien. Penelitian ini bertujuan untuk mengetahui hubungan antara kompetensi perawat dan pemberian perawatan spiritual pada perawat kritis. Jenis  penelitian  yang  digunakan  adalah  penelitian kuantitatif korelasi dengan desain penelitian cross sectional. Responden pada penelitian ini adalah perawat yang bekerja di Unit Rawat Intensif sebanyak 78 orang. Instrumen penelitian yang digunakan adalah Spiritual Care Giving Scale (SCGS) dan Spiritual Care Competence Scale (SCCS). Pada penelitian ini, data dianalisis secara bivariat untuk mengetahui hubungan kompetensi perawat dan pemberian perawatan spiritual. Secara umum, pemberian perawatan spiritual mempunyai hubungan yang kuat dengan kompetensi perawat (r=0.619) dimana setiap domain dalam Spiritual Care Giving Scale (SCGS) mempunyai hubungan yang kuat (p value 0.00) dengan kompetensi perawat dalam memberikan perawatan spiritual. Hasil analisa tersebut dapat disimpulkan bahwa kompetensi perawat tentang perawatan spiritual dapat mempengaruhi bagaimana pemberian perawatan spiritual kepada pasien. Penelitian selanjutnya diharapkan dapat melakukan intervensi berupa pelatihan pemberian perawatan spiritual untuk perawat agar dapat diaplikasikan di rumah sakit.

Values and self-perception of behaviour among critical care nurses

2021 ◽  
pp. 096973302199973
Author(s):  
Kaoru Ashida ◽  
Aki Kawakami ◽  
Tetsuharu Kawashima ◽  
Makoto Tanaka
Keyword(s):  
Critical Care ◽  
Moral Distress ◽  
Cross Sectional Study ◽  
Critical Care Nurses ◽  
Working Environment ◽  
Self Perception ◽  
Cross Sectional ◽  
Team Members ◽  
The Difference ◽  
Tokyo Medical

Background: Moral distress has various adverse effects on nurses working in critical care. Differences in personal values, and between values and self-perception of behaviour are factors that may cause moral distress. Research aims: The aims of this study were (1) to identify ethical values and self-perception of behaviour of critical care nurses in Japan and (2) to determine the items with a large difference between value and behaviour and the items with a large difference in value from others. Research design: A nationwide, cross-sectional study was conducted. Participants and research context: We developed a self-administered questionnaire with 28 items, which was completed by 1014 critical care nurses in Japan. The difference between value and self-perception of behaviour was calculated from the score of each value item minus the score of each self-perception of behaviour item. The size of the difference in value from the others was judged by the standard deviation of each item. Ethical considerations: The study was approved by the Ethics Committee of the Tokyo Medical and Dental University (approval nos. M2018-214, M2019-045). Results: The items with a large difference between value and behaviour sources were related to the working environment and decision-making support. The items with a large difference in value from others were related to hospital management and disclosure of information to patients. Discussion: Improving the working environment for nurses is important for reducing moral distress. Nurses are faced with a variety of choices, including advocating for patients and protecting the fair distribution of medical resources, and each nurse’s priorities might diverge from those of other team members, which can lead to conflict within the team. Conclusion: This study revealed items with particularly high risks of moral distress for nurses. The results provide foundational information that can guide the development of strategies to mitigate moral distress.

Dyspnea

2007 ◽  
Vol 18 (1) ◽  
pp. 45-60 ◽  
Author(s):  
Nancy Spector ◽  
Maria A. Connolly ◽  
Karen K. Carlson
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Clinical Practice ◽  
Critical Illness ◽  
Length Of Stay ◽  
Critical Care Nurses ◽  
Evidence Based ◽  
Common Symptom ◽  
Chronic Critical Illness ◽  
Planning Intervention

Dyspnea is a common symptom in patients with acute and chronic critical illness as well as in patients receiving palliative care. While dyspnea can be found in a variety of clinical arenas and across many specialties, the mechanisms that cause dyspnea are similar. Although not often the cause for admission to critical care, it may complicate and extend length of stay. This article defines and describes dyspnea and its pathophysiology. Critical care nurses should strive to implement interventions supported by evidence whenever possible. An evidence-based plan of care for the assessment, planning, intervention, and evaluation of the patient with dyspnea is outlined, using levels of recommendation based on the strength of available evidence. Two case studies are presented to illustrate its application to clinical practice.

scholarly journals Interrater reliability of Nursing Activities Score among Intensive Care Unit health professionals

2015 ◽  
Vol 49 (spe) ◽  
pp. 117-122 ◽  
Author(s):  
Marit Stuedahl ◽  
Sidsel Vold ◽  
Pål Klepstad ◽  
Siv Karlsson Stafseth
Keyword(s):  
Critical Care ◽  
Interrater Reliability ◽  
Nurse Managers ◽  
Critical Care Nurses ◽  
Nursing Workload ◽  
Kappa Statistics ◽  
Care Nurse ◽  
Medical Interventions ◽  
Selection Of Patients ◽  
Selection Of

ABSTRACT Objective To analyze the interrater reliability of NAS among critical care nurses and managers in an ICU. Method This was a methodological study performed in an adult, general ICU in Norway. In a random selection of patients, the NAS was scored on 101 patients by three raters: a critical care nurse, an ICU physician and a nurse manager. Interrater reliability was analyzed by agreement between groups and kappa statistics. Results The mean NAS were 88.4 (SD=16.2) and 88.7 (SD=24.5) respectively for the critical care nurses and nurse managers. A lower mean of 83.7 (SD=21.1) was found for physicians. The 18 medical interventions showed higher agreement between critical care nurses and physicians (85.6%), than between critical care nurses and nurse managers (78.7). In the five nursing activities the Kappa-coefficients were low for all activities in all compared groups. Conclusion The study indicated a satisfactory agreement of nursing workload between critical care nurses and managers.

A Vision for Excellence by Design

2019 ◽  
Vol 28 (4) ◽  
pp. 247-254 ◽  
Author(s):  
Patricia A. Hickey
Keyword(s):  
Critical Care ◽  
Moral Distress ◽  
Health Care Systems ◽  
Well Being ◽  
Organizational Health ◽  
Critical Care Nurses ◽  
Team Members ◽  
Care Systems ◽  
Care Improvement ◽  
The Impact

Generating evidence for care improvement has characterized my program of research spanning 20 years. Six domains are highlighted to advance the science and practice of critical care nursing in today’s complex health care systems. Employee well-being and taking care of team members are key priorities for successful leaders. Understanding that patient and staff outcomes are inextricably linked strengthens the need for care environments to be healing and holistic for staff and patients. The American Association of Critical-Care Nurses’ Healthy Work Environment framework empowers staff and optimizes the experience for patients, their families, and care teams. Appropriate staffing, guided by contemporary acuity measurement, takes into account the cognitive workload and complexity of nursing. Committing to a culture of certification and ensuring staffing models with appropriately educated and experienced nursing staff will remain important. In the past decade, we have established the impact of these specific nursing characteristics on improved patient outcomes. Understanding the attributes of empathic and empowered teams is requisite for authentic leadership. Interventions to mitigate moral distress are necessary to foster moral resilience among critical care nurses. The challenge for the future will be to support organizational health through the coexistence of highly reliable processes and clinical innovation. Excellence is achieved when systems are designed to support professional practice and clinical teams and environments.

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