Sample records for critical care doctors

  1. Stress levels of critical care doctors in India: A national survey. (United States)

    Amte, Rahul; Munta, Kartik; Gopal, Palepu B


    Doctors working in critical care units are prone to higher stress due to various factors such as higher mortality and morbidity, demanding service conditions and need for higher knowledge and technical skill. The aim was to evaluate the stress level and the causative stressors in doctors working in critical care units in India. A two modality questionnaire-based cross-sectional survey was conducted. In manual mode, randomly selected delegates attending the annual congress of Indian Society of Critical Care Medicine filled the questionnaire. In the electronic mode, the questionnaires were E-mailed to critical care doctors. These questionnaires were based on General Health Questionnaire-12 (GHQ-12). Completely filled 242 responses were utilized for comparative and correlation analysis. Prevalence of moderate to severe stress level was 40% with a mean score of 2 on GHQ-12 scale. Too much responsibility at times and managing VIP patients ranked as the top two stressors studied, while the difficult relationship with colleagues and sexual harassment were the least. Intensivists were spending longest hours in the Intensive Care Unit (ICU) followed by pulmonologists and anesthetists. The mean number of ICU bed critical care doctors entrusted with was 13.2 ± 6.3. Substance abuse to relieve stress was reported as alcohol (21%), anxiolytic or antidepressants (18%) and smoking (14%). Despite the higher workload, stress levels measured in our survey in Indian critical care doctors were lower compared to International data. Substantiation of this data through a wider study and broad-based measures to improve the quality of critical care units and quality of the lives of these doctors is the need of the hour.

  2. Wanted--doctors who care. (United States)

    Lovdal, L T; Pearson, R


    A study was conducted to determine what consumers value in doctors' behavior. Results indicate that consumers in the sample population studied prefer doctors who are friendly and caring as well as those who are technically competent. However, these respondents reported less favorable opinions about doctors' friendliness (i.e., affective behavior) than they did about doctors' competence (i.e., instrumental behavior).

  3. Critical Care (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  4. Utilizing Team Debate to Increase Student Abilities for Mentoring and Critical Appraisal of Global Health Care in Doctor of Nursing Practice Programs. (United States)

    Elliott, Naomi; Farnum, Karen; Beauchesne, Michelle


    Although graduates of doctor of nursing practice (DNP) programs are expected to demonstrate competence in advanced clinical scholarship, mentoring, and leadership, little is published about how team debate on a global health care topic supports DNP student learning and skill development. This article reports on an illuminative evaluation of DNP student learning experiences of team debate in the context of a 2-week international school program in Ireland. A focused illuminative evaluation approach involving a cohort of seven DNP students, who had participated in an international school team debate, was used. Data were collected using a Web-based qualitative questionnaire designed to elicit in-depth reflective accounts of DNP students' learning experiences. Content analysis revealed that team debate on a global health care topic enhanced learning in relation to fostering critical thinking and critical appraisal skills; encouraging teamwork; providing opportunities for mentoring, relationship building, and socialization into profession; and, from the DNP student perspective, increasing knowledge and global understanding of health care. This evaluation provides insights for nurse educators into the benefits of introducing team debate as a group activity to enhancing scholarly inquiry and mentoring skills of DNP students. Further research to evaluate team debate in other nurse education programs is needed. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Critical and Creative Thinking Nexus: Learning Experiences of Doctoral Students (United States)

    Brodin, Eva M.


    Critical and creative thinking constitute important learning outcomes at doctoral level across the world. While the literature on doctoral education illuminates this matter through the lens of experienced senior researchers, the doctoral students' own perspective is missing. Based upon interviews with 14 doctoral students from four disciplines at…

  6. Home care, hospitalizations and doctor visits


    Gonçalves Judite; Weaver France


    This study estimates the effects of formal home care on hospitalizations and doctor visits. We compare the effects of medically- and non-medically-related home care and investigate heterogeneous effects by age group and informal care availability. Two-part models are estimated, using data from Switzerland. In this federal country, home care policy is decentralized into cantons (i.e. states). The endogeneity of home care is addressed by using instrumental variables, canton and time fixed effec...

  7. Critical Care Team (United States)

    ... often uphold the patient's wishes. The critical care nurse becomes an important part of decision-making with the patient, the family and the care team. A registered nurse (RN) who is certified in critical care is ...

  8. Teamwork in obstetric critical care. (United States)

    Guise, Jeanne-Marie; Segel, Sally


    Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well trained and competent medically, they have not traditionally been trained in how to work well as part of a team. Given the complexity and acuity of critical care medicine, which often relies on more than one medical team, teamwork skills are essential. This chapter discusses the history and importance of teamwork in high-reliability fields, reviews key concepts and skills in teamwork, and discusses approaches to training and working in teams.

  9. Surgical Critical Care Initiative (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  10. Understanding Critical Thinking to Create Better Doctors (United States)

    Zayapragassarazan, Zayabalaradjane; Menon, Vikas; Kar, Sitanshu Sekhar; Batmanabane, Gitanjali


    Medical students master an enormous body of knowledge, but lack systematic problem solving ability and effective clinical decision making. High profile reports have called for reforms in medical education to create a better generation of doctors who can cope with the system based problems they would encounter in an interdisciplinary and…

  11. Barefoot Doctors and the "Health Care Revolution" in Rural China: A Study Centered on Shandong Province. (United States)

    Xu, Sanchun; Hu, Danian


    Barefoot doctors were rural medical personnel trained en masse, whose emergence and development had a particular political, economic, social, and cultural background. Like the rural cooperative medical care system, the barefoot doctor was a well-known phenomenon in the Cultural Revolution. Complicated regional differences and a lack of reliable sources create much difficulty for the study of barefoot doctors and result in differing opinions of their status and importance. Some scholars greatly admire barefoot doctors, whereas others harshly criticize them. This paper explores the rise and development of barefoot doctors based on a case study of Shandong province. I argue that the promotion of barefoot doctors was a consequence of the medical education revolution and an implementation of the Cultural Revolution in rural public health care, which significantly influenced medical services and development in rural areas. First, barefoot doctors played a significant role in accomplishing the first rural health care revolution by providing primary health care to peasants and eliminating endemic and infectious illnesses. Second, barefoot doctors were the agents who integrated Western and Chinese medicines under the direction of the state. As an essential part of the rural cooperative medical system, barefoot doctor personnel grew in number with the system's implementation. After the Cultural Revolution ended, the cooperative medical system began to disintegrate-a process that accelerated in the 1980s until the system's collapse in the wake of the de-collectivization. As a result, the number of barefoot doctors also ran down steadily. In 1985, "barefoot doctor" as a job title was officially removed from Chinese medical profession, demonstrating that its practice was non-universal and unsustainable. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. The roles and training of primary care doctors: China, India, Brazil and South Africa. (United States)

    Mash, Robert; Almeida, Magda; Wong, William C W; Kumar, Raman; von Pressentin, Klaus B


    China, India, Brazil and South Africa contain 40% of the global population and are key emerging economies. All these countries have a policy commitment to universal health coverage with an emphasis on primary health care. The primary care doctor is a key part of the health workforce, and this article, which is based on two workshops at the 2014 Towards Unity For Health Conference in Fortaleza, Brazil, compares and reflects on the roles and training of primary care doctors in these four countries. Key themes to emerge were the need for the primary care doctor to function in support of a primary care team that provides community-orientated and first-contact care. This necessitates task-shifting and an openness to adapt one's role in line with the needs of the team and community. Beyond clinical competence, the primary care doctor may need to be a change agent, critical thinker, capability builder, collaborator and community advocate. Postgraduate training is important as well as up-skilling the existing workforce. There is a tension between training doctors to be community-orientated versus filling the procedural skills gaps at the facility level. In training, there is a need to plan postgraduate education at scale and reform the system to provide suitable incentives for doctors to choose this as a career path. Exposure should start at the undergraduate level. Learning outcomes should be socially accountable to the needs of the country and local communities, and graduates should be person-centred comprehensive generalists.

  13. Why doctors should care about animal cruelty. (United States)

    Sherley, Miranda


    Animal cruelty is a significant problem for society, and there are good reasons why doctors should be particularly concerned by it. Increasing evidence for links between animal cruelty and child or spousal abuse is an area of growing concern internationally and of real importance to health professionals. This article aims to raise awareness of the relevance of animal cruelty to medical practice. The links between animal cruelty and human health are discussed broadly and some wider ethical issues raised. Animal cruelty impacts on human health in disparate ways: intentional and unintentional acts of cruelty may reflect underlying mental health problems that need to be addressed. Cruelty within the family setting is an important sentinel for domestic violence and should prompt an assessment for possible child abuse. Furthermore, animal cruelty raises important questions about the nature of empathy, and the type of society that we wish to live in.

  14. Use of antibiotics by primary care doctors in Hong Kong

    Directory of Open Access Journals (Sweden)

    Lam Tai


    Full Text Available Abstract Objectives To determine the use of antibiotics by primary care doctors. Methods General practitioners in Hong Kong were invited to fill in a short questionnaire on every patient with infection that they had seen on the first full working day once every three months for four consecutive quarters starting from December 2005. Results Forty six primary care doctors took part and a total of 3096 completed questionnaires were returned. The top three diagnoses were upper respiratory tract infection (46.7%, gastrointestinal infection (8.2% and pharyngitis (7.1%. Thirty percent of patient encounters with infections were prescribed antibiotics but only 5.2% of patient encounters with upper respiratory tract infection (URTI were prescribed antibiotics. Amino-penicillins were the most commonly used antibiotics while beta-lactam/beta-lactamase inhibitor combinations (BLBLIs were the second most commonly used antibiotics and they accounted for 16.5% and 14.0% of all antibiotics used respectively. Of all patients or their carers, those who demanded or wished for antibiotics were far more likely to be prescribed antibiotics (Pearson chi-square test, p Conclusion The antibiotic prescribing patterns of primary care doctors in Hong Kong are broadly similar to primary care doctors in other developed countries but a relatively low rate of antibiotics is used for URTI.

  15. Counseling Psychology Doctoral Students' Training Experiences in Primary Care Psychology (United States)

    Cox, Jared


    This qualitative study focused on counseling psychology doctoral students' perspectives regarding their practicum training experience in primary care psychology. The four participants included three females and one male. Semi-structured individual and focus group interviews were used to explore participants' experiences. The participants described…

  16. Perceived Caring of Instructors among Online Doctoral Nursing Students (United States)

    Walters, Gwendolyn M.


    The concept of caring has been integral to the practice of nursing and nursing education since the early teachings of Florence Nightingale. Significant changes in both the practice and the need for educating increasing numbers of advanced-degree nurses have resulted in an increase in online doctoral-level nursing programs. This internet-based…

  17. The master degree: A critical transition in STEM doctoral education (United States)

    Lange, Sheila Edwards

    The need to broaden participation in the nation's science, technology, engineering, and mathematics (STEM) undergraduate and graduate programs is currently a matter of national urgency. The small number of women and underrepresented minorities (URM) earning doctoral degrees in STEM is particularly troubling given significant increases in the number of students earning master's degrees since 1990. In the decade between 1990 and 2000, the total number of master's recipients increased by 42%. During this same time period, the number of women earning master's degrees increased by 56%, African Americans increased by 132%, American Indians by 101%, Hispanics by 146%, and Asian Americans by 117% (Syverson, 2003). Growth in underrepresented group education at the master's level raises questions about the relationship between master's and doctoral education. Secondary data analysis of the Survey of Earned Doctorates (SED) was used to examine institutional pathways to the doctorate in STEM disciplines and transitions from master's to doctoral programs by race and gender. While the study revealed no significant gender differences in pathways, compared to White and Asian American students, URM students take significantly different pathways to the doctorate. URM students are significantly more likely to earn the bachelor's, master's, and doctoral degrees at three different institutions. Their path is significantly more likely to include earning a master's degree en route to the doctorate. Further, URM students are more likely to experience transition between the master's and doctoral degrees, and the transitions are not limited to those who earn master's degrees at master's-only institutions. These findings suggest that earning a master's degree is more often a stepping stone to the doctorate for URM students. Master's degree programs, therefore, have the potential to be a valuable resource for policymakers and graduate programs seeking to increase the diversity of URM students

  18. Critical Care Statistics (United States)

    ... Banerjee R, Naessens JM, Seferian EG, et al. Economic implications of nighttime attending intensivist coverage in a ... Care Unit Admission of Infants with Very Low Birth Weight—19 States, 2006 . ... Multi-organ failure has a mortality rate of up to 15-28% when more than ...

  19. Doctors' learning experiences in end-of-life care

    DEFF Research Database (Denmark)

    Fosse, Anette; Ruths, Sabine; Malterud, Kirsti


    death could even be welcomed. Through challenging dialogues dealing with family members’ hope and trust, they learnt how to adjust words and decisions according to family and patient’s life story. Interdisciplinary role models helped them balance uncertainty and competence in the intermediate position......Background: Doctors often find dialogues about death difficult. In Norway, 45% of deaths take place in nursing homes. Newly qualified medical doctors serve as house officers in nursing homes during internship. Little is known about how nursing homes can become useful sites for learning about end-of-life...... care. The aim of this study was to explore newly qualified doctors’ learning experiences with end-of-life care in nursing homes, especially focusing on dialogues about death. Methods: House officers in nursing homes (n = 16) participated in three focus group interviews. Interviews were audiotaped...

  20. Ethical theory, ethnography, and differences between doctors and nurses in approaches to patient care. (United States)

    Robertson, D W


    OBJECTIVES: To study empirically whether ethical theory (from the mainstream principles-based, virtue-based, and feminist schools) usefully describes the approaches doctors and nurses take in everyday patient care. DESIGN: Ethnographic methods: participant observation and interviews, the transcripts of which were analysed to identify themes in ethical approaches. SETTING: A British old-age psychiatry ward. PARTICIPANTS: The more than 20 doctors and nurses on the ward. RESULTS: Doctors and nurses on the ward differed in their conceptions of the principles of beneficence and respect for patient autonomy. Nurses shared with doctors a commitment to liberal and utilitarian conceptions of these principles, but also placed much greater weight on relationships and character virtues when expressing the same principles. Nurses also emphasised patient autonomy, while doctors were more likely to advocate beneficence, when the two principles conflicted. CONCLUSION: The study indicates that ethical theory can, contrary to the charges of certain critics, be relevant to everyday health care-if it (a) attends to social context and (b) is flexible enough to draw on various schools of theory. PMID:8910782

  1. [Communication within the health care team: doctors and nurses]. (United States)

    Kollár, János


    Proper communication within the health care team is especially important in terms of creating safe emotional and professional conditions for the team members and for quality healing. The aim of the study is to explore the factors that hinder appropriate communication between doctors and nurses and thus to make the effective elimination of the communication disturbances possible. Investigation in main medical databases and general search engines were used for analysing the phenomenon. It was revealed that communication between doctors and nurses is restrained by factors that can be observed on individual, professional and system levels as well. Role confusion, lack of trust, communication barriers arising from hierarchical inequalities, leadership problems, differences in qualifications, burnout and organizational problems can equally be found amongst them. The effectiveness of communication between nurses and doctors in Hungary is especially strongly influenced by the fear of losing jobs, the financial problems arising from different degree of gratuity and the phenomenon of burnout. Changes on individual, professional and system levels are equally important for significant improvement in the communication between doctors and nurses. Joint trainings based on strong organizational development skills and joint conferences could promote significantly better flow of information, mutual appreciation and harmonization.

  2. A Critical Race Feminist Analysis of Men of Color Matriculating into a Higher Education Doctoral Program (United States)

    Squire, Dian D.; Kelly, Bridget Turner; Jourian, T. J.; Byrd, Ajani M.; Manzano, Lester J.; Bumbry, Michael


    In Fall, 2012, the Loyola University Chicago Higher Education program faculty admitted a doctoral cohort of 5 men of color. This article is a reflexive and reflective autoethnography that explores the college choice processes of 5 doctoral men of color through a Critical Race Feminist perspective. The faculty program chair's narrative supplements…

  3. Critical Autobiography in the Professional Doctorate: Improving Students' Writing through the Device of Literature (United States)

    Eastman, Christine; Maguire, Kate


    This paper argues for a pedagogic practice to overcome the challenges that many professional practitioners face in undertaking a professional doctorate. Recent examination feedback on a professional doctoral programme of 300 candidates in the UK highlighted that a number of candidates often struggle to write persuasively, critically and…

  4. What Is a Pediatric Critical Care Specialist? (United States)

    ... Text Size Email Print Share What is a Pediatric Critical Care Specialist? Page Content Article Body If ... in the PICU. What Kind of Training Do Pediatric Critical Care Specialists Have? Pediatric critical care specialists ...

  5. Barriers to HIV Care and Treatment by Doctors: A review of the ...

    African Journals Online (AJOL)

    As a result many doctors were reluctant to provide care to HIV infected patients and homophobia amongst doctors, fear of contact with patients and unwillingness to care were frequently reported.2 However, there has been an exponential increase in the number of HIV and AIDS related cases and more doctors are ...

  6. Mobile computing in critical care. (United States)

    Lapinsky, Stephen E


    Handheld computing devices are increasingly used by health care workers, and offer a mobile platform for point-of-care information access. Improved technology, with larger memory capacity, higher screen resolution, faster processors, and wireless connectivity has broadened the potential roles for these devices in critical care. In addition to the personal information management functions, handheld computers have been used to access reference information, management guidelines and pharmacopoeias as well as to track the educational experience of trainees. They can act as an interface with a clinical information system, providing rapid access to patient information. Despite their popularity, these devices have limitations related to their small size, and acceptance by physicians has not been uniform. In the critical care environment, the risk of transmitting microorganisms by such a portable device should always be considered.

  7. Confidence in critical care nursing. (United States)

    Evans, Jeanne; Bell, Jennifer L; Sweeney, Annemarie E; Morgan, Jennifer I; Kelly, Helen M


    The purpose of the study was to gain an understanding of the nursing phenomenon, confidence, from the experience of nurses in the nursing subculture of critical care. Leininger's theory of cultural care diversity and universality guided this qualitative descriptive study. Questions derived from the sunrise model were used to elicit nurses' perspectives about cultural and social structures that exist within the critical care nursing subculture and the influence that these factors have on confidence. Twenty-eight critical care nurses from a large Canadian healthcare organization participated in semistructured interviews about confidence. Five themes arose from the descriptions provided by the participants. The three themes, tenuously navigating initiation rituals, deliberately developing holistic supportive relationships, and assimilating clinical decision-making rules were identified as social and cultural factors related to confidence. The remaining two themes, preserving a sense of security despite barriers and accommodating to diverse challenges, were identified as environmental factors related to confidence. Practice and research implications within the culture of critical care nursing are discussed in relation to each of the themes.

  8. Stability in shifting sands: contemporary leadership roles in critical care. (United States)

    Endacott, R; Boulanger, C; Chamberlain, W; Hendry, J; Ryan, H; Chaboyer, W


    Contemporary nursing leadership roles in critical care are a reflection of the changing environment in which critical care is provided. In the UK, critical care nursing faces challenges in the form of: reduced number and seniority of medical staff cover for acute wards; mandated responsibility for management of patients outside of critical care units, without corresponding responsibility for managing staff; increased public and political awareness of deficits in critical care; increased use of Assistant Practitioners; and emphasis on longer-term outcomes from intensive care. New leadership roles have met these challenges head on with two main foci: patient management across the acute/critical care interface and hospital wide policies and practice. The leadership roles examined in this paper highlight three underpinning goals: improved quality and safety of patient care; improved communication between professionals; and empowerment of junior nurses and doctors. There has been considerable investment in strategic leadership roles for critical care nursing; evidence is developing of the return on this investment for patient and service outcomes. Consideration must now be given to the preparation, mentorship and development of leadership roles for the next generation of nurse leaders.

  9. Delirium in Pediatric Critical Care. (United States)

    Patel, Anita K; Bell, Michael J; Traube, Chani


    Delirium occurs frequently in the critically ill child. It is a syndrome characterized by an acute onset and fluctuating course, with behaviors that reflect a disturbance in awareness and cognition. Delirium represents global cerebral dysfunction due to the direct physiologic effects of an underlying medical illness or its treatment. Pediatric delirium is strongly associated with poor outcomes, including increased mortality, prolonged intensive care unit length of stay, longer time on mechanical ventilation, and increased cost of care. With heightened awareness, the pediatric intensivist can detect, treat, and prevent delirium in at-risk children. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. A critical exploration of science doctoral programs: Counterstories from underrepresented women of color (United States)

    Bancroft, Senetta F.

    Most studies exploring the experiences of underrepresented doctoral students of color in science fields focus on their socialization into predominantly white institutions. While the socialization process is fundamental to doctoral success and consequently deserves attention, it is critical to inquire into how the widespread and lasting perception of people of color as socioculturally deficient shapes underrepresented students` socialization into science doctoral programs. Further, the existing research literature and educational policies addressing the persistent underrepresentation of students of color in science doctorates remain fixated on increasing racial diversity for U.S. economic security rather than racial equity. In view of the limitation of existing research literature, in this study, drawing from critical race theories, fictive-kinship, and forms of capital, I use counterstorytelling to recast racial inequities in the education of science doctorates as a problem of social justice, not as an issue of the students' sociocultural deficits or as a matter of economic security. Through interviews I examined the experiences, from elementary school to current careers, of three women of color who were science doctoral students. Participants' counterstories revealed institutionalized racism embedded in doctoral programs exploited their identities and dismissed their lived experiences, thereby, relegating them to outsiders-within academe. This marginalization precluded the inclusive socialization of participants into their doctoral programs and ultimately set up barriers to their pursuit of scientific careers. This study divulges the academic and career consequences of the sustained privilege disparities between underrepresented students of color's experience and the experiences of their white and Asian counterparts. In light of the participants' experiences, I recommend that, in order to change the existing policy of socially integrating students into oppressive

  11. Attitudes of Doctors and Nurses toward the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Rolando Bonal Ruiz


    Full Text Available Background: the fact that chronic diseases replace traditional causes of morbidity and mortality in a country, or are on a par with major common health problems, demands the development of new strategies to address them. Objective: to explore attitudes of doctors and nurses from the Rolando López Peña Polyclinic toward the Chronic Care Model. Methods: a quantitative and qualitative cross-sectional study was conducted including the 22 family physicians and 26 nurses who provide care to patients with chronic diseases and were at the polyclinic at the time of the study. All were administered a 5 point Likert scale and a focus group interview, which was taped, transcribed and analyzed. Results: the attitudinal results correspond with the actions assessed in each component of the model, being the most common barriers: the lack of awareness and training on the new approaches to care of these patients, work overload created by other programs such as the maternal-child and vector control programs, uncertainties on the effectiveness of patient education and ignorance of the practice guidelines. Conclusions: favorable attitudes toward the introduction of the model to the practice of the family physician and nurse predominated as long as organizational changes are made and the suggestions of these service providers are put into practice with the support of the decision makers of the health sector.

  12. Transforming doctor-patient relationships to promote patient-centered care: lessons from palliative care. (United States)

    Yedidia, Michael J


    Palliative care was studied for its potential to yield lessons for transforming doctor-patient relationships to promote patient-centered care. Examination of patient and provider experiences of the transition from curative to palliative care promises valuable insights about establishing and maintaining trust as the goals of care shift and about addressing a broad spectrum of patient needs. The study was guided by a conceptual framework grounded in existing models to address five dimensions of doctor-patient relationships: range of needs addressed, source of authority, maintenance of trust, emotional involvement, and expression of authenticity. Data collection included observation of the care of 40 patients in the inpatient hospice unit and at home, interviews with patients and family members, and in-depth interviews with 22 physicians and two nurses providing end-of-life care. Standard qualitative procedures were used to analyze the data, incorporating techniques for maximizing the validity of the results and broadening their relevance to other contexts. Findings provide evidence for challenging prominent assumptions about possibilities for doctor-patient relationships: questioning the merits of the prohibition on emotional involvement, dependence on protocols for handling difficult communication issues, unqualified reliance on consumer empowerment to assure that care is responsive to patients' needs, and adoption of narrowly defined boundaries between medical and social service systems in caring for patients. Medical education can play a role in preparing doctors to assume new roles by openly addressing management of emotions in routine clinical work, incorporating personal awareness training, facilitating reflection on interactions with patients through use of standardized patients and videotapes, and expanding capacity to effectively address a broad range of needs through teamwork training.

  13. Palliative care for older people – exploring the views of doctors and nurses from different fields in Germany

    Directory of Open Access Journals (Sweden)

    Schneider Nils


    Full Text Available Abstract Background Providing appropriate palliative care for older people is a major task for health care systems worldwide, and up to now it has also been one of the most neglected. Focusing on the German health care system, we sought to explore the attitudes of health professionals regarding their understanding of palliative care for older patients and its implementation. Methods In a qualitative study design, focus groups were established consisting of general practitioners, geriatricians, palliative care physicians, palliative care nurses and general nurses (a total of 29 participants. The group discussions were recorded, transcribed, coded and analysed using the methodological approach of Qualitative Description. Results Deficiencies in teamwork and conflicting role definitions between doctors and nurses and between family practitioners and medical specialists were found to be central problems affecting the provision of appropriate palliative care for older people. It was emphasized that there are great advantages to family doctors playing a leading role, as they usually have the longest contacts to the patients. However, the professional qualifications of family doctors were to some extent criticized. The general practitioners for their part criticized the increasing specialization on the field of palliative care. All groups complained that the German compensation system gives insufficient consideration to the time-consuming care of older patients, and about excessive bureaucracy. Conclusion General practitioners are the central health professionals in the delivery of palliative care for older people. They should however be encouraged to involve specialized services such as palliative care teams where necessary. With the German health care reform of 2007, a legal framework has been created that allows for this. As far as its realization is concerned, it must be ensured that the spotlight remains on the needs of the patients and not on

  14. Providing support to doctors working in intensive care

    LENUS (Irish Health Repository)

    Murphy, JFA


    ‘Jading’ is a process of exhaustion in which apathy and cynicism replace the drive to be responsive and caring. ‘Burnout’ a term first coined in the psychology literature in 1974 was based on Graham Greene’s novel ‘A Burnt-Out Case1. It is the umbrella description for disengagement in the workplace setting characterised by withdrawal, denial and inefficiency. There is an alienation from the pressures of work. Marshall and Kasman2 defined it as ‘the loss of motivation for creative thought’. It is the opposite of engagement which is associated with energy and optimism. People who experience all 3 symptoms- emotional exhaustion, negative attitude towards patients, reduced sense of personal accomplishment- have the greatest degree of burnout. It doesn’t get better by being ignored. These processes have serious consequences for the individual involved and the hospital that they work in. The doctor underperforms and the Unit becomes dysfunctional There is decreased quality of care, increased absenteeism, and high staff turnover. There is an inability to make decisions and a failure to set priorities.

  15. Factors influencing turnover intention among primary care doctors: a cross-sectional study in Chongqing, China. (United States)

    Wen, Tong; Zhang, Yan; Wang, Xue; Tang, Guo


    The intention to leave a job, known as turnover intention, among primary care doctors has a significant impact on primary health care service delivery. We investigated primary care doctors' turnover intention and analysed associated factors involved in primary health facilities in Chongqing, China. A total of 440 doctors were interviewed, they were selected using a multi-stage stratified random sampling method. The survey instrument was a self-administered questionnaire which assessed socio-demographic and work-related characteristics, job satisfaction and turnover intention. The data were analysed using χ 2 test, one-way analysis of variance, exploratory factor analysis and linear regression analysis. Our study found that 42.3% of the primary care doctors we sampled in Chongqing, China, intended to resign. Location, age, job title, doctor's position level, work pressure and job satisfaction were associated with turnover intention. Job satisfaction included both employment-related job satisfaction (including "your chance of promotion", "your rate of pay" and two other items) and satisfaction with the job itself (including "the freedom to choose your own method of working", "your job safety" and two other items). Improving job satisfaction, in terms of salary, promotion and job safety, is crucial for reducing turnover intention among primary care doctors. Therefore, we suggest that the government increase its financial investment in primary care facilities, especially in less-developed areas, and reform incentive mechanisms to improve the job satisfaction of primary care doctors. The government should consider policies such as establishing a social pension programme for village-level doctors and providing more opportunities for job promotion among primary care doctors, especially township-level doctors. Attention should also be paid to the impact of rapid urbanization, which could lead to increased workload or increased opportunities for career development, thus

  16. practice gap in critical care nursing students

    African Journals Online (AJOL)

    Guided reflection as a tool to deal with the theory– practice gap in critical care ... was used during semi-structured interviews during the data collection process. ... a description of incidents experienced, critical analysis of knowledge, critical ...

  17. A critical ethnography of doctor-patient interaction in southern Iran. (United States)

    Sadati, Ahmad Kalateh; Iman, Mohammad Taghi; Lankarani, Kamran Bagheri; Derakhshan, Soghra


    Doctor-patient interaction is a subject with ethical ramifications, besides being an important issue in medical sociology. The main goal of this critical study is to explore the interactional experience of hospital admitted patients. For this reason, the study, carried out in an educational hospital in southern Iran, entailed 156 recorded clinical consultations, 920 hours of participant observation, and six focus groups consisting of patients and their families. The research method used is Critical Ethnography, which was introduced by PF Carspecken. The results showed that negative interactional experience was common among the participants. Six related themes were: doctors' inattentiveness; weak interaction; violation of patients' privacy; unjustified pain; long waiting period and ambiguity; and faceless physicians. According to the participants' observations, poor interaction with doctors has led to these negative experiences. The findings showed that doctors were inconsiderate about patients' concerns and due to this, patients were dissatisfied. Theoretically, this form of fragmented collaboration has deep roots in the framework of modern medicine, but in the context of this study, the intensity of the fragmentation between doctors and patients was observed to be intolerable. To solve this problem, models of patient-centredness and narrative medicine are recommended. In addition, the health system should monitor and evaluate the observance of ethics by physicians.

  18. Encouraging primary care research: evaluation of a one-year, doctoral clinical epidemiology research course. (United States)

    Liira, Helena; Koskela, Tuomas; Thulesius, Hans; Pitkälä, Kaisu


    Research and PhDs are relatively rare in family medicine and primary care. To promote research, regular one-year research courses for primary care professionals with a focus on clinical epidemiology were started. This study explores the academic outcomes of the first four cohorts of research courses and surveys the participants' perspectives on the research course. An electronic survey was sent to the research course participants. All peer-reviewed scientific papers published by these students were retrieved by literature searches in PubMed. Primary care in Finland. A total of 46 research course participants who had finished the research courses between 2007 and 2012. Of the 46 participants 29 were physicians, eight nurses, three dentists, four physiotherapists, and two nutritionists. By the end of 2014, 28 of the 46 participants (61%) had published 79 papers indexed in PubMed and seven students (15%) had completed a PhD. The participants stated that the course taught them critical thinking, and provided basic research knowledge, inspiration, and fruitful networks for research. A one-year, multi-professional, clinical epidemiology based research course appeared to be successful in encouraging primary care research as measured by research publications and networking. Activating teaching methods, encouraging focus on own research planning, and support from peers and tutors helped the participants to embark on research projects that resulted in PhDs for 15% of the participants. Clinical research and PhDs are rare in primary care in Finland, which has consequences for the development of the discipline and for the availability of clinical lecturers at the universities. A clinical epidemiology oriented, one-year research course increased the activity in primary care research. Focus on own research planning and learning the challenges of research with peers appeared to enhance the success of a doctoral research course. A doctoral research course encouraged networking, and

  19. The SASPREN primary care survey - who consults the family doctor?

    African Journals Online (AJOL)

    Sentinel Practitioner Research Networ1< (SASPREN). Participants. All patients who ... research-minded family doctors, distributed across the country, who voluntarily ..... Organization, Objectives, Policies and Methods. S AIr Fain PT

  20. The role of the visiting doctor in primary care clinics

    African Journals Online (AJOL)

    Teams to produce job descriptions for such doctors, groups of clinic nurses in 2 districts in North West Province ... respect as a basis for teamwork, and ensuring networking and co-ordination. ..... expectations on them, with an emphasis.

  1. Obstetric critical care services in South Africa

    Directory of Open Access Journals (Sweden)

    Gladness Nethathe


    Full Text Available More than half of all global maternal deaths occur in Africa. A large percentage of these deaths are preventable, and lack of access to adequate critical care facilities is a contributing factor. There are limited published data on the clinical and management challenges presented by the critically ill obstetric patient admitted to the intensive care unit in our setting, and more data are required in order to better define the critical care needs of this group of patients.

  2. Physicians' professionalism at primary care facilities from patients' perspective: The importance of doctors' communication skills. (United States)

    Sari, Merry Indah; Prabandari, Yayi Suryo; Claramita, Mora


    Professionalism is the core duty of a doctor to be responsible to the society. Doctors' professionalism depicts an internalization of values and mastery of professionals' standards as an important part in shaping the trust between doctors and patients. Professionalism consists of various attributes in which current literature focused more on the perspective of the health professionals. Doctors' professionalism may influence patients' satisfaction, and therefore, it is important to know from the patients' perspectives what was expected of medical doctors' professionalism. This study was conducted to determine the attributes of physician professionalism from the patient's perspective. This was a qualitative research using a phenomenology study design. In-depth interviews were conducted with 18 patients with hypertension and diabetes who had been treated for at least 1 year in primary care facilities in the city of Yogyakarta, Indonesia. The results of the interview were transcribed, encoded, and then classified into categories. Communication skills were considered as the top priority of medical doctors' attributes of professionalism in the perspectives of the patients. This study revealed that communication skill is the most important aspects of professionalism which greatly affected in the process of health care provided by the primary care doctors. Doctor-patient communication skills should be intensively trained during both basic and postgraduate medical education.

  3. The critical care air transport program. (United States)

    Beninati, William; Meyer, Michael T; Carter, Todd E


    The critical care air transport team program is a component of the U.S. Air Force Aeromedical Evacuation system. A critical care air transport team consists of a critical care physician, critical care nurse, and respiratory therapist along with the supplies and equipment to operate a portable intensive care unit within a cargo aircraft. This capability was developed to support rapidly mobile surgical teams with high capability for damage control resuscitation and limited capacity for postresuscitation care. The critical care air transport team permits rapid evacuation of stabilizing casualties to a higher level of care. The aeromedical environment presents important challenges for the delivery of critical care. All equipment must be tested for safety and effectiveness in this environment before use in flight. The team members must integrate the current standards of care with the limitation imposed by stresses of flight on their patient. The critical care air transport team capability has been used successfully in a range of settings from transport within the United States, to disaster response, to support of casualties in combat.

  4. Gender Parity in Critical Care Medicine. (United States)

    Mehta, Sangeeta; Burns, Karen E A; Machado, Flavia R; Fox-Robichaud, Alison E; Cook, Deborah J; Calfee, Carolyn S; Ware, Lorraine B; Burnham, Ellen L; Kissoon, Niranjan; Marshall, John C; Mancebo, Jordi; Finfer, Simon; Hartog, Christiane; Reinhart, Konrad; Maitland, Kathryn; Stapleton, Renee D; Kwizera, Arthur; Amin, Pravin; Abroug, Fekri; Smith, Orla; Laake, Jon H; Shrestha, Gentle S; Herridge, Margaret S


    Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. These documents inform and shape patient care around the world. In this Perspective we discuss the importance of diversity on guideline panels, the disproportionately low representation of women on critical care guideline panels, and existing initiatives to increase the representation of women in corporations, universities, and government. We propose five strategies to ensure gender parity within critical care medicine.

  5. Open access in the critical care environment. (United States)

    South, Tabitha; Adair, Brigette


    Open access has become an important topic in critical care over the last 3 years. In the past, critical care had restricted access and set visitation guidelines to protect patients. This article provides a review of the literature related to open access in the critical care environment, including the impact on patients, families, and health care providers. The ultimate goal is to provide care centered on patients and families and to create a healing environment to ensure safe passage of patients through their hospital stays. This outcome could lead to increased patient/family satisfaction. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Summative assessment in a doctor of pharmacy program: a critical insight

    Directory of Open Access Journals (Sweden)

    Wilbur K


    Full Text Available Kerry Wilbur College of Pharmacy, Qatar University, Doha, Qatar Background: The Canadian-accredited post-baccalaureate Doctor of Pharmacy program at Qatar University trains pharmacists to deliver advanced patient care. Emphasis on acquisition and development of the necessary knowledge, skills, and attitudes lies in the curriculum’s extensive experiential component. A campus-based oral comprehensive examination (OCE was devised to emulate a clinical viva voce and complement the extensive formative assessments conducted at experiential practice sites throughout the curriculum. We describe an evaluation of the final exit summative assessment for this graduate program. Methods: OCE results since the inception of the graduate program (3 years ago were retrieved and recorded into a blinded database. Examination scores among each paired faculty examiner team were analyzed for inter-rater reliability and linearity of agreement using intraclass correlation and Spearman’s correlation coefficient measurements, respectively. Graduate student ranking from individual examiner OCE scores was compared with that of other relative ranked student performance. Results: Sixty-one OCEs were administered to 30 graduate students over 3 years by a composite of eleven different pairs of faculty examiners. Intraclass correlation measures demonstrated that examiner team reliability was low and linearity of agreements was inconsistent. Only one examiner team in each respective academic year was found to have statistically significant inter-rater reliability, and linearity of agreements was inconsistent in all years. No association was found between examination performance rankings and other academic parameters. Conclusion: Critical review of our final summative assessment implies it is lacking robustness and defensibility. Measures are in place to continue the quality improvement process and develop and implement an alternative means of evaluation within a more

  7. Training doctors for primary care in China: Transformation of general practice education. (United States)

    Li, Donald


    China is known for developing a cadre of "Barefoot Doctors" to address her rural healthcare needs in past. The tradition of barefoot doctors has inspired similar developments in several other countries across world. Recently China has embarked upon an ambitious new mission to create a primary care workforce consisting of trained general practitioners having international standard skillsets. This editorial provides an insight into the current status of policy deliberations with regards to training of primary care doctors and a new surge in general practice education in China.

  8. Ethical persuasion: the rhetoric of communication in critical care. (United States)

    Dubov, Alex


    This article reviews the ethics of rhetoric in critical care. Rational appeals in critical care fail to move patients or surrogates to a better course of action. Appeals to their emotions are considered illegitimate because they may preclude autonomous choice. This article discusses whether it is always unethical to change someone's beliefs, whether persuasive communication is inherently harmful and whether it leaves no space for voluntariness. To answer these questions, the article engages with Aristotle's work, Rhetoric. In considering whether there is a place for emotionally charged messages in a patient-provider relationship, the article intends to delineate the nature of this relationship and describe the duties this relationship implies. The article presents examples of persuasive communication used in critical care and discusses whether providers may have a duty to persuade patients. This duty is supported by the fact that doctors often influence patients' and families' choices by framing presented options. Doctors should assume responsibility in recognizing these personal and contextual influences that may influence the medical choices of their patients. They should attempt to modify these contextual factors and biases in a way that would assist patients and families in reaching the desired outcomes. The opening sections surveyed a number of definitions found in relevant literature and outlined some of the concepts included in the proposed definition. This definition helps to distinguish instances of persuasion from cases of manipulation, coercion and deception. Considering the fact that patients and families often make irrational decisions and the fact that doctors inadvertently influence their choices, the article suggested that persuasion can be a positive tool in medical communication. When patients or families clearly do not understand the risks or make decisions that contradict their long-term goals, persuasion can be used as a positive influence.

  9. Critical Care Organizations: Business of Critical Care and Value/Performance Building. (United States)

    Leung, Sharon; Gregg, Sara R; Coopersmith, Craig M; Layon, A Joseph; Oropello, John; Brown, Daniel R; Pastores, Stephen M; Kvetan, Vladimir


    New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1). The goal of this article was to provide a roadmap and call attention to key factors that adult critical care medicine leadership in both academic and nonacademic setting should consider when planning for value-based care. Relevant medical literature was accessed through a literature search. Material published by federal health agencies and other specialty organizations was also reviewed. Collaboratively and iteratively, taskforce members corresponded by electronic mail and held monthly conference calls to finalize this report. The business and value/performance critical care organization building section comprised of leaders of critical care organizations with expertise in critical care administration, healthcare management, and clinical practice. Two phases of critical care organizations care integration are described: "horizontal," within the system and regionalization of care as an initial phase, and "vertical," with a post-ICU and postacute care continuum as a succeeding phase. The tools required for the clinical and financial transformation are provided, including the essential prerequisites of forming a critical care organization; the manner in which a critical care organization can help manage transformational domains is considered. Lastly, how to achieve organizational health system support for critical care organization implementation is discussed. A critical care organization that incorporates functional clinical horizontal and

  10. Southern African Journal of Critical Care

    African Journals Online (AJOL)

    This Journal publishes scientific articles related to multidisciplinary critical and intensive medical care and the emergency care of critically ill humans. Other websites related to this journal: Vol 33, No 2 (2017). DOWNLOAD FULL TEXT Open Access DOWNLOAD FULL TEXT ...

  11. Year in review 2010: Critical Care - infection

    DEFF Research Database (Denmark)

    Pagani, Leonardo; Afshari, Arash; Harbarth, Stephan


    established approaches to the optimal management of infections in the intensive care unit. Rapid infection diagnosis, antibiotic dosing and optimization through pharmacologic indices, progress in the implementation of effective antimicrobial stewardship and infection control programs, and management of fungal...... infections are some of the most relevant issues in this special patient population. During the last 18 months, Critical Care and other journals have provided a wide array of descriptive and interventional clinical studies and scientific reports helping clinical investigators and critical care physicians...

  12. Leader of the Maternity care: Doctors or midwives

    DEFF Research Database (Denmark)

    Wagle, Rajendra R.


    Technology of delivery of health care for developing countries is not a resolved issue. Moreover, maternity care differs from other areas of health care in many ways. Developing countries have to carefully adapt to what has been done in developed countries. Recent debate and data on maternity...... health care organisation have been in favour of midwifery-led maternity care. Midwifery-led maternity care is described as the best and necessary part of the sufficiently and thus inevitably health producing maternity health care organisation....

  13. Doctoral Dissertation Topics in Education: Do They Align with Critical Issues?

    Directory of Open Access Journals (Sweden)

    Ethan J Allen


    Full Text Available American society faces complex educational issues which impact many facets of its national interests. Institutions of higher education are granting doctoral degrees to educational leaders, but it is not known to what extent their dissertation topics are aligned with both longstanding and critical issues in education. Using a theoretical framework synthesizing Paul and Elder’s critical thinking model and Kuhlthau’s information seeking process, this study examines a set of education doctoral dissertation topical selections and categorizes them by general themes in relationship to many of the recognized educational issues in the United States. Investigators categorized dissertations from four departments within the College of Education of their home institution. The dataset, retrieved from ProQuest Dissertations and Theses Global, consisted of 231 documents published between 2005 and 2014. Through an inter-rater process examining dissertation titles, abstracts, and keywords, the dissertations were assigned critical issue themes culled from nine editions of a college text, and then categorized under a broader topical scheme situated within a well-used educational research website. Findings indicated that most dissertations concentrated in studies that researched problems and issues within schools. Further, some of the issues considered longstanding were not studied by dissertation authors within the sample. For example, privatization of schools and classroom discipline and justice were not selected for study. Findings also suggest new directions for those responsible for dissertation supervision and topic selection. The study adds to the literature on dissertation topic selection that addresses existing educational issues.

  14. Critical care nursing: Embedded complex systems. (United States)

    Trinier, Ruth; Liske, Lori; Nenadovic, Vera


    Variability in parameters such as heart rate, respiratory rate and blood pressure defines healthy physiology and the ability of the person to adequately respond to stressors. Critically ill patients have lost this variability and require highly specialized nursing care to support life and monitor changes in condition. The critical care environment is a dynamic system through which information flows. The critical care unit is typically designed as a tree structure with generally one attending physician and multiple nurses and allied health care professionals. Information flow through the system allows for identification of deteriorating patient status and timely interventionfor rescue from further deleterious effects. Nurses provide the majority of direct patient care in the critical care setting in 2:1, 1:1 or 1:2 nurse-to-patient ratios. The bedside nurse-critically ill patient relationship represents the primary, real-time feedback loop of information exchange, monitoring and treatment. Variables that enhance information flow through this loop and support timely nursing intervention can improve patient outcomes, while barriers can lead to errors and adverse events. Examining patient information flow in the critical care environment from a dynamic systems perspective provides insights into how nurses deliver effective patient care and prevent adverse events.

  15. Recent advances in multidisciplinary critical care. (United States)

    Blot, Stijn; Afonso, Elsa; Labeau, Sonia


    The intensive care unit is a work environment where superior dedication is crucial for optimizing patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the numerous research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovation in the field. This article broadly summarizes new developments in multidisciplinary intensive care. It provides elementary information about advanced insights in the field via brief descriptions of selected articles grouped by specific topics. Issues considered include care for heart patients, mechanical ventilation, delirium, nutrition, pressure ulcers, early mobility, infection prevention, transplantation and organ donation, care for caregivers, and family matters. ©2015 American Association of Critical-Care Nurses.


    Directory of Open Access Journals (Sweden)

    Rahul Sanjeev Chaudhary


    Full Text Available BACKGROUND Hand hygiene practices of health care workers has been shown to be an effective measure in preventing hospital acquired infections. This concept has been aptly used to improve understanding, training, monitoring, and reporting hand hygiene among healthcare workers. We conducted this study to assess the knowledge of doctors and health care workers regarding hand scrub. METHODS A study was conducted among doctors and health care workers in a tertiary care hospital. Knowledge was evaluated by using self-structured questionnaire based on the guidelines of hand hygiene prescribed by WHO. RESULTS The awareness and knowledge of preoperative surgical hand scrubbing was moderate in doctors, but unfortunately poor in HCWs. CONCLUSION Our study highlights the need for introducing measures in order to increase the knowledge of preoperative hand scrub in teaching hospital which may translate into good practices.

  17. The critical care cascade: a systems approach. (United States)

    Ghosh, Rishi; Pepe, Paul


    To emphasize the evolving body of evidence that supports the need for a more seamless and interconnected continuum of patient care for a growing compendium of critical care conditions, starting in the prehospital and emergency department (ED) phases of management and continuing through ICU and rehabilitation services. The care of critically ill and injured patients has become increasingly complex. It now has been demonstrated that, for a number of such critical care conditions, optimal management not only relies heavily on the talents of highly coordinated, multidisciplinary teams, but it also may require shared responsibilities across a continuum of longitudinal care involving numerous specialties and departments. This continuum usually needs to begin in the prehospital and ED settings with management extending through specialized in-hospital diagnostic and interventional suites to traditional ICU and rehabilitation programs. In recent years, examples of these conditions have included the development of systems of care for trauma, cardiac arrest, myocardial infarction, stroke, sepsis syndromes, toxicology and other critical illnesses. Although the widespread implementation of such multidisciplinary, multispecialty critical care cascades of care has been achieved most commonly in trauma care, current healthcare delivery systems generally tend to employ compartmentalized organization for the majority of other critical care patients. Accordingly, optimal systematic care often breaks down in the management of these complex patients due to barriers such as lack of interoperable communication between teams, disjointed transfers between services, unnecessary time-consuming, re-evaluations and transitional pauses in time-dependent circumstances, deficiencies in cross-disciplinary education and quality assurance loops, and significant variability in patient care practices. Such barriers can lead to adverse outcomes in this fragile patient population. This article discusses

  18. The European Donor Hospital Education Programme (EDHEP): addressing the training needs of doctors and nurses who break bad news, care for the bereaved, and request donation

    NARCIS (Netherlands)

    Blok, G. A.; van Dalen, J.; Jager, K. J.; Ryan, M.; Wijnen, R. M.; Wight, C.; Morton, J. M.; Morley, M.; Cohen, B.


    The competence of critical care staff when it comes to death and organ donation can make the difference between a family's agreeing to or refusing the latter. Doctors and nurses often feel uncomfortable approaching relatives about donation and attribute this to a lack of training. Bereaved relatives

  19. Empowerment in critical care - a concept analysis. (United States)

    Wåhlin, Ingrid


    The purpose of this paper was to analyse how the concept of empowerment is defined in the scientific literature in relation to critical care. As empowerment is a mutual process affecting all individuals involved, the perspectives of not only patients and next of kin but also staff were sought. A literature review and a concept analysis based on Walker and Avant's analysis procedure were used to identify the basic elements of empowerment in critical care. Twenty-two articles with a focus on critical care were discovered and included in the investigation. A mutual and supportive relationship, knowledge, skills, power within oneself and self-determination were found to be the common attributes of empowerment in critical care. The results could be adapted and used for all parties involved in critical care - whether patients, next of kin or staff - as these defining attributes are assumed to be universal to all three groups, even if the more specific content of each attribute varies between groups and individuals. Even if empowerment is only sparsely used in relation to critical care, it appears to be a very useful concept in this context. The benefits of improving empowerment are extensive: decreased levels of distress and strain, increased sense of coherence and control over situation, and personal and/or professional development and growth, together with increased comfort and inner satisfaction. © 2016 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College.

  20. The Norwegian National Summary Care Record: a qualitative analysis of doctors' use of and trust in shared patient information. (United States)

    Dyb, Kari; Warth, Line Lundvoll


    This paper explores Norwegian doctors' use of and experiences with a national tool for sharing core patient health information. The summary care record (SCR; the Kjernejournal in Norwegian) is the first national system for sharing patient information among the various levels and institutions of health care throughout the country. The health authorities have invested heavily in the development, implementation and deployment of this tool, and as of 2017 all Norwegian citizens have a personalised SCR. However, as there remains limited knowledge about health professionals' use of, experiences with and opinions regarding this new tool, the purpose of this study was to explore doctors' direct SCR experiences. We conducted 25 in-depth interviews with 10 doctors from an emergency ward, 5 doctors from an emergency clinic and 10 doctors from 5 general practitioner offices. We then transcribed, thematically coded and analysed the interviews utilising a grounded theory approach. The SCRs contain several features for providing core patient information that is particularly relevant in acute or emergency situations; nonetheless, we found that the doctors generally used only one of the tool's six functions, namely, the pharmaceutical summary. In addition, they primarily used this summary for a few subgroups of patients, including in the emergency ward for unconscious patients, for elderly patients with multiple prescriptions and for patients with substance abuse conditions. The primary difference of the pharmaceutical summary compared with the other functions of the tool is that patient information is automatically updated from a national pharmaceutical server, while other clinically relevant functions, like the critical information category, require manual updates by the health professionals themselves, thereby potentially causing variations in the accuracy, completeness and trustworthiness of the data. Therefore, we can assume that the popularity of the pharmaceutical summary

  1. Workplace violence against resident doctors in a tertiary care hospital in Delhi. (United States)

    Anand, Tanu; Grover, Shekhar; Kumar, Rajesh; Kumar, Madhan; Ingle, Gopal Krishna


    Healthcare workers particularly doctors are at high risk of being victims of verbal and physical violence perpetrated by patients or their relatives. There is a paucity of studies on work-related violence against doctors in India. We aimed to assess the exposure of workplace violence among doctors, its consequences among those who experienced it and its perceived risk factors. This study was done among doctors working in a tertiary care hospital in Delhi. Data were collected by using a self-administered questionnaire containing items for assessment of workplace violence against doctors, its consequences among those who were assaulted, reporting mechanisms and perceived risk factors. Of the 169 respondents, 104 (61.4%) were men. The mean (SD) age of the study group was 28.6 (4.2) years. Sixty-nine doctors (40.8%) reported being exposed to violence at their workplace in the past 12 months. However, there was no gender-wise difference in the exposure to violence (p=0.86). The point of delivery of emergency services was reported as the most common place for experiencing violence. Verbal abuse was the most common form of violence reported (n=52; 75.4%). Anger, frustration and irritability were the most common symptoms experienced by the doctors who were subjected to violence at the workplace. Only 44.2% of doctors reported the event to the authorities. 'Poor communication skills' was considered to be the most common physician factor responsible for workplace violence against doctors. A large proportion of doctors are victims of violence by their patients or relatives. Violence is being under-reported. There is a need to encourage reporting of violence and prepare healthcare facilities to tackle this emerging issue for the safety of physicians.

  2. Online doctor reviews: do they track surgeon volume, a proxy for quality of care? (United States)

    Segal, Jeffrey; Sacopulos, Michael; Sheets, Virgil; Thurston, Irish; Brooks, Kendra; Puccia, Ryan


    Increasingly, consumers are accessing the Internet seeking health information. Consumers are also using online doctor review websites to help select their physician. Such websites tally numerical ratings and comments from past patients. To our knowledge, no study has previously analyzed whether doctors with positive online reputations on doctor review websites actually deliver higher quality of care typically associated with better clinical outcomes and better safety records. For a number of procedures, surgeons who perform more procedures have better clinical outcomes and safety records than those who perform fewer procedures. Our objective was to determine if surgeon volume, as a proxy for clinical outcomes and patient safety, correlates with online reputation. We investigated the numerical ratings and comments on 9 online review websites for high- and low-volume surgeons for three procedures: lumbar surgery, total knee replacement, and bariatric surgery. High-volume surgeons were randomly selected from the group within the highest quartile of claims submitted for reimbursement using the procedures' relevant current procedural terminology (CPT) codes. Low-volume surgeons were randomly selected from the lowest quartile of submitted claims for the procedures' relevant CPT codes. Claims were collated within the Normative Health Information Database, covering multiple payers for more than 25 million insured patients. Numerical ratings were found for the majority of physicians in our sample (547/600, 91.2%) and comments were found for 385/600 (64.2%) of the physicians. We found that high-volume (HV) surgeons could be differentiated from low-volume (LV) surgeons independently by analyzing: (1) the total number of numerical ratings per website (HV: mean = 5.85; LV: mean = 4.87, Pcustomer service (HV: mean = 0.24; LV: mean = 0.22, P=.52); and (3) proportion of scathing criticism/total comments about customer service (HV: mean = 0.19; LV: mean = 0.21, P=.48). Online

  3. Determinants of doctors' decisions to inquire about sexual dysfunction in Malaysian primary care settings. (United States)

    Tong, Seng Fah; Low, Wah Yun; Ismail, Shaiful Bahari; Trevena, Lyndal; Wilcock, Simon


    Perceptions of how receptive men are to sexual health inquiry may affect Malaysian primary care doctors' decisions to initiate such a discussion with their male patients. This paper quantifies the impact of doctors' perceptions of men's receptivity on male sexual health inquiry. Sexual health inquiry is one of the five areas in a study on determinants of offering preventive health checks to Malaysian men. This was a cross sectional survey among primary care doctors in Malaysia. The questionnaire was based on an empirical model defining the determinants of primary care doctors' intention to offer health checks. The questionnaire measured: (I) perceived receptivity of male patients to sexual health inquiry; (II) doctors' attitudes towards the importance of sexual health inquiries; (III) perceived competence and, (IV) perceived external barriers. The outcome variable was doctors' intention in asking about sexual dysfunction in three different contexts (minor complaints visits, follow-up visits and health checks visits). All items were measured on the Likert scale of 1 to 5 (strongly disagree/unlikely to strongly agree/likely) and internally validated. 198 doctors participated (response rate 70.4%). Female primary care doctors constituted 54.5%. 78% of respondents were unlikely to ask about sexual dysfunction in visits for minor complaints to their male patients, 43.6% in follow up visits and 28.2% in health checks visits. In ordinal regression analysis, positive perception of men's receptivity to sexual health inquiry significantly predicted the doctors' intention in asking sexual dysfunction in all three contexts; i.e., minor complaints visits (P=0.013), follow-up visits (Phealth checks visits (P=0.002). Perceived competence in sexual health inquiry predicted their intention in the follow-up visits (P=0.006) and health checks visits (Phealth checks only predicted their intention in the follow-up visits (P=0.010). Whilst sexual health inquiry should be initiated in an

  4. March critical care journal club: sequelae of critical care

    Directory of Open Access Journals (Sweden)

    Raschke RA


    Full Text Available No abstract available. Article truncated at 150 words. We focused on the topic of long-term sequelae of acute respiratory failure requiring mechanical ventilation. Our discussion panel included the fellows, many of our faculty including Drs. Robbins, Mathew, Singarajah, Thomas, Rinne, Garcia-Orr, and Nair, and invited guests from Palliative Care Medicine: Dr. Carleton, and Julie Lehn (from the VAMC and BGSMC respectively. The long term clinical outcomes of two groups of patients were examined. The first group was comprised of survivors of acute respiratory distress syndrome (ARDS requiring mechanical ventilation of any duration. Although the short-term mortality of ARDS has improved, previously unrecognized long-term sequelae have become a focus of research. Studies have now shown that significant depression, cognitive deficits similar in magnitude to those of mild Alzheimer’s, and post-traumatic stress disorder (PTSD each occur in approximately 25-30% of these patients (1-4. PTSD continues in about a quarter of patients even out to eight years after discharge (2. Functional ...

  5. Critical thinking in patient centered care. (United States)

    Mitchell, Shannon H; Overman, Pamela; Forrest, Jane L


    Health care providers can enhance their critical thinking skills, essential to providing patient centered care, by use of motivational interviewing and evidence-based decision making techniques. The need for critical thinking skills to foster optimal patient centered care is being emphasized in educational curricula for health care professions. The theme of this paper is that evidence-based decision making (EBDM) and motivational interviewing (MI) are tools that when taught in health professions educational programs can aid in the development of critical thinking skills. This paper reviews the MI and EBDM literature for evidence regarding these patient-centered care techniques as they relate to improved oral health outcomes. Comparisons between critical thinking and EBDM skills are presented and the EBDM model and the MI technique are briefly described followed by a discussion of the research to date. The evidence suggests that EBDM and MI are valuable tools; however, further studies are needed regarding the effectiveness of EBDM and MI and the ways that health care providers can best develop critical thinking skills to facilitate improved patient care outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Factors influencing prospective mother with prenatal qualified doctor care among the reproductive women in Bangladesh. (United States)

    Kiser, Humayun; Nasrin, Tasmina


    Maternal and child mortality are the key indicators of health and development of the country. Maternal and child health are interconnected to prenatal care. Consulting a doctor at the prenatal stage will not only ensure mother's and her unborn babies' safety, but also has a great influence to reduce the maternal and infant mortality. In this paper, an attempt has been made to analyze the status of prenatal care provided by the qualified doctor among pregnant mothers in Bangladesh. Data and required information of 8793 reproductive women were collected from the Bangladesh Demographic and Health Survey (BDHS) 2014. Logistic regression model has been used to identify the most significant determinants of the prenatal doctor visits. In this research, it is found that prenatal cares by a qualified doctor during pregnancy depend on several social and demographic characteristics of a woman. It is observed that women staying both urban and rural areas have similar behaviour of caring regarding their pregnancy related complications. Beside this Respondent's age, education, her husband's education and the number of ever born children have significant contribution on prenatal doctor visit. On the other hand, division, religion, husband's desire for children has no effect on it. Overall the model is able to predict 71.65% women into their appropriate group based on these factors.

  7. Intensive and critical care medicine

    International Nuclear Information System (INIS)

    Aochi, Osamu; Amaha, Keisuke; Takeshita, Hiroshi


    Eight papers in this volume are in INIS scope, respectively dealing with the scientific use of the chest radiograph in intensive care unit, xenon computed tomography cerebral blood flow in diagnosis and management of symptomatic vasospasm and severe head injury, therapeutic relevance of MRI in acute head trauma, computerized tomography in the diagnosis of cerebral air embolism, thallium 201 myocardial perfusion during weaning from mechanical ventilation, thoracic computed tomography for ICU patients, and the effect of xenon inhalation upon internal carotid artery blood flow in awake monkeys. (H.W.). refs.; figs.; tabs

  8. Caring for a critically ill Amish newborn. (United States)

    Gibson, Elizabeth A


    This article describes a neonatal nurse's personal experience in working with a critically ill newborn and his Amish family in a newborn intensive care unit in Montana. The description includes a cultural experience with an Amish family with application to Madeleine Leininger's theory of culture care diversity and universality.

  9. Doctors' learning experiences in end-of-life care - a focus group study from nursing homes. (United States)

    Fosse, Anette; Ruths, Sabine; Malterud, Kirsti; Schaufel, Margrethe Aase


    Doctors often find dialogues about death difficult. In Norway, 45% of deaths take place in nursing homes. Newly qualified medical doctors serve as house officers in nursing homes during internship. Little is known about how nursing homes can become useful sites for learning about end-of-life care. The aim of this study was to explore newly qualified doctors' learning experiences with end-of-life care in nursing homes, especially focusing on dialogues about death. House officers in nursing homes (n = 16) participated in three focus group interviews. Interviews were audiotaped and transcribed verbatim. Data were analysed with systematic text condensation. Lave & Wenger's theory about situated learning was used to support interpretations, focusing on how the newly qualified doctors gained knowledge of end-of-life care through participation in the nursing home's community of practice. Newly qualified doctors explained how nursing home staff's attitudes taught them how calmness and acceptance could be more appropriate than heroic action when death was imminent. Shifting focus from disease treatment to symptom relief was demanding, yet participants comprehended situations where death could even be welcomed. Through challenging dialogues dealing with family members' hope and trust, they learnt how to adjust words and decisions according to family and patient's life story. Interdisciplinary role models helped them balance uncertainty and competence in the intermediate position of being in charge while also needing surveillance. There is a considerable potential for training doctors in EOL care in nursing homes, which can be developed and integrated in medical education. This practice based learning arena offers newly qualified doctors close interaction with patients, relatives and nurses, teaching them to perform difficult dialogues, individualize medical decisions and balance their professional role in an interdisciplinary setting.

  10. Knowledge, awareness and practice of ethics among doctors in tertiary care hospital. (United States)

    Singh, Surjit; Sharma, Pramod Kumar; Bhandari, Bharti; Kaur, Rimplejeet


    With the advancement of healthcare and medical research, doctors need to be aware of the basic ethical principles. This cross-sectional study is an attempt to assess the knowledge, awareness, and practice of health-care ethics among health-care professionals. After taking written informed consent, a standard questionnaire was administered to 117 doctors. No personal information was recorded on the questionnaire so as to ensure the confidentiality and anonymity of participants. Data analysis was done using SPSS version 21 (IBM Corp., Armonk, NY, USA). Statistically significant difference observed between the opinions of consultant and senior resident (SRs) on issues like, adherence to confidentiality; paternalistic attitude of doctors (doctors should do their best for the patient irrespective of patient's opinion); doctor's decision should be final in case of disagreement and interest in learning ethics ( P patient wishes, informing patient regarding wrongdoing, informing close relatives, seeking consent for children and patients' consent for procedures. Furthermore, no significant difference observed between the two with respect to the practice of health-care ethics. Surprisingly, the response of clinical and nonclinical faculty did not differ as far as awareness and practice of ethics were concerned. The significant difference is observed in the knowledge, awareness, and practice of ethics among consultants and SRs. Conferences, symposium, and workshops, on health-care ethics, may act as a means of sensitizing doctors and thus will help to bridge this gap and protect the well-being and confidentiality of the patients. Such an effort may bring about harmonious change in the doctor-patient relationship.

  11. Medication communication between nurses and doctors for paediatric acute care: An ethnographic study. (United States)

    Borrott, Narelle; Kinney, Sharon; Newall, Fiona; Williams, Allison; Cranswick, Noel; Wong, Ian; Manias, Elizabeth


    To examine how communication between nurses and doctors occurred for managing medications in inpatient paediatric settings. Communication between health professionals influences medication incidents' occurrence and safe care. An ethnographic study was undertaken. Semi-structured interviews, observations and focus groups were conducted in three clinical areas of an Australian tertiary paediatric hospital. Data were transcribed verbatim and thematically analysed using the Medication Communication Model. The actual communication act revealed health professionals' commitment to effective medication management and the influence of professional identities on medication communication. Nurses and doctors were dedicated to providing safe, effective medication therapy for children, within their scope of practice and perceived role responsibilities. Most nurses and junior doctors used tentative language in their communication while senior doctors tended to use direct language. Irrespective of language style, nurses actively engaged with doctors to promote patients' needs. Yet, the medical hierarchical structure, staffing and attendant expectations influenced communication for medication management, causing frustration among nurses and doctors. Doctors' lack of verbal communication of documented changes to medication orders particularly troubled nurses. Nurses persisted in their efforts to acquire appropriate orders for safe medication administration to paediatric patients. Collaborative practice between nurses and doctors involved complex, symbiotic relationships. Their dedication to providing safe medication therapy to paediatric patients facilitated effective medication management. At times, shortcomings in interdisciplinary communication impacted on potential and actual medication incidents. Understanding of the complexities affecting medication communication between nurses and doctors helps to ensure interprofessional respect for each other's roles and inherent demands

  12. Factors affecting the referral of primary health care doctors toward ...

    African Journals Online (AJOL)

    Hend Al-Namash


    Jun 8, 2011 ... There is a worldwide epidemic of overweight, obesity, and morbid obesity ... the evolution of bariatric surgery.4 Controversy exists regard- ing the best ..... attitudes and practices among Israeli primary care physicians. Int J.

  13. Critical care management of acute ischemic stroke. (United States)

    Coplin, William M


    Acute ischemic stroke (AIS) can have profound and devastating effects on the CNS and several other organs. Approximately 15% to 20% of patients with AIS are admitted to an intensive care unit and cared for by a multidisciplinary team. This article discusses the critical care management of patients with AIS. Patients with AIS require attention to airway, pulmonary status, blood pressure, glucose, temperature, cardiac function, and, sometimes, life-threatening cerebral edema. The lack of disease-specific data has led to numerous management approaches and limited guidance on choosing among them. Existing guidelines emphasize risk factors, prevention, natural history, and prevention of bleeding but provide little discussion of the complex critical care issues involved in caring for patients with AIS.

  14. [Investigation of doctors' and nurses' perceptions and implementation of delirium management in intensive care unit]. (United States)

    Luo, H B; Wang, X T; Tang, B; Zhu, Z N; Guo, H L; Li, Z Z; Sun, J H; Liu, D W


    Objective: To investigate doctors' and nurses' perceptions and implementation of delirium management in intensive care unit. Methods: A total of 197 doctors and nurses in 2 general ICUs and 3 special ICUs at Peking Union Medical College Hospital finished a self-designed questionnaire of delirium management. Results: There were 47 males and 150 females, 43 doctors and 154 nurses who participated in the survey.One hundred and twenty five participators were from general ICU and the others from special ICU. The ICU staff had a significant difference on the perceptions and implementation of delirium management( P delirium assessment" ( P delirium management,especially in special ICUs. Delirium management should be included as a routine care in ICU to improve patients' outcome.

  15. "Just Imagine That…": A Solution Focused Approach to Doctoral Research Supervision in Health and Social Care (United States)

    Walsh, Kenneth; Doherty, Kathleen; Andersen, Loretta; Bingham, Sharon; Crookes, Patrick; Ford, Karen; McSherry, Robert


    Effective supervision in doctoral research is critical to successful and timely completion. However, supervision is a complex undertaking with structural as well as relational challenges for both students and supervisors. This instructional paper describes an internationally applicable approach to supervision that we have developed in the health…

  16. International medical migration: a critical conceptual review of the global movements of doctors and nurses. (United States)

    Bradby, Hannah


    This paper critically appraises the discourse around international medical migration at the turn of the 21st century. A critical narrative review of a range of English-language sources, including grey literature, books and research reports, traces the development and spread of specific causative models. The attribution of causative relations between the movement of skilled medical workers, the provision of health care and population health outcomes illustrates how the global reach of biomedicine has to be understood in the context of local conditions. The need to understand migration as an aspect of uneven global development, rather than a delimited issue of manpower services management, is illustrated with reference to debates about 'brain drain' of Africa's health-care professionals, task-shifting and the crisis in health-care human resources. The widespread presumed cause of shortages of skilled health-care staff in sub-Saharan Africa was overdetermined by a compelling narrative of rich countries stealing poor countries' trained health-care professionals. This narrative promotes medical professional interests and ignores historical patterns of underinvestment in health-care systems and structures. Sociological theories of medicalization suggest that the international marketization of medical recruitment is a key site where the uneven global development of capital is at work. A radical reconfiguration of medical staffing along the lines of 'task-shifting' in rich and poor countries' health-care systems alike offers one means of thinking about global equity in access to quality care. © The Author(s) 2014.

  17. Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy. (United States)

    Hager, David R; Persaud, Rosemary A; Naseman, Ryan W; Choudhary, Kavish; Carter, Kristen E; Hansen, Amanda


    Background: While hospital beds continue to decline as patients previously treated as inpatients are stabilized in ambulatory settings, the number of critical care beds available in the United States continues to rise. Growth in pharmacy student graduation, postgraduate year 2 critical care (PGY2 CC) residency programs, and positions has also increased. There is a perception that the critical care trained pharmacist market is saturated, yet this has not been evaluated since the rise in pharmacy graduates and residency programs. Purpose: To describe the current perception of critical care residency program directors (CC RPDs) and directors of pharmacy (DOPs) on the critical care pharmacist job market and to evaluate critical care postresidency placement and anticipated changes in PGY2 CC programs. Methods: Two electronic surveys were distributed from October 2015 to November 2015 through Vizient/University HealthSystem Consortium, American Society of Health-System Pharmacists (ASHP), Society of Critical Care Medicine, and American College of Clinical Pharmacy listservs to target 2 groups of respondents: CC RPDs and DOPs. Questions were based on the ASHP Pharmacy Forecast and the Pharmacy Workforce Center's Aggregate Demand Index and were intended to identify perceptions of the critical care market of the 2 groups. Results: Of 116 CC RPDs, there were 66 respondents (56.9% response rate). Respondents have observed an increase in applicants; however, they do not anticipate increasing the number of positions in the next 5 years. The overall perception is that there is a balance in supply and demand in the critical care trained pharmacist market. A total of 82 DOPs responded to the survey. Turnover of critical care pharmacists within respondent organizations is expected to be low. Although a majority of DOPs plan to expand residency training positions, only 9% expect to increase positions in critical care PGY2 training. Overall, DOP respondents indicated a balance of

  18. Smoking trends amongst young doctors of a tertiary care hospital - Mayo Hospital, Lahore - Pakistan

    International Nuclear Information System (INIS)

    Chudhary, M.K.; Younis, M.; Bukhari, M.H.


    The World Health Organization cites tobacco use as one of the biggest public health threats the world has ever faced. Tobacco is the number one preventable cause of disability and death. Tobacco has many negative health effects which many of the smokers know them well. In Pakistan tobacco use is common in general public and the health professionals don't lack behind this habit. To study the smoking trends amongst young doctors of Mayo Hospital. Questionnaire based descriptive study. This study was conducted at the Institute of Chest Medicine, Mayo Hospital - A tertiary care hospital affiliated with King Edward Medical University, Lahore. Out of 250 doctors, 180 (72%) were males and 70 (28%) were female. Amongst 180 male doctors 97 (53.88%) were smokers and 83 (46.21%) were non smokers. Amongst 70 female doctors 8 (11.43%) were smokers and 62 (88.57%) were non smokers. Smoking is common among male young doctors but it is less common in female doctors. (author)

  19. The image ofan ideal psychiatrist inthe eyes of medical students, patients and doctors involved inpsychiatric care

    Directory of Open Access Journals (Sweden)

    Aleksandra Margulska


    Full Text Available Aim: The aim of the study was to determine differences in the image of ideal psychiatrist (IIP among patients, doctors involved in psychiatric care and medical students and also between individuals with different work experience (doctors vs. students. The psychiatrist’s personality seems an important factor in supporting therapeutic process; therefore it is worth searching for the patient’s needs. Materials and methods: Three groups participated in the study: patients of the psychiatric units, medical students of 6th year and psychiatrists. The Gough and Heilbrun ACL (Adjective Check List – based on Mur‑ ray’s theory of needs – was used to assess IIP. Results: Data analysis revealed statistically significant differences among patients, doctors and students involving five scales: Nurturance, Aggression, Change, Succorance and Deference. Patients had lower scores on Change scale than doctors and higher scores on the Nurturance, Succurance and Deference than stu‑ dents. Psychiatrists had higher scores on Nurturance and Deference scale and lower score on Aggression scale than students. Conclusions: The findings showed differences in the expectations of patients compared to those of students and doctors. The most significant difference that was observed involved the Change. It may indicate that patients prefer order, conventional approach and stability in psychiatrist’s personality traits more commonly than doctors. Study findings suggest that work experience has impact on IIP: with increasing work experience, opinion about IIP comes closer to patients’ expectations.

  20. An emerging model of maternity care: smartphone, midwife, doctor? (United States)

    Tripp, Nadia; Hainey, Kirsten; Liu, Anthony; Poulton, Alison; Peek, Michael; Kim, Jinman; Nanan, Ralph


    Mobile technology in the form of the smartphone is widely used, particularly in pregnancy and they are an increasing and influential source of information. To describe the diverse nature of pregnancy related applications (apps) for the smartphone and to flag that these apps can potentially affect maternity care and should be considered in future planning of care provision. The 2 smartphone platforms, Apple and Android, were searched for pregnancy related apps and reviewed for their purpose and popularity. iTunes and Google Play returned 1059 and 497 pregnancy related apps respectively. Forty percent of the apps were informative, 13% interactive, 19% had features of a medical tool and 11% were social media apps. By far the most popular apps, calculated as the number of reviews multiplied by average reviewer rating, were those with interactive features. The popularity of pregnancy-related apps could indicate a shift towards patient empowerment within maternity care provision. The traditional model of 'shared maternity care' needs to accommodate electronic devices into its functioning. Reliance on healthcare professionals may be reduced by the availability of interactive and personalised information delivered via a smartphone. This combined with the fact that smartphones are widely used by many women of childbearing age, has the potential to modify maternity care and experiences of pregnancy. Therefore it is important that healthcare professionals and policy-makers are more aware of these new developments, which are likely to influence healthcare and alter health-seeking behaviour. In addition healthcare professionals need to consider whether to discuss the use of apps in pregnancy with the women in their care. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  1. What does it means to be a critical scholar? A metalogue between science education doctoral students (United States)

    Cian, Heidi; Dsouza, Nikeetha; Lyons, Renee; Alston, Daniel


    This manuscript is written in response to Lydia Burke and Jesse Bazzul's article Locating a space of criticality as new scholars in science education. As doctoral students finding our place in the culture of science education, we respond by discussing our journeys towards the development of a scholarly identity, with particular focus on whether or how we see ourselves as critical scholars. Since each of us authoring this paper has a different perspective, a metalogue format is utilized to ensure all of our voices and journeys are represented. We use the Burke and Bazzul article as a platform for conversations about challenges faced for emerging scholars in the field of science education and explore how we see our role in responding to these challenges. Specifically, we discuss the barriers to publication, dissemination of research to practitioners, and how to approach these problems from a grounding in critical theory. As a result of our conversations, we conclude that there is a need to reshape the field of science education to invite more unorthodox research perspectives, methodologies, and publication formats. To do so, the issues we explore require a continued conversation between emerging scholars, practicing researchers, and practicing educators.

  2. ICT and the future of health care: aspects of doctor-patient communication. (United States)

    Haluza, Daniela; Jungwirth, David


    The current digital revolution is particularly relevant for interactions of healthcare providers with patients and the community as a whole. The growing public acceptance and distribution of new communication tools such as smart mobile phones provide the prerequisite for information and communication technology (ICT) -assisted healthcare applications. The present study aimed at identifying specifications and perceptions of different interest groups regarding future demands of ICT-supported doctor-patient communication in Austria. German-speaking Austrian healthcare experts (n = 73; 74 percent males; mean age, 43.9 years; SD 9.4) representing medical professionals, patient advocates, and administrative personnel participated in a 2-round online Delphi process. Participants evaluated scenario-based benefits and obstacles for possible prospect introduction as well as degree of innovation, desirability, and estimated implementation dates of two medical care-related future set ups. Panelists expected the future ICT-supported doctor-patient dialogue to especially improve the three factors doctors-patient relationship, patients' knowledge, and quality of social health care. However, lack of acceptance by doctors, data security, and monetary aspects were considered as the three most relevant barriers for ICT implementation. Furthermore, inter-group comparison regarding desirability of future scenarios showed that medical professionals tended to be more skeptical about health-related technological innovations (p ICT-supported collaboration and communication between doctors and patients.

  3. A leadership programme for critical care. (United States)

    Crofts, Linda


    This paper describes the genesis, design and implementation of a leadership programme for critical care. This was an initiative funded by the National Health Service (NHS) Nursing Leadership Project and had at the core of its design flexibility to meet the needs of the individual hospitals, which took part in it. Participation was from the multi-disciplinary critical care team. Six NHS hospitals took part in the programme which was of 20 days duration and took place on hospital sites. The programme used the leadership model of as its template and had a number of distinct components; a baseline assessment, personal development, principles of leadership and critical case reviews. The programme was underpinned by three themes; working effectively in multi-professional teams to provide patient focussed care, managing change through effective leadership and developing the virtual critical care service. Each group set objectives pertinent to their own organisation's needs. The programme was evaluated by a self-reporting questionnaire; group feedback and feedback from stakeholders. Programme evaluation was positive from all the hospitals but it was clear that the impact of the programme varied considerably between the groups who took part. It was noted that there was some correlation between the success of the programme and organisational 'buy in' as well as the organisational culture within which the participants operated. A key feature of the programme success was the critical case reviews, which were considered to be a powerful learning tool and medium for group learning and change management.

  4. Aeromedical Evacuation Enroute Critical Care Validation Study (United States)


    percentile TP, suggesting that TPs assumed complex postures to accomplish patient care tasks. The findings suggest that ergonomic specifications...bending has been associated with back pain (Guo, 2002). Enhanced medical treatment capabilities (e.g., enroute critical care nurses [ECCN...heights, including ergonomic factors such as medic stance and stability and the medic’s ability to maneuver into challenging work angles. The light

  5. [The listening doctor; appropriate care in the last phase of life]. (United States)

    Molenaar, Jan C


    In his report 'Everything that can be done should not necessarily be done. Appropriate care in the last phase of life', the chairman of the steering committee of the Royal Dutch Medical Association says: 'I wish that doctors would listen to their patients.' This wish sets the tone of the report, which signals overtreatment in patients' last years of life and advocates a more restrained approach by doctors in this phase. The message is, however, that for this to take place a complete U-turn in modern medical thinking and management is needed.

  6. Risky business: human factors in critical care. (United States)

    Laussen, Peter C; Allan, Catherine K; Larovere, Joan M


    Remarkable achievements have occurred in pediatric cardiac critical care over the past two decades. The specialty has become well defined and extremely resource intense. A great deal of focus has been centered on optimizing patient outcomes, particularly mortality and early morbidity, and this has been achieved through a focused and multidisciplinary approach to management. Delivering high-quality and safe care is our goal, and during the Risky Business symposium and simulation sessions at the Eighth International Conference of the Pediatric Cardiac Intensive Care Society in Miami, December 2010, human factors, systems analysis, team training, and lessons learned from malpractice claims were presented.

  7. Critical Care Implications of the Affordable Care Act. (United States)

    Dogra, Anjali P; Dorman, Todd


    To provide an overview of key elements of the Affordable Care Act. To evaluate ways in which the Affordable Care Act will likely impact the practice of critical care medicine. To describe strategies that may help health systems and providers effectively adapt to changes brought about by the Affordable Care Act. Data sources for this concise review include search results from the PubMed and Embase databases, as well as sources relevant to public policy such as the text of the Patient Protection and Affordable Care Act and reports of the Congressional Budget Office. As all of the Affordable Care Act's provisions will not be fully implemented until 2019, we also drew upon cost, population, and utilization projections, as well as the experience of existing state-based healthcare reforms. The Affordable Care Act represents the furthest reaching regulatory changes in the U.S. healthcare system since the 1965 Medicare and Medicaid provisions of the Social Security Act. The Affordable Care Act aims to expand health insurance coverage to millions of Americans and place an emphasis on quality and cost-effectiveness of care. From models which link pay and performance to those which center on episodic care, the Affordable Care Act outlines sweeping changes to health systems, reimbursement structures, and the delivery of critical care. Staffing models that include daily rounding by an intensivist, palliative care integration, and expansion of the role of telemedicine in areas where intensivists are inaccessible are potential strategies that may improve quality and profitability of ICU care in the post-Affordable Care Act era.

  8. The research agenda for trauma critical care

    NARCIS (Netherlands)

    Asehnoune, Karim; Balogh, Zsolt; Citerio, Giuseppe; Cap, Andre; Billiar, Timothy; Stocchetti, Nino; Cohen, Mitchell J.; Pelosi, Paolo; Curry, Nicola; Gaarder, Christine; Gruen, Russell; Holcomb, John; Hunt, Beverley J.; Juffermans, Nicole P.; Maegele, Mark; Midwinter, Mark; Moore, Frederick A.; O'Dwyer, Michael; Pittet, Jean-François; Schöchl, Herbert; Schreiber, Martin; Spinella, Philip C.; Stanworth, Simon; Winfield, Robert; Brohi, Karim


    In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus

  9. Dopamine in heart failure and critical care

    NARCIS (Netherlands)

    Smit, AJ

    Dopamine is widely used in critical care to prevent renal function loss. Nevertheless sufficient evidence is still lacking of reduction in end points like mortality or renal replacement therapy. Dopaminergic treatment in chronic heart failure (CHF) has provided an example of unexpected adverse

  10. Personality factors of critical care nurses. (United States)

    Levine, C D; Wilson, S F; Guido, G W


    Two hundred members of the American Association of Critical-Care Nurses responded to a mail-out survey done to determine the psychologic profile of critical care nurses in terms of self-esteem, gender identity, and selected personality characteristics. The instruments used were Cattell's 16 PR, the Personal Attributes Questionnaire (PAQ), and the Texas Social Behavior Inventory (TSBI). Their personality factors tended to be aggressive, assertive, competitive, persevering, moralistic, resourceful, and mechanical. The nurses who enjoyed the field most were of the androgynous or masculine type and had high levels of self-esteem. On the basis of these findings, the nurse recruiter or faculty member doing career counseling could assess the personality characteristics, gender identity, and self-esteem levels of interested nurses. The goal would be to identify nurses who would both enjoy the field and remain active in critical care nursing after orientation. The goal could also be to help nurses dissatisfied with critical care nursing to seek means of improving their self-esteem.

  11. Reimbursement for critical care services in India (United States)

    Jayaram, Raja; Ramakrishnan, Nagarajan


    There are significant variations in critical care practices, costs, and reimbursements in various countries. Of note, there is a paucity of reliable information on remuneration and reimbursement models for intensivists in India. This review article aims to analyze the existing reimbursement models in United States and United Kingdom and propose a frame-work model that may be applicable in India. PMID:23833469

  12. Understanding critical care nurses' autonomy in Jordan. (United States)

    Maharmeh, Mahmoud


    Purpose The aim of this study was to describe Jordanian critical care nurses' experiences of autonomy in their clinical practice. Design/methodology/approach A descriptive correlational design was applied using a self-reported cross-sectional survey. A total of 110 registered nurses who met the eligibility criteria participated in this study. The data were collected by a structured questionnaire. Findings A majority of critical care nurses were autonomous in their decision-making and participation in decisions to take action in their clinical settings. Also, they were independent to develop their own knowledge. The study identified that their autonomy in action and acquired knowledge were influenced by a number of factors such as gender and area of practice. Practical implications Nurse's autonomy could be increased if nurses are made aware of the current level of autonomy and explore new ways to increase empowerment. This could be offered through classroom lectures that concentrate on the concept of autonomy and its implication in practice. Nurses should demonstrate autonomous nursing care at the same time in the clinical practice. This could be done through collaboration between educators and clinical practice to help merge theory to practice. Originality/value Critical care nurses were more autonomous in action and knowledge base. This may negatively affect the quality of patient care and nurses' job satisfaction. Therefore, improving nurses' clinical decision-making autonomy could be done by the support of both hospital administrators and nurses themselves.

  13. Mobile technology supporting trainee doctors' workplace learning and patient care: an evaluation. (United States)

    Hardyman, Wendy; Bullock, Alison; Brown, Alice; Carter-Ingram, Sophie; Stacey, Mark


    The amount of information needed by doctors has exploded. The nature of knowledge (explicit and tacit) and processes of knowledge acquisition and participation are complex. Aiming to assist workplace learning, Wales Deanery funded "iDoc", a project offering trainee doctors a Smartphone library of medical textbooks. Data on trainee doctors' (Foundation Year 2) workplace information seeking practice was collected by questionnaire in 2011 (n = 260). iDoc baseline questionnaires (n = 193) collected data on Smartphone usage alongside other workplace information sources. Case reports (n = 117) detail specific instances of Smartphone use. Most frequently (daily) used information sources in the workplace: senior medical staff (80% F2 survey; 79% iDoc baseline); peers (70%; 58%); and other medical/nursing team staff (53% both datasets). Smartphones were used more frequently by males (p mobile technology used for simple (information-based), complex (problem-based) clinical questions and clinical procedures (skills-based scenarios). From thematic analysis, the Smartphone library assisted: teaching and learning from observation; transition from medical student to new doctor; trainee doctors' discussions with seniors; independent practice; patient care; and this 'just-in-time' access to reliable information supported confident and efficient decision-making. A variety of information sources are used regularly in the workplace. Colleagues are used daily but seniors are not always available. During transitions, constant access to the electronic library was valued. It helped prepare trainee doctors for discussions with their seniors, assisting the interchange between explicit and tacit knowledge.By supporting accurate prescribing and treatment planning, the electronic library contributed to enhanced patient care. Trainees were more rapidly able to medicate patients to reduce pain and more quickly call for specific assessments. However, clinical decision-making often requires

  14. Malaysian primary care doctors' views on men's health: an unresolved jigsaw puzzle. (United States)

    Tong, Seng Fah; Low, Wah Yun; Ismail, Shaiful Bahari; Trevena, Lyndal; Willcock, Simon


    Men have been noted to utilise health care services less readily then women. Primary care settings provide an opportunity to engage men in health care activities because of close proximity to the target group (men in the community). Understanding attitudes towards men's health among Malaysian primary care doctors is important for the effective delivery of health services to men. We aimed to explore the opinions and attitudes of primary care doctors (PCDs) relating to men's health and help-seeking behaviour. A qualitative approach to explore the opinions of 52 PCDs was employed, using fourteen in-depth interviews and eight focus group discussions in public and private settings. Purposive sampling of PCDs was done to ensure maximum variation in the PCD sample. Interviews were recorded and transcribed verbatim for analysis. Open coding with thematic analysis was used to identify key issues raised in the interview. The understanding of the concept of men's health among PCDs was fragmented. Although many PCDs were already managing health conditions relevant and common to men, they were not viewed by PCDs as "men's health". Less attention was paid to men's help-seeking behaviour and their gender roles as a potential determinant of the poor health status of men. There were opposing views about whether men's health should focus on men's overall health or a more focused approach to sexual health. There was also disagreement about whether special attention was warranted for men's health services. Some doctors would prioritise more common conditions such as hypertension, diabetes and hypercholesterolaemia. The concept of men's health was new to PCDs in Malaysia. There was wide variation in understanding and opposing attitudes towards men's health among primary care doctors. Creating awareness and having a systematic approach would facilitate PCDs in delivering health service to men.

  15. Malaysian primary care doctors' views on men's health: an unresolved jigsaw puzzle

    Directory of Open Access Journals (Sweden)

    Ismail Shaiful


    Full Text Available Abstract Background Men have been noted to utilise health care services less readily then women. Primary care settings provide an opportunity to engage men in health care activities because of close proximity to the target group (men in the community. Understanding attitudes towards men's health among Malaysian primary care doctors is important for the effective delivery of health services to men. We aimed to explore the opinions and attitudes of primary care doctors (PCDs relating to men's health and help-seeking behaviour. Methods A qualitative approach to explore the opinions of 52 PCDs was employed, using fourteen in-depth interviews and eight focus group discussions in public and private settings. Purposive sampling of PCDs was done to ensure maximum variation in the PCD sample. Interviews were recorded and transcribed verbatim for analysis. Open coding with thematic analysis was used to identify key issues raised in the interview. Results The understanding of the concept of men's health among PCDs was fragmented. Although many PCDs were already managing health conditions relevant and common to men, they were not viewed by PCDs as "men's health". Less attention was paid to men's help-seeking behaviour and their gender roles as a potential determinant of the poor health status of men. There were opposing views about whether men's health should focus on men's overall health or a more focused approach to sexual health. There was also disagreement about whether special attention was warranted for men's health services. Some doctors would prioritise more common conditions such as hypertension, diabetes and hypercholesterolaemia. Conclusions The concept of men's health was new to PCDs in Malaysia. There was wide variation in understanding and opposing attitudes towards men's health among primary care doctors. Creating awareness and having a systematic approach would facilitate PCDs in delivering health service to men.

  16. Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting. (United States)

    Liu, Wei; Gerdtz, Marie; Manias, Elizabeth


    This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication

  17. Intergroup communication between hospital doctors: implications for quality of patient care. (United States)

    Hewett, David G; Watson, Bernadette M; Gallois, Cindy; Ward, Michael; Leggett, Barbara A


    Hospitals involve a complex socio-technical health system, where communication failures influence the quality of patient care. Research indicates the importance of social identity and intergroup relationships articulated through power, control, status and competition. This study focused on interspecialty communication among doctors for patients requiring the involvement of multiple specialist departments. The paper reports on an interview study in Australia, framed by social identity and communication accommodation theories of doctors' experiences of managing such patients, to explore the impact of communication. Interviews were undertaken with 45 doctors working in a large metropolitan hospital, and were analysed using Leximancer (text mining software) and interpretation of major themes. Findings indicated that intergroup conflict is a central influence on communication. Contested responsibilities emerged from a model of care driven by single-specialty ownership of the patient, with doctors allowed to evade responsibility for patients over whom they had no sense of ownership. Counter-accommodative communication, particularly involving interpersonal control, appeared as important for reinforcing social identity and winning conflicts. Strategies to resolve intergroup conflict must address structural issues generating an intergroup climate and evoke interpersonal salience to moderate their effect.

  18. Creating better doctors: exploring the value of learning medicine in primary care. (United States)

    Newbronner, Elizabeth; Borthwick, Rachel; Finn, Gabrielle; Scales, Michael; Pearson, David


    Across the UK, 13% of undergraduate medical education is undertaken in primary care (PC). Students value their experiences in this setting but uncertainty remains about the extent to which these placements influence their future practice. To explore the impact of PC based undergraduate medical education on the development of medical students and new doctors as clinicians, and on students' preparedness for practice. Mixed method study across two UK medical schools. Focus groups and individual interviews with Year 5 medical students, Foundation Year 2 doctors and GP Specialty Trainees; online surveys of Year 5 medical students and Foundation Year 2 doctors. PC placements play an important part in the development of all 'apprentice' doctors, not just those wanting to become GPs. They provide a high quality learning environment, where students can: gradually take on responsibility; build confidence; develop empathy in their approach to patient care; and gain understanding of the social context of health and illness. The study suggests that for these results to be achieved, PC placements have to be high quality, with strong links between practice-based learning and teaching/assessment in medical school. GP tutors need to be enthusiastic and students actively involved in consultations.

  19. Ethics and research in critical care. (United States)

    Silverman, Henry J; Lemaire, Francois


    The past few years have witnessed several controversies regarding the ethics of conducting research involving critically ill patients, and such research is ethically challenging. Research ethics is a changing field, one that is influenced by empirical data, contemporary events, and new ideas regarding aspects of clinical trial design and protection of human subjects. We describe recent thoughts regarding several aspects of research ethics in the critical care context. The ability of the research community to conduct research ethically and to maintain public trust would benefit from heightened awareness to the principles and requirements that govern such research.

  20. African American Doctoral Students at For-Profit Colleges and Universities: A Critical Race Theory Exploration (United States)

    Hall, Jodi


    Many people regard the doctorate as the pinnacle of success. Despite the challenges of completing the terminal degree, the dream of earning the doctoral degree remains a goal for many every year. Understanding the phenomenon of African American student enrollment at for-profit colleges and universities (FPCUs) is necessary because many African…

  1. A comparative study on the clinical decision-making processes of nurse practitioners vs. medical doctors using scenarios in a secondary care environment. (United States)

    Thompson, Stephen; Moorley, Calvin; Barratt, Julian


    To investigate the decision-making skills of secondary care nurse practitioners compared with those of medical doctors. A literature review was conducted, searching for articles published from 1990 - 2012. The review found that nurse practitioners are key to the modernization of the National Health Service. Studies have shown that compared with doctors, nurse practitioners can be efficient and cost-effective in consultations. Qualitative research design. The information processing theory and think aloud approach were used to understand the cognitive processes of 10 participants (5 doctors and 5 nurse practitioners). One nurse practitioner was paired with one doctor from the same speciality and they were compared using a structured scenario-based interview. To ensure that all critical and relevant cues were covered by the individual participating in the scenario, a reference model was used to measure the degree of successful diagnosis, management and treatment. This study was conducted from May 2012 - January 2013. The data were processed for 5 months, from July to November 2012. The two groups of practitioners differed in the number of cue acquisitions obtained in the scenarios. In our study, nurse practitioners took 3 minutes longer to complete the scenarios. This study suggests that nurse practitioner consultations are comparable to those of medical doctors in a secondary care environment in terms of correct diagnoses and therapeutic treatments. The information processing theory highlighted that both groups of professionals had similar models for decision-making processes. © 2016 John Wiley & Sons Ltd.

  2. Pressure Injury Knowledge in Critical Care Nurses. (United States)

    Miller, Donna M; Neelon, Lisa; Kish-Smith, Kathleen; Whitney, Laura; Burant, Christopher J

    The purpose of this study was to identify pressure injury knowledge in critical care nurses related to prevention and staging following multimodal education initiatives. Postintervention descriptive study. The sample comprised 32 RNs employed in medical intensive care/coronary intensive care or surgical intensive care units. The study setting was a 237-bed Veterans Affairs acute care hospital in the Midwestern United States. Critical care RNs were asked to participate in this project over a 3-week period following a multimodal 2-year education initiative. Nurses completed the paper version of the 72-item Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT) to determine pressure injury knowledge level. Calculated mean cumulative scores and subscores for items related to prevention and staging, respectively. Pearson correlations were used to examine associations between nursing staff characteristics and the PZ-PUKT prevention and staging scores. The cumulative score on the PZ-PUKT was 51.66 (72%); nurses with 5 to 10 years' experience had a higher mean score than nurses with experiences of 20 years or more (mean ± SD = 54.25 ± 4.37 vs 49.5 ± 7.12), but the difference was not statistically significant. Nurses scored higher on the staging system-related items as compared to the prevention-related items (81% vs 70%). Nurses achieved higher staging subscale scores if they were younger (r =-0.41, P < .05), had less experience (r =-0.43, P < .05), and if they worked in the medical intensive care unit (r = 0.37, P < .05). Study findings indicate gaps in knowledge related to pressure injury practice; participants had greater knowledge of staging rather than prevention. Cumulative and subscale findings can be used to direct educational efforts needed to improve and maintain an effective pressure injury prevention program.

  3. A Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health-care Professionals. A Call for Action. (United States)

    Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N


    Burnout syndrome (BOS) occurs in all types of health-care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health-care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health-care professionals and diminish the harmful consequences of BOS, both for critical care health-care professionals and for patients.

  4. Laboratory test result interpretation for primary care doctors in South Africa

    Directory of Open Access Journals (Sweden)

    Naadira Vanker


    Full Text Available Background: Challenges and uncertainties with test result interpretation can lead to diagnostic errors. Primary care doctors are at a higher risk than specialists of making these errors, due to the range in complexity and severity of conditions that they encounter. Objectives: This study aimed to investigate the challenges that primary care doctors face with test result interpretation, and to identify potential countermeasures to address these. Methods: A survey was sent out to 7800 primary care doctors in South Africa. Questionnaire themes included doctors’ uncertainty with interpreting test results, mechanisms used to overcome this uncertainty, challenges with appropriate result interpretation, and perceived solutions for interpreting results. Results: Of the 552 responses received, the prevalence of challenges with result interpretation was estimated in an average of 17% of diagnostic encounters. The most commonly-reported challenges were not receiving test results in a timely manner (51% of respondents and previous results not being easily available (37%. When faced with diagnostic uncertainty, 84% of respondents would either follow-up and reassess the patient or discuss the case with a specialist, and 67% would contact a laboratory professional. The most useful test utilisation enablers were found to be: interpretive comments (78% of respondents, published guidelines (74%, and a dedicated laboratory phone line (72%. Conclusion: Primary care doctors acknowledge uncertainty with test result interpretation. Potential countermeasures include the addition of patient-specific interpretive comments, the availability of guidelines or algorithms, and a dedicated laboratory phone line. The benefit of enhanced test result interpretation would reduce diagnostic error rates.

  5. Making space for empathy: supporting doctors in the emotional labour of clinical care


    Kerasidou, Angeliki; Horn, Ruth


    Background The academic and medical literature highlights the positive effects of empathy for patient care. Yet, very little attention has been given to the impact of the requirement for empathy on the physicians themselves and on their emotional wellbeing. Discussion The medical profession requires doctors to be both clinically competent and empathetic towards the patients. In practice, accommodating both requirements can be difficult for physicians. The image of the technically skilful, rat...

  6. An educational model for improving diet counselling in primary care. A case study of the creative use of doctors' own diet, their attitudes to it and to nutritional counselling of their patients with diabetes

    DEFF Research Database (Denmark)

    Olivarius, Niels de Fine; Palmvig, Birthe; Andreasen, Anne Helms


    Nutritional counseling; Nutritional education; Nutritional assessment; Primary care; Continuing medical education; Doctors' diet; Doctors attitudes; Doctors' knowledge; Body mass index; Educational model; Food frequency questionaire......Nutritional counseling; Nutritional education; Nutritional assessment; Primary care; Continuing medical education; Doctors' diet; Doctors attitudes; Doctors' knowledge; Body mass index; Educational model; Food frequency questionaire...

  7. Critical care in the emergency department.

    LENUS (Irish Health Repository)

    O'Connor, Gabrielle


    BACKGROUND: The volume and duration of stay of the critically ill in the emergency department (ED) is increasing and is affected by factors including case-mix, overcrowding, lack of available and staffed intensive care beds and an ageing population. The purpose of this study was to describe the clinical activity associated with these high-acuity patients and to quantify resource utilization by this patient group. METHODS: The study was a retrospective review of ED notes from all patients referred directly to the intensive care team over a 6-month period from April to September 2004. We applied a workload measurement tool, Therapeutic Intervention Scoring System (TISS)-28, which has been validated as a surrogate marker of nursing resource input in the intensive care setting. A nurse is considered capable of delivering nursing activities equal to 46 TISS-28 points in each 8-h shift. RESULTS: The median score from our 69 patients was 19 points per patient. Applying TISS-28 methodology, we estimated that 3 h 13 min nursing time would be spent on a single critically ill ED patient, with a TISS score of 19. This is an indicator of the high levels of personnel resources required for these patients in the ED. ED-validated models to quantify nursing and medical staff resources used across the spectrum of ED care is needed, so that staffing resources can be planned and allocated to match service demands.

  8. Making space for empathy: supporting doctors in the emotional labour of clinical care. (United States)

    Kerasidou, Angeliki; Horn, Ruth


    The academic and medical literature highlights the positive effects of empathy for patient care. Yet, very little attention has been given to the impact of the requirement for empathy on the physicians themselves and on their emotional wellbeing. The medical profession requires doctors to be both clinically competent and empathetic towards the patients. In practice, accommodating both requirements can be difficult for physicians. The image of the technically skilful, rational, and emotionally detached doctor dominates the profession, and inhibits physicians from engaging emotionally with their patients and their own feelings, which forms the basis for empathy. This inhibition has a negative impact not only on the patients but also on the physicians. The expression of emotions in medical practice is perceived as unprofessional and many doctors learn to supress and ignore their feelings. When facing stressful situations, these physicians are more likely to suffer from depression and burnout than those who engage with and reflect on their feelings. Physicians should be supported in their emotional work, which will help them develop empathy. Methods could include questionnaires that aid self-reflection, and discussion groups with peers and supervisors on emotional experiences. Yet, in order for these methods to work, the negative image associated with the expression of emotions should be questioned. Also, the work conditions of physicians should improve to allow them to make use of these tools. Empathy should not only be expected from doctors but should be actively promoted, assisted and cultivated in the medical profession.

  9. The agency of patients and carers in medical care and self-care technologies for interacting with doctors. (United States)

    Nunes, Francisco; Andersen, Tariq; Fitzpatrick, Geraldine


    People living with Parkinson's disease engage in self-care for most of the time but, two or three times a year, they meet with doctors to re-evaluate the condition and adjust treatment. Patients and (informal) carers participate actively in these encounters, but their engagement might change as new patient-centred technologies are integrated into healthcare infrastructures. Drawing on a qualitative study that used observations and interviews to investigate consultations, and digital ethnography to understand interactions in an online community, we describe how patients and carers living with Parkinson's participate in the diagnosis and treatment decisions, engage in discussions to learn about certain topics, and address inappropriate medication. We contrast their engagement with a review of self-care technologies that support interactions with doctors, to investigate how these artefacts may influence the agency of patients and carers. Finally, we discuss design ideas for improving the participation of patients and carers in technology-mediated scenarios.

  10. Doctor-patient interaction in Finnish primary health care as perceived by first year medical students

    Directory of Open Access Journals (Sweden)

    Mäntyselkä Pekka


    Full Text Available Abstract Background In Finland, public health care is the responsibility of primary health care centres, which render a wide range of community level preventive, curative and rehabilitative medical care. Since 1990's, medical studies have involved early familiarization of medical students with general practice from the beginning of the studies, as this pre-clinical familiarisation helps medical students understand patients as human beings, recognise the importance of the doctor-patient relationship and identify practicing general practitioners (GPs as role models for their professional development. Focused on doctor-patient relationship, we analysed the reports of 2002 first year medical students in the University of Kuopio. The students observed GPs' work during their 2-day visit to primary health care centres. Methods We analysed systematically the texts of 127 written reports of 2002, which represents 95.5% of the 133 first year pre-clinical medical students reports. The reports of 2003 (N = 118 and 2004 (N = 130 were used as reference material. Results Majority of the students reported GPs as positive role models. Some students reported GPs' poor attitudes, which they, however, regarded as a learning opportunity. Students generally observed a great variety of responsibilities in general practice, and expressed admiration for the skills and abilities required. They appreciated the GPs' interest in patients concerns. GPs' communication styles were found to vary considerably. Students reported some factors disturbing the consultation session, such as the GP staring at the computer screen and other team members entering the room. Working with marginalized groups, the chronically and terminally ill, and dying patients was seen as an area for development in the busy Finnish primary health care centres. Conclusion During the analysis, we discovered that medical students' perceptions in this study are in line with the previous findings about the

  11. Burnout among middle-grade doctors of tertiary care hospital in Saudi Arabia. (United States)

    Agha, Adnan; Mordy, Ayedh; Anwar, Eram; Saleh, Noha; Rashid, Imran; Saeed, Mona


    Burnout Syndrome is a mental condition caused by chronic exposure to work related stress and is identified by the presence of any of the three distinct elements of emotional exhaustion, depersonalization and lack of personal accomplishment. Middle grade doctors are the backbone of any tertiary care hospital / medical institution, partaking in unscheduled and inpatient care. The aim of this study was to assess the presence of burnout syndrome in the middle grade doctors in a tertiary care hospital in Saudi Arabia. The study was conducted at the Armed Forces Hospital Southern Region, Khamis Mushyt, from August to October 2012 in departments with at least fifty inpatient admissions per month and with at least five middle grade (Resident, Registrar and Senior Registrar) doctors. The departments were Obstetrics and Gynecology, Internal Medicine, Pediatrics, Emergency, General Surgery and Nephrology. This was a cross sectional descriptive and analytical study using the Maslach Burnout Inventory-Health Services Survey and a self-reported stressor-identifying questionnaire to ascertain possible precursors of, or contributing factors to, Burnout Syndrome. A total of 96 proformas/questionnaires were collected anonymously to maintain confidentiality and burnout syndrome was identified in as high as 88.5% of the respondents with high emotional exhaustion in 68.8%, high depersonalization in 63.6% and low personal accomplishment in 38.5%. The authors concluded that burnout syndrome is high among the middle-grade doctors in this medical facility and that urgent steps are needed to address this problem to ensure that these physicians remain physically and mentally healthy.

  12. Exploiting big data for critical care research. (United States)

    Docherty, Annemarie B; Lone, Nazir I


    Over recent years the digitalization, collection and storage of vast quantities of data, in combination with advances in data science, has opened up a new era of big data. In this review, we define big data, identify examples of critical care research using big data, discuss the limitations and ethical concerns of using these large datasets and finally consider scope for future research. Big data refers to datasets whose size, complexity and dynamic nature are beyond the scope of traditional data collection and analysis methods. The potential benefits to critical care are significant, with faster progress in improving health and better value for money. Although not replacing clinical trials, big data can improve their design and advance the field of precision medicine. However, there are limitations to analysing big data using observational methods. In addition, there are ethical concerns regarding maintaining confidentiality of patients who contribute to these datasets. Big data have the potential to improve medical care and reduce costs, both by individualizing medicine, and bringing together multiple sources of data about individual patients. As big data become increasingly mainstream, it will be important to maintain public confidence by safeguarding data security, governance and confidentiality.

  13. Systems biology in critical-care nursing. (United States)

    Schallom, Lynn; Thimmesch, Amanda R; Pierce, Janet D


    Systems biology applies advances in technology and new fields of study including genomics, transcriptomics, proteomics, and metabolomics to the development of new treatments and approaches of care for the critically ill and injured patient. An understanding of systems biology enhances a nurse's ability to implement evidence-based practice and to educate patients and families on novel testing and therapies. Systems biology is an integrated and holistic view of humans in relationship with the environment. Biomarkers are used to measure the presence and severity of disease and are rapidly expanding in systems biology endeavors. A systems biology approach using predictive, preventive, and participatory involvement is being utilized in a plethora of conditions of critical illness and injury including sepsis, cancer, pulmonary disease, and traumatic injuries.

  14. Reptile Critical Care and Common Emergencies. (United States)

    Music, Meera Kumar; Strunk, Anneliese


    Reptile emergencies are an important part of exotic animal critical care, both true emergencies and those perceived as emergencies by owners. The most common presentations for reptile emergencies are addressed here, with information on differential diagnoses, helpful diagnostics, and approach to treatment. In many cases, reptile emergencies are actually acute presentations originating from a chronic problem, and the treatment plan must include both clinical treatment and addressing husbandry and dietary deficiencies at home. Accurate owner expectations must be set in order to have owner compliance to long-term treatment plans. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Doctor-patient communication without family is most frequently practiced in patients with malignant tumors in home medical care settings. (United States)

    Kimura, Takuma; Imanaga, Teruhiko; Matsuzaki, Makoto


    Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.

  16. Doctors and patients in pain: Conflict and collaboration in opioid prescription in primary care. (United States)

    Esquibel, Angela Y; Borkan, Jeffrey


    Use of chronic opioid therapy (COT) for chronic noncancer pain has dramatically increased in the United States. Patients seek compassionate care and relief while physicians struggle to manage patients' pain effectively without doing harm. This study explores the narratives of chronic noncancer pain patients receiving chronic opioid therapy and those of their physicians to better understand the effects of COT on the doctor-patient relationship. A mixed method study was conducted that included in-depth interviews and qualitative analysis of 21 paired patients with chronic pain and their physicians in the following groups: patients, physicians, and patient-physician pairs. Findings revealed that patients' narratives focus on suffering from chronic pain, with emphasis on the role of opioid therapy for pain relief, and physicians' narratives describe the challenges of treating patients with chronic pain on COT. Results elucidate the perceptions of ideal vs difficult patients and show that divergent patterns surrounding the consequences, utility, and goals of COT can negatively affect the doctor-patient relationship. The use of paired interviews through a narrative lens in this exploratory study offers a novel and informative approach for clinical practice and research. The findings have significant implications for improving doctor-patient communication and health outcomes by encouraging shared decision making and goal-directed health care encounters for physicians and patients with chronic pain on COT. This study found patterns of understanding pain, opioid pain medications, and the doctor-patient relationship for patients with chronic pain and their physicians using a narrative lens. Thematic findings in this exploratory study, which include a portrayal of collaborative vs conflictual relationships, suggest areas of future intervention and investigation. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  17. Dual agency in critical care nursing: Balancing responsibilities towards colleagues and patients. (United States)

    Trapani, Josef; Scholes, Julie; Cassar, Maria


    To explore critical care nurses' decisions to seek help from doctors. Despite their well-documented role in improving critically ill patients' outcomes, research indicates that nurses rarely take decisions about patients' treatment modalities on their own and constantly need to seek advice or authorization for their clinical decisions, even for protocol-guided actions. However, research around the factors related to, and the actual process of, such referrals is limited. A grounded theory study, underpinned by a symbolic interactionist perspective. Data collection took place in a general intensive care unit between 2010 - 2012 and involved: 20 hours of non-participant and 50 hours of participant observation; ten informal and ten formal interviews; and two focus groups with ten nurses, selected by purposive and theoretical sampling. Data analysis was guided by the dimensional analysis approach to generating grounded theory. Nurses' decisions to seek help from doctors involve weighing up several occasionally conflicting motivators. A central consideration is that of balancing their moral obligation to safeguard patients' interests with their duty to respect doctors' authority. Subsequently, nurses end up in a position of dual agency as they need to concurrently act as an agent to medical practitioners and patients. Nurses' dual agency relationship with patients and doctors may deter their moral obligation of keeping patients' interest as their utmost concern. Nurse leaders and educators should, therefore, enhance nurses' assertiveness, courage and skills to place patients' interest at the forefront of all their actions and interactions. © 2016 John Wiley & Sons Ltd.

  18. Culture, demographics, and critical care issues: an overview. (United States)

    Núñez, Germán R


    The population dynamic and the immigration trends in the United States continue to challenge health care professionals who each day must serve an increasingly diverse population. Today's physicians must not only have a solid background in medical sciences but they must also have knowledge of how culture, race, and ethnicity impact how patients view and accept traditional Western practices. Whether doctors and patients are close in the "context spectrum" will often determine their ability to communicate beyond the spoken language. According to a report of the American Medical Association, by the year 2000, out of a total 812,770 physicians, only 2.5% were Black, 3.5% Hispanic, and 8.9% Asian. Only a fraction of a percent was American Native/Alaskan Native. Therefore, the majority of the physicians are Caucasian, and it could be assumed that they would likely be accustomed to high-context communication styles. The gross of the demographic changes and population increases in the United States during the past 10 years can be attributed to immigration from regions of the world where low-context communication styles are prevalent. Such differences between physicians and patients can create difficult, tense situations in an already charged atmosphere as can be that of a critical care unit.

  19. The trajectory of experience of critical care nurses in providing end-of-life care: A qualitative descriptive study. (United States)

    Ong, Keh Kiong; Ting, Kit Cheng; Chow, Yeow Leng


    To understand the perceptions of critical care nurses towards providing end-of-life care. There has been an increasing interest in end-of-life care in the critical care setting. In Singapore, approximately half of deaths in the hospital occur during critical care. While nurses are well positioned to provide end-of-life care to patients and their family members, they faced barriers to providing end-of-life care. Also, providing end-of-life care has profound positive and negative psychological effects on nurses, with the latter being more prominent. Qualitative descriptive design. Data collection was performed in a medical intensive care unit of a public tertiary hospital in Singapore. Ten registered nurses were purposively sampled and interviewed individually using a semi-structured interview guide. A codebook was developed to guide coding, and data were thematically analysed. Rigour was maintained. Nurses went through a trajectory of experience. They experienced the culture of care and developed dissatisfaction with it. The tension shaped their perception and meaning of life and death, and they developed mechanisms to reach resolution. This study provides insight on nurses' perception as a trajectory of experience and raised several implications on clinical practice, policy and research. There is a need to alleviate the tension nurses face and to facilitate coming to terms with the tension by improving the culture of care and supporting nurses. Nurses could be involved more in decision-making and empowered to start end-of-life care conversations within the team and with family members. Communication with family members and between nurses and doctors could be improved. Support for nurses providing end-of-life care could be enhanced through promoting social networks, education and bereavement support. Further research is needed to explore ways to support and empower nurses to provide end-of-life care in critical care. © 2017 John Wiley & Sons Ltd.

  20. Perception, attitude and usage of complementary and alternative medicine among doctors and patients in a tertiary care hospital in India. (United States)

    Roy, Vandana; Gupta, Monica; Ghosh, Raktim Kumar


    Complementary and alternative medicine (CAM) has been practiced in India for thousands of years. The aim of this study was to determine the extent of use, perception and attitude of doctors and patients utilizing the same healthcare facility. This study was conducted among 200 doctors working at a tertiary care teaching Hospital, India and 403 patients attending the same, to determine the extent of usage, attitude and perception toward CAM. The use of CAM was more among doctors (58%) when compared with the patients (28%). Among doctors, those who had utilized CAM themselves, recommended CAM as a therapy to their patients (52%) and enquired about its use from patients (37%) to a greater extent. CAM was used concomitantly with allopathic medicine by 60% patients. Very few patients (7%) were asked by their doctors about CAM use, and only 19% patients voluntarily informed their doctors about the CAM they were using. Most patients who used CAM felt it to be more effective, safer, less costly and easily available in comparison to allopathic medicines. CAM is used commonly by both doctors and patients. There is a lack of communication between doctors and patients regarding CAM, which may be improved by sensitization of doctors and inclusion of CAM in the medical curriculum.

  1. What factors are critical to attracting NHS foundation doctors into specialty or core training? A discrete choice experiment. (United States)

    Scanlan, Gillian Marion; Cleland, Jennifer; Johnston, Peter; Walker, Kim; Krucien, Nicolas; Skåtun, Diane


    Multiple personal and work-related factors influence medical trainees' career decision-making. The relative value of these diverse factors is under-researched, yet this intelligence is crucially important for informing medical workforce planning and retention and recruitment policies. Our aim was to investigate the relative value of UK doctors' preferences for different training post characteristics during the time period when they either apply for specialty or core training or take time out. We developed a discrete choice experiment (DCE) specifically for this population. The DCE was distributed to all Foundation Programme Year 2 (F2) doctors across Scotland as part of the National Career Destination Survey in June 2016. The main outcome measure was the monetary value of training post characteristics, based on willingness to forgo additional potential income and willingness to accept extra income for a change in each job characteristic calculated from regression coefficients. 677/798 F2 doctors provided usable DCE responses. Location was the most influential characteristic of a training position, followed closely by supportive culture and then working conditions. F2 doctors would need to be compensated by an additional 45.75% above potential earnings to move from a post in a desirable location to one in an undesirable location. Doctors who applied for a training post placed less value on supportive culture and excellent working conditions than those who did not apply. Male F2s valued location and a supportive culture less than female F2s. This is the first study focusing on the career decision-making of UK doctors at a critical careers decision-making point. Both location and specific job-related attributes are highly valued by F2 doctors when deciding their future. This intelligence can inform workforce policy to focus their efforts in terms of making training posts attractive to this group of doctors to enhance recruitment and retention. © Article author

  2. Implementation of the European Working Time Directive in an NHS trust: impact on patient care and junior doctor welfare. (United States)

    McIntyre, Hugh F; Winfield, Sarah; Te, Hui Sen; Crook, David


    To comply with the European Working Time Directive (EWTD), from 1 August 2009, junior doctors are required to work no more than 48 hours per week. In accordance with this, East Sussex Hospitals Trust introduced changes to working practice in August 2007. To assess the impact upon patient care and junior doctor welfare a retrospective observational survey comparing data from the year prior to and the year following August 2007 was conducted. No impact on the standard of patient care, as measured by length of stay, death during admission or readmission was found. However, there was a notable increase in episodes of sick leave among junior doctors. Implementation of the EWTD may maintain standards of patient care but may be detrimental to the welfare of doctors in training.

  3. Pulmonary Hypertension in Pregnancy: Critical Care Management

    Directory of Open Access Journals (Sweden)

    Adel M. Bassily-Marcus


    Full Text Available Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases.

  4. The role of the female doctorally prepared nurse in caring for infertile women. (United States)

    Marshak, L S


    Today, in medical and nursing literature, infertility is described as a couple problem, with interventions aimed at treating the couple. While not dismissing the fact that the conception does involve both genders, the reality of infertility treatment is that the woman, not the couple, undergoes the majority of infertility testing and treatment. The numerous physical demands made of women during infertility investigation and therapy are associated with significant emotional and informational needs. As such, all infertility practices should offer supportive counseling to their clients. Incorporation of such services into general infertility treatment will ensure that the greatest number of female infertility clients receive the information and emotional support they need. The health care professional best qualified to provide these services is the female doctorally prepared nurse. By virtue of both her gender and training, she is more likely to be capable of intervening therapeutically, woman to woman, in a sensitive and empathic manner. Furthermore, she can anticipate extending her role to include the following services: (a) provision of basic gynecological care, (b) follow-up of patients on hormone therapy, (c) coordination of patient care, (d) provision of supportive counseling, and (e) participation in research. To secure a position, the female doctorally prepared nurse needs to recognize the importance of promoting herself in the infertility marketplace. Ultimately, both the establishment and survival of her role will depend on her professional uniqueness.

  5. Critical Care Organizations: Building and Integrating Academic Programs. (United States)

    Moore, Jason E; Oropello, John M; Stoltzfus, Daniel; Masur, Henry; Coopersmith, Craig M; Nates, Joseph; Doig, Christopher; Christman, John; Hite, R Duncan; Angus, Derek C; Pastores, Stephen M; Kvetan, Vladimir


    Academic medical centers in North America are expanding their missions from the traditional triad of patient care, research, and education to include the broader issue of healthcare delivery improvement. In recent years, integrated Critical Care Organizations have developed within academic centers to better meet the challenges of this broadening mission. The goal of this article was to provide interested administrators and intensivists with the proper resources, lines of communication, and organizational approach to accomplish integration and Critical Care Organization formation effectively. The Academic Critical Care Organization Building section workgroup of the taskforce established regular monthly conference calls to reach consensus on the development of a toolkit utilizing methods proven to advance the development of their own academic Critical Care Organizations. Relevant medical literature was reviewed by literature search. Materials from federal agencies and other national organizations were accessed through the Internet. The Society of Critical Care Medicine convened a taskforce entitled "Academic Leaders in Critical Care Medicine" on February 22, 2016 at the 45th Critical Care Congress using the expertise of successful leaders of advanced governance Critical Care Organizations in North America to develop a toolkit for advancing Critical Care Organizations. Key elements of an academic Critical Care Organization are outlined. The vital missions of multidisciplinary patient care, safety, and quality are linked to the research, education, and professional development missions that enhance the value of such organizations. Core features, benefits, barriers, and recommendations for integration of academic programs within Critical Care Organizations are described. Selected readings and resources to successfully implement the recommendations are provided. Communication with medical school and hospital leadership is discussed. We present the rationale for critical


    Directory of Open Access Journals (Sweden)

    V. I. Tkachenko


    Full Text Available The assessment of results of new guidelines’ implementation in type 2 diabetes and quality of care is actual in Ukraine. The aim of our research is to develop a simple methodology for assessing the quality of diabetes care during new diabetes guideline implementation in Ukraine. Materials and Methods. We conducted a systematic review of S6 Ukrainian and 148 foreign literature in assessment of diabetes care, quality indicators, based on which our method was formed, its approbation was held. Statistical analysis was performed using Excel 2007, SPSS, Statistica 6.0. Results. We have developed a questionnaire by adapting existing English-language questionnaire GUIDANCE to Ukrainian health care system and added questions about knowledge and results of implementation new Ukrainian guidelines in diabetes care. The validation of questionnaire included expertise on content validity, reliability (Cronbach’s alpha level = 0.87, the sensitivity (0.7 and specificity (0.82. The method consists of use developed questionnaire for doctors in conjunction with the data of statistical reports and valid versions of questionnaires for diabetes patients ADDQoL DTSQ. The example of application of this method for assessment the quality of diabetes care is described and was informative. The proposed method allows to analyze all aspects of the quality of diabetes care.

  7. Health care reform in Russia: a survey of head doctors and insurance administrators. (United States)

    Twigg, Judyth L


    In keeping with the introduction of market-oriented reforms since the collapse of the Soviet Union, Russia's health care system has undergone a series of sweeping changes since 1992. These reforms, intended to overhaul socialized methods of health care financing and delivery and to replace them with a structure of competitive incentives to improve efficiency and quality of care, have met with mixed levels of implementation and results. This article probes some of the sources of support for and resistance to change in Russia's system of health care financing and delivery. It does so through a national survey of two key groups of participants in that system: head doctors in Russian clinics and hospitals, and the heads of the regional-level quasi-governmental medical insurance Funds. The survey results demonstrate that, on the whole, both head doctors and health insurance Fund directors claim to support the recent health care system reforms, although the latter's support is consistently statistically significantly stronger than that of the former. In addition, the insurance Fund directors' responses to the survey questions tend consistently to fall in the shape of a standard bell curve around the average responses, with a small number of respondents more in agreement with the survey statements than average, and a similarly small number of respondents less so. By contrast, the head doctors, along a wide variety of reform measures, split into two camps: one that strongly favors the marketization of health care, and one that would prefer a return to Soviet-style socialized medicine. The survey results show remarkable national consistency, with no variance according to the respondents' geographic location, regional population levels or other demographic or health characteristics, age of respondents, or size of health facility represented. These findings demonstrate the emergence of well-defined bureaucratic and political constituencies, their composition mixed depending

  8. The self-construal of nurses and doctors: beliefs on interdependence and independence in the care of older people. (United States)

    Voyer, Benjamin G; Reader, Tom


    To compare the self-construal of nurses and doctors and establish whether their roles affect perceptions of independence and interdependence. Previous research has identified that errors in patient care occur when health professionals do not work cohesively as a team and have divergent beliefs about collaboration. Thus, it is important to understand factors shaping these beliefs. Although these are usually explained by aspects of group norms, the concept of self-construal may serve as an underlying explanation. A quasi-experimental design was used. One hundred and two nurses and doctors working in three nursing homes in Belgium took part in this study in 2009. Nurses' and doctors' self-construal was measured at their workplace, using Singelis' self-construal scale. Statistical differences between nurses and doctors were investigated using analysis of covariance. Results showed statistically significant differences between doctors' and nurses' self-construal. Doctors reported higher and dominant levels of 'independent self-construal' compared with nurses. There were no differences between nurses and doctors for interdependence. However, gender differences emerged with male doctors reporting lower levels of interdependent self-construal than male nurses. Conversely, female doctors reported higher levels of interdependent self-construal than female nurses. Differences in the roles and training of nurses and doctors and in knowledge of their interdependencies may explain differences in self-construal. This might be useful for understanding why nurses and doctors develop divergent attitudes towards teamwork. Training that focuses on sharing knowledge on team interdependencies may positively influence teamwork attitudes and behaviour. © 2013 John Wiley & Sons Ltd.

  9. Knowledge, Skills and Experience Managing Tracheostomy Emergencies: A Survey of Critical Care Medicine trainees

    LENUS (Irish Health Repository)

    Nizam, AA


    Since the development of percutaneous tracheostomy, the number of tracheostomy patients on hospital wards has increased. Problems associated with adequate tracheostomy care on the wards are well documented, particularly the management of tracheostomy-related emergencies. A survey was conducted among non-consultant hospital doctors (NCHDs) starting their Critical Care Medicine training rotation in a university affiliated teaching hospital to determine their basic knowledge and skills in dealing with tracheostomy emergencies. Trainees who had received specific tracheostomy training or who had previous experience of dealing with tracheostomy emergencies were more confident in dealing with such emergencies compared to trainees without such training or experience. Only a minority of trainees were aware of local hospital guidelines regarding tracheostomy care. Our results highlight the importance of increased awareness of tracheostomy emergencies and the importance of specific training for Anaesthesia and Critical Care Medicine trainees.

  10. [Continuous medical education of general practitioners/family doctors in chronic wound care]. (United States)

    Sinozić, Tamara; Kovacević, Jadranka


    A number of healthcare professionals, specialists in different fields and with different levels of education, as well as non-healthcare professionals, are involved in the care of chronic wound patients, thus forming a multidisciplinary team that is not only responsible for the course and outcome of treatment, but also for the patient quality of life. Family doctor is also member of the team the task of which is to prevent, diagnose, monitor and anticipate complications and relapses, as well as complete recovery of chronic wound patients, with the overall care continuing even after the wound has healed, or is involved in palliative care. A family medicine practitioner with specialized education and their team of associates in the primary health care, along with material conditions and equipment improvement, can provide quality care for patients with peripheral cardiovascular diseases and chronic wounds, organized according to the holistic approach. It is essential that all professional associations of family medicine as well as professional associations of other specialties - fields that are involved in wound prevention and treatment - be included in developing the continuous medical education program. The benefits of modern information technology should be used to good advantage. The education should be adapted to the needs of family practitioners in terms of the form, place, time, volume, financial affordability and choice of topic. The interest shown in team education should be transformed into specialized programs in the creation of which it is essential to include both physicians and nurses and their respective professional associations. Special attention should be paid to education and training of young doctors/nurses, those with less work experience, those that have not yet been part of such education, those that lack experience in working with wound patients, those whose teams deal mostly with elderly patients, and also residents in family medicine and

  11. Providing care for critically ill surgical patients: challenges and recommendations. (United States)

    Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M


    Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed.

  12. "Doctor, Why Didn't You Adopt My Baby?" Observant Participation, Care, and the Simultaneous Practice of Medicine and Anthropology. (United States)

    Sufrin, Carolyn


    Medical anthropology has long appreciated the clinical encounter as a rich source of data and a key site for critical inquiry. It is no surprise, then, that a number of physician-anthropologists have used their clinical insights to make important contributions to the field. How does this duality challenge and enhance the moral practice and ethics of care inherent both to ethnography and to medicine? How do bureaucratic and professional obligations of HIPAA and the IRB intersect with aspirations of anthropology to understand human experience and of medicine to heal with compassion? In this paper, I describe my simultaneous fieldwork and clinical practice at an urban women's jail in the United States. In this setting, being a physician facilitates privileged access to people and spaces within, garners easy trust, and enables an insider perspective more akin to observant participation than participant observation. Through experiences of delivering the infants of incarcerated pregnant women and of being with the mothers as they navigate drug addiction, child custody battles, and re-incarceration, the roles of doctor and anthropologist become mutually constitutive and transformative. Moreover, the dual practice reveals congruities and cracks in each discipline's ethics of care. Being an anthropologist among informants who may have been patients reworks expectations of care and necessitates ethical practice informed by the dual roles.

  13. Find a Doctor (United States)

    ... Manager Book Appointments Getting Care When on Active Duty Getting Care When Traveling What's Covered Health Care Dental Care ... Manager Book Appointments Getting Care When on Active Duty Getting Care When Traveling Bread Crumbs Home Find a Doctor ...

  14. [Level of knowledge and action on lipaemia among Spanish primary and specialist care doctors. Press cholesterol study]. (United States)

    Abellán Alemán, José; Leal Hernández, Mariano; Martínez Pastor, Antonio; Hernández Menárguez, Fernando; García-Galbis Marín, José Antonio; Jara Gómez, Purificación


    To find the level of knowledge, the guidelines for action and the monitoring of lipaemia by Spanish primary care and specialist doctors. A self-defined questionnaire of 12 items was designed. Data on the population treated and the subjective evaluation of objectives, and on the management and monitoring of lipid parameters were filled in. A total of 1998 doctors from the whole of Spain took part; 68.8% of the doctors interviewed worked in primary health care and 30.2% in specialist centres or hospitals. A 91% of the doctors said they followed international consensus on monitoring lipaemia. The most commonly used objective therapeutic parameter for treating lipaemia was LDL-cholesterol (83%), followed by total cholesterol (62%), HDL-cholesterol (56%) and triglycerides (51%). If the patient's lipaemia was well controlled, then 21.8% of doctors reduced the doses of lipid-lowerers. In general terms, no great differences were appreciated between the criteria followed by PC and by specialist doctors. The criteria for action on lipaemia could be improved. There are no important differences of view or action in clinical and therapeutic criteria for Lipaemia cases between PC and specialist doctors.

  15. November 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA


    Full Text Available No abstract available. Article truncated at 150 words. Mehta S, Burry L, Cook D, Fergusson D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol. JAMA 2012;308:1985-92. PDFThis study was a multi-center, randomized controlled trial that compared protocolized sedation with protocolized sedation plus daily sedation interruption. The protocol used to titrate benzodiazepine and opioid infusions incorporated a validated scale (Sedation-agitation Scale (SAS or Richmond Agitation Sedation Scale (RASS in order to maintain a comfortable but arousable state. Four hundred and thirty mechanically ventilated, critically ill patients were recruited from medical and surgical ICUs in 16 institutions in North America. The study showed no benefit in the group that underwent daily sedation interruption - length of intubation was 7 days, length of ICU stay was 10 days and length of hospital stay was 20 days in both groups. There was no significant difference in the incidence of delirium (53 vs. ...

  16. Ethical budgets: a critical success factor in implementing new public management accountability in health care. (United States)

    Bosa, Iris M


    New public management accountability is increasingly being introduced into health-care systems throughout the world - albeit with mixed success. This paper examines the successful introduction of new management accounting systems among general practitioners (GPs) as an aspect of reform in the Italian health-care system. In particular, the study examines the critical role played by the novel concept of an 'ethical budget' in engaging the willing cooperation of the medical profession in implementing change. Utilizing a qualitative research design, with in-depth interviews with GPs, hospital doctors and managers, along with archival analysis, the present study finds that management accounting can be successfully implemented among medical professionals provided there is alignment between the management imperative and the ethical framework in which doctors practise their profession. The concept of an 'ethical budget' has been shown to be an innovative and effective tool in achieving this alignment.

  17. Healthcare reform: the role of coordinated critical care. (United States)

    Cerra, F B


    To evaluate and editorialize the evolving role of the discipline of critical care as a healthcare delivery system in the process of healthcare reform. The sources included material from the Federal Office of Management and Budget, Health Care Financing Review, President Bush's Office, Association of American Medical Colleges, and publications of the Society of Critical Care Medicine. Data were selected that the author felt was relevant to the healthcare reform process and its implications for the discipline of critical care. The data were extracted by the author to illustrate the forces behind healthcare reform, the implications for the practice of critical care, and role of critical care as a coordinated (managed) care system in the process of healthcare reform. Healthcare reform has been initiated because of a number of considerations that arise in evaluating the current healthcare delivery system: access, financing, cost, dissatisfactions with the mechanisms of delivery, and political issues. The reform process will occur with or without the involvement of critical care practitioners. Reforms may greatly alter the delivery of critical care services, education, training, and research in critical care. Critical care has evolved into a healthcare delivery system that provides services to patients who need and request them and provides these services in a coordinated (managed) care model. Critical care practitioners must become involved in the healthcare reform process, and critical care services that are effective must be preserved, as must the education, training, and research programs. Critical care as a healthcare delivery system utilizing a coordinated (managed) care model has the potential to provide services to all patients who need them and to deliver them in a manner that is cost effective and recognized as providing added value.

  18. Caring behaviours directly and indirectly affect nursing students' critical thinking. (United States)

    Chen, Shu-Yueh; Chang, Hsing-Chi; Pai, Hsiang-Chu


    The purpose of this study was to determine the effect of caring behaviours on critical thinking and to examine whether self-reflection mediates the effect of caring on critical thinking. We also tested whether caring behaviours moderated the relationship between self-reflection and critical thinking. For this descriptive, correlational, cross-sectional study, we recruited 293 fifth-year nursing students from a junior college in southern Taiwan. Data were collected in 2014 on critical thinking, caring behaviours and self-reflection with insight using the Taiwan Critical Thinking Disposition Inventory, a Chinese version of the Caring Assessment Report Evaluation Q-sort, and a Chinese version of the Self-Reflection and Insight Scale, respectively. Relationships among variables were analysed by structural equation modelling, with the partial least squares method and Sobel test. The results showed that caring behaviours significantly positively affected critical thinking (β = 0.56, t = 12.37, p critical thinking (β = 0.34, t = 6.48, p critical thinking. Caring behaviours did not, however, moderate the relationship between self-reflection (β = 0.001, t = 0.021, p > 0.05) and critical thinking. Caring behaviours directly affect self-reflection with insight and critical thinking. In addition, caring behaviours also indirectly affect critical thinking through self-reflection and insight. © 2017 Nordic College of Caring Science.

  19. The role of doctors in provision of support for primary health care ...

    African Journals Online (AJOL)

    South African Family Practice ... Twelve clinics reported that doctors spent time teaching staff during the visit. ... During focus group discussions, both doctors and nurses stated that doctors' visits were generally helpful, but both groups felt strongly that the time spent in the clinic during visits was too short, and that the doctor ...

  20. Are doctor of pharmacy curricula in developing countries adequate to train graduates to provide pharmaceutical care?

    Directory of Open Access Journals (Sweden)

    Ramalingam Peraman


    Full Text Available Doctor of Pharmacy (PharmD program is a new dimension of pharmacy education in developing countries. The PharmD graduates are expected to participate in patient health care by providing pharmaceutical care. The graduates should have enough necessary clinical knowledge, competitiveness and skills in community, hospital and clinical pharmacy related services. There is a need of curriculum that fit into the program outcome that helps to attain graduate competency. Programs in India, Pakistan, Iran and Nepal were reviewed based on the available literature. Even though it is evident that the PharmD curriculum in developing countries has made an attempt to provide patient-oriented approach for pharmacists, the existing curriculum, training and orientation have several pitfalls. It needs assessment, evaluation and improvement.

  1. Feminization and marginalization? Women Ayurvedic doctors and modernizing health care in Nepal. (United States)

    Cameron, Mary


    The important diversity of indigenous medical systems around the world suggests that gender issues, well understood for Western science, may differ in significant ways for non-Western science practices and are an important component in understanding how social dimensions of women's health care are being transformed by global biomedicine. Based on ethnographic research conducted with formally trained women Ayurvedic doctors in Nepal, I identify important features of medical knowledge and practice beneficial to women patients, and I discuss these features as potentially transformed by modernizing health care development. The article explores the indirect link between Ayurveda's feminization and its marginalization, in relation to modern biomedicine, which may evolve to become more direct and consequential for women's health in the country.

  2. How physician electronic health record screen sharing affects patient and doctor non-verbal communication in primary care. (United States)

    Asan, Onur; Young, Henry N; Chewning, Betty; Montague, Enid


    Use of electronic health records (EHRs) in primary-care exam rooms changes the dynamics of patient-physician interaction. This study examines and compares doctor-patient non-verbal communication (eye-gaze patterns) during primary care encounters for three different screen/information sharing groups: (1) active information sharing, (2) passive information sharing, and (3) technology withdrawal. Researchers video recorded 100 primary-care visits and coded the direction and duration of doctor and patient gaze. Descriptive statistics compared the length of gaze patterns as a percentage of visit length. Lag sequential analysis determined whether physician eye-gaze influenced patient eye gaze, and vice versa, and examined variations across groups. Significant differences were found in duration of gaze across groups. Lag sequential analysis found significant associations between several gaze patterns. Some, such as DGP-PGD ("doctor gaze patient" followed by "patient gaze doctor") were significant for all groups. Others, such DGT-PGU ("doctor gaze technology" followed by "patient gaze unknown") were unique to one group. Some technology use styles (active information sharing) seem to create more patient engagement, while others (passive information sharing) lead to patient disengagement. Doctors can engage patients in communication by using EHRs in the visits. EHR training and design should facilitate this. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. A marketing clinical doctorate programs. (United States)

    Montoya, Isaac D; Kimball, Olive M


    Over the past decade, clinical doctorate programs in health disciplines have proliferated amid both support and controversy among educators, professional organizations, practitioners, administrators, and third-party payers. Supporters argue that the explosion of new knowledge and increasing sophistication of technology have created a need for advanced practice models to enhance patient care and safety and to reduce costs. Critics argue that necessary technological advances can be incorporated into existing programs and believe that clinical doctorates will increase health care costs, not reduce them. Despite the controversy, many health disciplines have advanced the clinical doctorate (the most recent is the doctor of nursing practice in 2004), with some professions mandating the doctorate as the entry-level degree (i.e., psychology, pharmacy, audiology, and so on). One aspect of the introduction of clinical doctoral degrees has been largely overlooked, and that is the marketing aspect. Because of marketing considerations, some clinical doctorates have been more successfully implemented and accepted than others. Marketing is composed of variables commonly known as "the four P's of marketing": product, price, promotion, and place. This report explores these four P's within the context of clinical doctorates in the health disciplines.

  4. Spin doctoring


    Vozková, Markéta


    1 ABSTRACT The aim of this text is to provide an analysis of the phenomenon of spin doctoring in the Euro-Atlantic area. Spin doctors are educated people in the fields of semiotics, cultural studies, public relations, political communication and especially familiar with the infrastructure and the functioning of the media industry. Critical reflection of manipulative communication techniques puts spin phenomenon in historical perspective and traces its practical use in today's social communica...

  5. Outcome evaluation of a new model of critical care orientation. (United States)

    Morris, Linda L; Pfeifer, Pamela; Catalano, Rene; Fortney, Robert; Nelson, Greta; Rabito, Robb; Harap, Rebecca


    The shortage of critical care nurses and the service expansion of 2 intensive care units provided a unique opportunity to create a new model of critical care orientation. The goal was to design a program that assessed critical thinking, validated competence, and provided learning pathways that accommodated diverse experience. To determine the effect of a new model of critical care orientation on satisfaction, retention, turnover, vacancy, preparedness to manage patient care assignment, length of orientation, and cost of orientation. A prospective, quasi-experimental design with both quantitative and qualitative methods. The new model improved satisfaction scores, retention rates, and recruitment of critical care nurses. Length of orientation was unchanged. Cost was increased, primarily because a full-time education consultant was added. A new model for nurse orientation that was focused on critical thinking and competence validation improved retention and satisfaction and serves as a template for orientation of nurses throughout the medical center.

  6. Requirements for reflection in the critical care environment

    Directory of Open Access Journals (Sweden)

    Celia J. Filmalter


    Full Text Available Background: Reflection is recognised as an important method for practice development. The importance of reflection is well documented in the literature, but the requirements for reflection remain unclear. Objectives: To explore and describe the requirements for reflection in the critical care environment as viewed by educators of qualified critical care nurses. Method: A focus group interview was conducted to explore and describe the views of educators of qualified critical care nurses regarding requirements for reflection in the critical care environment. Results: The themes that emerged from the focus group were buy-in from stakeholders –management, facilitators and critical care nurses, and the need to create an environment where reflection can occur. Conclusion: Critical care nurses should be allowed time to reflect on their practice and be supported by peers as well as a facilitator in a non-intimidating way to promote emancipatorypractice development.

  7. February 2013 critical care journal club

    Directory of Open Access Journals (Sweden)

    Robbins RA


    Full Text Available No abstract available. Article truncated after 150 words. Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, Zhou Q, Matte A, Walter SD, Lamontagne F, Granton JT, Arabi YM, Arroliga AC, Stewart TE, Slutsky AS, Meade MO; the OSCILLATE Trial Investigators and the Canadian Critical Care Trials Group. High-Frequency Oscillation in Early Acute Respiratory Distress Syndrome. N Engl J Med. 2013;368:795-805. Young D, Lamb SE, Shah S, Mackenzie I, Tunnicliffe W, Lall R, Rowan K, Cuthbertson BH; the OSCAR Study Group. High-Frequency Oscillation for Acute Respiratory Distress Syndrome. N Engl J Med. 2013;368:806-13. Malhotra A, Drazen JM. High-Frequency Oscillatory Ventilation on Shaky Ground. N Engl J Med. 2013;368:863-5. Two articles and an accompanying editorial, the later co-authored by none less than the editor, appeared in the New England Journal of Medicine this week. These all dealt with the use of high-frequency oscillatory ventilation (HFOV in the adult respiratory distress syndrome (ARDS. As the editorial points …

  8. Multiple trauma in children: critical care overview. (United States)

    Wetzel, Randall C; Burns, R Cartland


    Multiple trauma is more than the sum of the injuries. Management not only of the physiologic injury but also of the pathophysiologic responses, along with integration of the child's emotional and developmental needs and the child's family, forms the basis of trauma care. Multiple trauma in children also elicits profound psychological responses from the healthcare providers involved with these children. This overview will address the pathophysiology of multiple trauma in children and the general principles of trauma management by an integrated trauma team. Trauma is a systemic disease. Multiple trauma stimulates the release of multiple inflammatory mediators. A lethal triad of hypothermia, acidosis, and coagulopathy is the direct result of trauma and secondary injury from the systemic response to trauma. Controlling and responding to the secondary pathophysiologic sequelae of trauma is the cornerstone of trauma management in the multiply injured, critically ill child. Damage control surgery is a new, rational approach to the child with multiple trauma. The selection of children for damage control surgery depends on the severity of injury. Major abdominal vascular injuries and multiple visceral injuries are best considered for this approach. The effective management of childhood multiple trauma requires a combined team approach, consideration of the child and family, an organized trauma system, and an effective quality assurance and improvement mechanism.

  9. The research agenda for trauma critical care. (United States)

    Asehnoune, Karim; Balogh, Zsolt; Citerio, Giuseppe; Cap, Andre; Billiar, Timothy; Stocchetti, Nino; Cohen, Mitchell J; Pelosi, Paolo; Curry, Nicola; Gaarder, Christine; Gruen, Russell; Holcomb, John; Hunt, Beverley J; Juffermans, Nicole P; Maegele, Mark; Midwinter, Mark; Moore, Frederick A; O'Dwyer, Michael; Pittet, Jean-François; Schöchl, Herbert; Schreiber, Martin; Spinella, Philip C; Stanworth, Simon; Winfield, Robert; Brohi, Karim


    In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice. The timing and efficacy of platelet transfusions remain in question, while new blood products need to be developed and evaluated, including whole blood variants, lyophilised products and novel red cell storage modalities. The current cornerstones of TBI management are intracranial pressure control, maintenance of cerebral perfusion pressure and avoidance of secondary insults (such as hypotension, hypoxaemia, hyperglycaemia and pyrexia). Therapeutic hypothermia and decompressive craniectomy are controversial therapies. Further research into these strategies should focus on identifying which subgroups of patients may benefit from these interventions. Prediction of the long-term outcome early after TBI remains challenging. Early magnetic resonance imaging has recently been evaluated for predicting the long-term outcome in mild and severe TBI. Novel biomarkers may also help in outcome prediction and may predict chronic neurological symptoms. For trauma in general, rehabilitation is complex and multidimensional, and the optimal timing for commencement of rehabilitation needs investigation. We propose priority areas for clinical trials in the next 10 years.

  10. Rationing critical care medicine: recent studies and current trends. (United States)

    Ward, Nicholas S


    This paper reviews the literature on the rationing of critical care resources. Although much has been written about the concept of rationing, there have been few scientific studies as to its prevalence. A recent meta-analysis reviewed all previously published studies on rationing access to intensive care units but little is known about practices within the intensive care unit. Much literature in the past few years has focused on the growing use of critical care resources and projections for the future. Several authors suggest there may be a crisis in financial or personnel resources if some rationing does not take place. Other papers have argued that the methods of rationing critical care previously proposed, such as limiting the care of dying patients or using cost-effectiveness analysis to determine care, may not be effective or viewed as ethical by some. Finally, several recent papers review how critical care is practiced and allocated in India and Asian countries that already practice open rationing in their health care systems. There is currently no published evidence that overt rationing is taking place in critical care medicine. There is growing evidence that in the future, the need for critical care may outstrip financial resources unless some form of rationing takes place. It is also clear from the literature that choosing how to ration critical care will be a difficult task.

  11. A critical examination of developments in nursing doctoral education in the United States

    Directory of Open Access Journals (Sweden)

    Shaké Ketefian


    Full Text Available Graduate nursing education in the United States is undergoing major transformations, as a result of factors both within nursing and in the larger society.OBJECTIVE: In this paper the authors examine the trends and factors that are influencing the changes, especially in doctoral education, for both nurse scientist and advanced practice preparation.CONCLUSION: The paper provides a background that serves as context, it gives an overview of the PhD and the DNP degrees, focusing on the recent changes and identifying the most compelling issues and concerns, ending with a series of recommendations.

  12. [Conflict styles observed in doctors and nurses in health care organization]. (United States)

    Brestovacki, Branislava; Milutinović, Dragana; Cigić, Tomislav; Grujić, Vera; Simin, Dragana


    Health care workers often come into conflict situations while performing their daily activities. People behave differently when they come into conflicts and they are usually not aware of their own reactions. The aim of this paper was to establish the presence of conflict styles among health workers and the differences in relation to demographic characteristics (education, working experience, managerial position). The research was done as a cross-sectional study and through surveys. The conflict handling questionnaire was used as the research instrument. The questionnaire contained 30 statements arranged in five dimensions of conflict styles. The sample included one hundred nurses and fifty-five doctors. The research showed that accommodating was the most often used conflict style. There was no significant difference in styles of managerial and non-managerial staff, but there was a significant difference in the styles adopted by doctors and nurses. It should be noted that nurses used avoiding and accommodating conflict styles much more often. It is important to increase the awareness of conflict existence and the possibility of solving the problem constructively in order to achieve more efficient duty performance.


    Directory of Open Access Journals (Sweden)

    Husain Isa Hasan, Yusuf Nooh, Adel Salman Alsayyad


    Full Text Available Background: Burnout isa type of prolonged response to chronic job-related stress appears as a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment. Objectives: The present study investigated level of burnout, compare burnout levels in view of demographic factors and to identify the potential risk factors that lead to high level of burnout among secondary care doctors in Ministry of Health in Bahrain kingdom. Methods: The study was carried out in 230 doctors. A questionnaire survey was administered: The level of “burnout” was evaluated using the Maslach Burnout Inventory; socio-demographic variables were collected as well. Results: the mean response rate was 87.8%. The prevalence of the three dimensions of burn out was 43.1% with high emotional exhaustion, 26.7% with high depersonalization and 51.5% reported low personal accomplishment. In general, the profiles of an individual with high burn out were between 30-40 years old Bahraini married physician with no children. Conclusion: a high level burnout was found among the studied population. The study results underline significant relations that were found to link burn out with various socio-demographic variables.

  14. 'What makes an excellent mental health doctor?' A response integrating the experiences and views of service users with critical reflections of psychiatrists. (United States)

    Gunasekara, Imani; Patterson, Sue; Scott, James G


    While therapeutic relationships are appropriately recognised as the foundation of mental health service, service users commonly report suboptimal experiences. With shared understanding critical to improvement in practice, we explored service users' experiences and expectations of psychiatrists and consultations, engaging psychiatrists throughout the process. Using an iterative qualitative approach we co-produced a response to the question 'what makes an excellent mental health doctor?' Experiences and expectations of psychiatrists were explored in interviews with 22 service users. Data collection, analysis and interpretation were informed by consultation with peer workers. Findings were contextualised in formal consultations with psychiatrists. As 'masters of their craft', excellent mental health doctors engage authentically with service users as people (not diagnoses). They listen, validate experiences and empathise affectively and cognitively. They demonstrate phronesis, applying clinical knowledge compassionately. Psychiatrists share service users' aspiration of equitable partnership but competing demands and 'professional boundaries' constrain engagement. Consistent delivery of the person-centred, recovery-oriented care promoted by policy and sought by service users will require substantial revision of the structure and priorities of mental health services. The insights and experiences of service users must be integral to medical education, and systems must provide robust support to psychiatrists. © 2017 John Wiley & Sons Ltd.

  15. When doctor becomes patient: challenges and strategies in caring for physician-patients. (United States)

    Domeyer-Klenske, Amy; Rosenbaum, Marcy


    The current study was aimed at exploring the challenges that arise in the doctor-patient relationship when the patient is also a physician and identifying strategies physicians use to meet these challenges. No previous research has systematically investigated primary care physicians' perspectives on caring for physician-patients. Family medicine (n=15) and general internal medicine (n=14) physicians at a large Midwestern university participated in semi-structured interviews where they were asked questions about their experiences with physician-patients and the strategies they used to meet the unique needs of this patient population. Thematic analysis was used to identify common responses. Three of the challenges most commonly discussed by physician participants were: (1) maintaining boundaries between relationships with colleagues or between roles as physician/colleague/friend, (2) avoiding assumptions about patient knowledge and health behaviors, and (3) managing physician-patients' access to informal consultations, personal test results, and opinions from other colleagues. We were able to identify three main strategies clinicians use in addressing these perceived challenges: (1) Ignore the physician-patient's background, (2) Acknowledge the physician-patient's background and negotiate care, and (3) Allow care to be driven primarily by the physician-patient. It is important that primary care physicians understand the challenges inherent in treating physicians and develop a strategy with which they are comfortable addressing them. Explicitly communicating with the physician-patient to ensure boundaries are maintained, assumptions about the physician-patient are avoided, and physician-patient access is properly managed are key to providing quality care to physician-patients.

  16. The social accountability of doctors: a relationship based framework for understanding emergent community concepts of caring. (United States)

    Green-Thompson, Lionel P; McInerney, Patricia; Woollard, Bob


    Social accountability is defined as the responsibility of institutions to respond to the health priorities of a community. There is an international movement towards the education of health professionals who are accountable to communities. There is little evidence of how communities experience or articulate this accountability. In this grounded theory study eight community based focus group discussions were conducted in rural and urban South Africa to explore community members' perceptions of the social accountability of doctors. The discussions were conducted across one urban and two rural provinces. Group discussions were recorded and transcribed verbatim. Initial coding was done and three main themes emerged following data analysis: the consultation as a place of love and respect (participants have an expectation of care yet are often engaged with disregard); relationships of people and systems (participants reflect on their health priorities and the links with the social determinants of health) and Ubuntu as engagement of the community (reflected in their expectation of Ubuntu based relationships as well as part of the education system). These themes were related through a framework which integrates three levels of relationship: a central community of reciprocal relationships with the doctor-patient relationship as core; a level in which the systems of health and education interact and together with social determinants of health mediate the insertion of communities into a broader discourse. An ubuntu framing in which the tensions between vulnerability and power interact and reflect rights and responsibility. The space between these concepts is important for social accountability. Social accountability has been a concept better articulated by academics and centralized agencies. Communities bring a richer dimension to social accountability through their understanding of being human and caring. This study also creates the connection between ubuntu and social

  17. [Acceptability and feasibility among primary care doctors of the opportunistic search for HIV in Health Care centers in Spain]. (United States)

    Puentes Torres, Rafael Carlos; Aguado Taberné, Cristina; Pérula de Torres, Luis Ángel; Espejo Espejo, José; Castro Fernández, Cristina; Fransi Galiana, Luis


    To evaluate the acceptability and feasibility of the opportunistic search of HIV according to primary care doctors' experience. To set up the profile of the physician involved in this study. Observational, transversal study. Primary Care Centers of the National Health System. General practitioners and residents who participated in VIH-AP study to measure the acceptability of HIV opportunistic search by patients. Self-filling survey to collect data on age, sex, teaching skills, amount of years dedicated to research, time working with the same quota of patients, acceptability and feasibility of opportunistic HIV search. A total of 197 physicians with a mean age of 45.2±9.7 (SD) years. 18.8% were under 36years old, 70.1% were women and 62.4% had teaching skills. 55.8% worked in towns with a population over 100,000 inhabitants and the mean of years working with the same quota of patients was 6.4±6.6. 91.9% (95%CI: 88.1-98.7) of them considered the opportunistic search of HIV acceptable and 89.3% (95%CI: 85.0-93.6), feasible to perform. The multivariate analysis showed positive relation between the acceptability/feasibility and teaching skills (OR: 2.74; 95%CI: 1.16-6.49). The acceptance of the screening by patients was 93.1% and this was positively related to how long the doctor had worked with the same quota, teaching skills and the amount of years dedicated to research. HIV opportunistic search is an acceptable and feasible method for primary care professionals. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  18. Doctor-patient communication and cancer patients' choice of alternative therapies as supplement or alternative to conventional care. (United States)

    Salamonsen, Anita


    Cancer patients' use of complementary and alternative medicine (CAM) is widespread, despite the fact that clinical studies validating the efficacy of CAM remain sparse in the Nordic countries. The purpose of this study was to explore possible connections between cancer patients' communication experiences with doctors and the decision to use CAM as either supplement or alternative to conventional treatment (CT). The Regional Committee for Medical and Health Research Ethics and the Norwegian Data Inspectorate approved the study. From a group of 52 cancer patients with self-reported positive experiences from use of CAM, 13 were selected for qualitative interviews. Six used CAM as supplement, and seven as alternative to CT, periodically or permanently. Communication experiences with 46 doctors were described. The analysis revealed three connections between doctor-patient communication and patients' treatment decisions: (i) negative communication experiences because of the use of CAM; (ii) negative communication experiences resulted in the decision to use CAM, and in some cases to decline CT; and (iii) positive communication experiences led to the decision to use CAM as supplement, not alternative to CT. The patients, including the decliners of CT, wanted to discuss treatment decisions in well-functioning interpersonal processes with supportive doctors. In doctors' practices and education of doctors, a greater awareness of potential positive and negative outcomes of doctor-patient communication that concern CAM issues could be of importance. More research is needed to safeguard CAM users' treatment decisions and their relationship to conventional health care. © 2012 The Author. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  19. Systems modeling and simulation applications for critical care medicine (United States)


    Critical care delivery is a complex, expensive, error prone, medical specialty and remains the focal point of major improvement efforts in healthcare delivery. Various modeling and simulation techniques offer unique opportunities to better understand the interactions between clinical physiology and care delivery. The novel insights gained from the systems perspective can then be used to develop and test new treatment strategies and make critical care delivery more efficient and effective. However, modeling and simulation applications in critical care remain underutilized. This article provides an overview of major computer-based simulation techniques as applied to critical care medicine. We provide three application examples of different simulation techniques, including a) pathophysiological model of acute lung injury, b) process modeling of critical care delivery, and c) an agent-based model to study interaction between pathophysiology and healthcare delivery. Finally, we identify certain challenges to, and opportunities for, future research in the area. PMID:22703718

  20. Systems modeling and simulation applications for critical care medicine. (United States)

    Dong, Yue; Chbat, Nicolas W; Gupta, Ashish; Hadzikadic, Mirsad; Gajic, Ognjen


    Critical care delivery is a complex, expensive, error prone, medical specialty and remains the focal point of major improvement efforts in healthcare delivery. Various modeling and simulation techniques offer unique opportunities to better understand the interactions between clinical physiology and care delivery. The novel insights gained from the systems perspective can then be used to develop and test new treatment strategies and make critical care delivery more efficient and effective. However, modeling and simulation applications in critical care remain underutilized. This article provides an overview of major computer-based simulation techniques as applied to critical care medicine. We provide three application examples of different simulation techniques, including a) pathophysiological model of acute lung injury, b) process modeling of critical care delivery, and c) an agent-based model to study interaction between pathophysiology and healthcare delivery. Finally, we identify certain challenges to, and opportunities for, future research in the area.

  1. Collaborative Care for Older Adults with low back pain by family medicine physicians and doctors of chiropractic (COCOA)

    DEFF Research Database (Denmark)

    Goertz, Christine M; Salsbury, Stacie A; Vining, Robert D


    commonly doctors of chiropractic. However, a collaborative model of treatment coordination between these two provider groups has yet to be tested. The primary aim of the Collaborative Care for Older Adults Clinical Trial is to develop and evaluate the clinical effectiveness and feasibility of a patient......-centered, collaborative care model with family medicine physicians and doctors of chiropractic for the treatment of low back pain in older adults. METHODS/DESIGN: This pragmatic, pilot randomized controlled trial will enroll 120 participants, age 65 years or older with subacute or chronic low back pain lasting at least...... one month, from a community-based sample in the Quad-Cities, Iowa/Illinois, USA. Eligible participants are allocated in a 1:1:1 ratio to receive 12 weeks of medical care, concurrent medical and chiropractic care, or collaborative medical and chiropractic care. Primary outcomes are self-rated back pain...

  2. Spiritual Experiences of Muslim Critical Care Nurses. (United States)

    Bakir, Ercan; Samancioglu, Sevgin; Kilic, Serap Parlar


    The purpose of this study was to determine the experiences and perceptions of intensive care nurses (ICNs) about spirituality and spiritual care, as well as the effective factors, and increase the sensitivity to the subject. In this study, we examined spiritual experiences, using McSherry et al. (Int J Nurs Stud 39:723-734, 2002) Spirituality and spiritual care rating scale (SSCRS), among 145 ICNs. 44.8% of the nurses stated that they received spiritual care training and 64.1% provided spiritual care to their patients. ICNs had a total score average of 57.62 ± 12.00 in SSCRS. As a consequence, it was determined that intensive care nurses participating in the study had insufficient knowledge about spirituality and spiritual care, but only the nurses with sufficient knowledge provided the spiritual care to their patients.

  3. Doctors Today

    LENUS (Irish Health Repository)

    Murphy, JFA


    Doctors’ relationship with patients and their role in society is changing. Until the 1960s doctors concentrated on the welfare of patients with less emphasis placed on patients’ rights1. Over recent decades there has been increasing empowerment of the individual across all facets of society including health care. Doctors continue to be perceived as having expertise and authority over medical science. Patients, however, now hold sway over questions of values or preferences. We all must be aware of this change in the doctor- patient interaction. We need to be more aware of the outcomes that patients view as important. The concept of shared decision-making with the patient is now widely appreciated. The process involves a change in mind set particularly for doctors who trained in an earlier era.

  4. Critical care providers refer to information tools less during communication tasks after a critical care clinical information system introduction. (United States)

    Ballermann, Mark; Shaw, Nicola T; Mayes, Damon C; Gibney, R T Noel


    Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.

  5. mHealth: Knowledge and use among doctors and nurses in public secondary health-care facilities of Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    Bukola Samuel Owolabi


    Full Text Available Objectives: Mobile health (mHealth is gaining importance worldwide, changing and improving the way healthcare and services are provided, but its role is just emerging in Nigeria. This study aimed to assess the knowledge and use of mHealth among health workers and the provisions for its use in public secondary health-care facilities of Lagos State, Nigeria. Methods: The study was a descriptive cross-sectional study carried out among 65 doctors and 135 nurses selected using a two-staged sampling method. Data were collected with pretested self-administered questionnaires and analyzed with EpiInfo™ 7. Results: Majority (doctors 84.6%, nurses 91.1% had not heard of the term “mHealth,” but most (doctors 96.9%, nurses 87.4% were aware of the use of mobile phones in health-care delivery. Only three (27.3% (health call centers/health-care telephone helpline, appointment reminders, and mobile telemedicine out of 11 mHealth components listed were mostly known. Most doctors simply used patient monitoring/surveillance and mobile telemedicine, while nurses mainly used treatment compliance and appointment reminder services. Majority were willing to use more mHealth services if available in their hospital. All the doctors and 97% of nurses had mobile phones. However, only about one-quarter (27.5% had smartphones with applications used for mHealth purposes. Conclusions: Knowledge, awareness, and use of mHealth services were low. Doctors and nurses should be enlightened and trained on ways to use mHealth services to improve health-care delivery, mHealth services should be made available in the hospitals, and use of smartphones encouraged as they portend better adaptability for mHealth use.

  6. Challenges faced by palliative care physicians when caring for doctors with advanced cancer

    NARCIS (Netherlands)

    Noble, S. I. R.; Nelson, A.; Finlay, I. G.


    Background: It is possible that patients with advanced cancer, who are from the medical profession, have different or additional care needs than other patients. Previous training, professional experiences and access to information and services may influence their needs and subsequent illness

  7. The critical care nursing workforce in Western Cape hospitals - a ...

    African Journals Online (AJOL)

    Background. A global shortage of registered nurses (RNs) has been reported internationally, and confirmed in South Africa by the National Audit of Critical Care services. Critical care nurses (CCNs) especially are in great demand and short supply. Purpose. The purpose of this study was to quantify the nursing workforce ...

  8. Assessment of students' critical-thinking and problem-solving abilities across a 6-year doctor of pharmacy program. (United States)

    Gleason, Brenda L; Gaebelein, Claude J; Grice, Gloria R; Crannage, Andrew J; Weck, Margaret A; Hurd, Peter; Walter, Brenda; Duncan, Wendy


    To determine the feasibility of using a validated set of assessment rubrics to assess students' critical-thinking and problem-solving abilities across a doctor of pharmacy (PharmD) curriculum. Trained faculty assessors used validated rubrics to assess student work samples for critical-thinking and problem-solving abilities. Assessment scores were collected and analyzed to determine student achievement of these 2 ability outcomes across the curriculum. Feasibility of the process was evaluated in terms of time and resources used. One hundred sixty-one samples were assessed for critical thinking, and 159 samples were assessed for problem-solving. Rubric scoring allowed assessors to evaluate four 5- to 7-page work samples per hour. The analysis indicated that overall critical-thinking scores improved over the curriculum. Although low yield for problem-solving samples precluded meaningful data analysis, it was informative for identifying potentially needed curricular improvements. Use of assessment rubrics for program ability outcomes was deemed authentic and feasible. Problem-solving was identified as a curricular area that may need improving. This assessment method has great potential to inform continuous quality improvement of a PharmD program.

  9. Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression. (United States)

    Adams, A; Vail, L; Buckingham, C D; Kidd, J; Weich, S; Roter, D


    This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries

  10. Web-based resources for critical care education. (United States)

    Kleinpell, Ruth; Ely, E Wesley; Williams, Ged; Liolios, Antonios; Ward, Nicholas; Tisherman, Samuel A


    To identify, catalog, and critically evaluate Web-based resources for critical care education. A multilevel search strategy was utilized. Literature searches were conducted (from 1996 to September 30, 2010) using OVID-MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature with the terms "Web-based learning," "computer-assisted instruction," "e-learning," "critical care," "tutorials," "continuing education," "virtual learning," and "Web-based education." The Web sites of relevant critical care organizations (American College of Chest Physicians, American Society of Anesthesiologists, American Thoracic Society, European Society of Intensive Care Medicine, Society of Critical Care Medicine, World Federation of Societies of Intensive and Critical Care Medicine, American Association of Critical Care Nurses, and World Federation of Critical Care Nurses) were reviewed for the availability of e-learning resources. Finally, Internet searches and e-mail queries to critical care medicine fellowship program directors and members of national and international acute/critical care listserves were conducted to 1) identify the use of and 2) review and critique Web-based resources for critical care education. To ensure credibility of Web site information, Web sites were reviewed by three independent reviewers on the basis of the criteria of authority, objectivity, authenticity, accuracy, timeliness, relevance, and efficiency in conjunction with suggested formats for evaluating Web sites in the medical literature. Literature searches using OVID-MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature resulted in >250 citations. Those pertinent to critical care provide examples of the integration of e-learning techniques, the development of specific resources, reports of the use of types of e-learning, including interactive tutorials, case studies, and simulation, and reports of student or learner satisfaction, among other general

  11. Awareness among tertiary care doctors about Pharmacovigilance Programme of India: Do endocrinologists differ from others?

    Directory of Open Access Journals (Sweden)

    Pramod Kumar Sharma


    Full Text Available Background and Objectives: Reporting adverse drug reactions (ADRs associated with drug use is an important factor in patient safety. Majority of ADRs are preventable through improved prescribing and monitoring. Endocrinologists prescribe drugs with actions on almost all organs and for relatively longer durations. ADR are expected following the use of these drugs. Pharmacovigilance is the study of drug-related adverse effects aimed at protecting patients and public from drug-related harms. The concept of pharmacovigilance is relatively new in India, and this survey is an attempt to explore awareness among doctors of an establishing institution of national importance. Materials and Methods: The survey was conducted on faculty and resident doctors by administering a written structured questionnaire in a voluntary manner. The questionnaire contained questions meant to evaluate their awareness, understanding, and misconception about ADR reporting. Identity of the responder was kept confidential. Results: A total of 106 (faculty = 56; residents = 50 participated in survey. The most common cause cited for not reporting an ADR was “do not know how to report” by 64.15%. Majority of them (64% had no information about the Pharmacovigilance Programme of India (PvPI, and only few (8.5% had actually reported or published an ADR. Interpretation and Conclusions: ADRs are major public health problem that needs to be addressed at all levels of health care. High index of clinical suspicion are crucial for their timely detection and management. Various educational interventions have shown to improve medical professionals' awareness, understanding about ADRs and in their reporting behavior. PvPI is an important initiative toward ensuring patient safety.

  12. Reiki therapy: a nursing intervention for critical care. (United States)

    Toms, Robin


    Complementary and alternative medicine (CAM) is not generally associated with the complexity and intensity of critical care. Most CAM therapies involve slow, calming techniques that seem to be in direct contrast with the fast-paced, highly technical nature of critical care. However, patients in critical care often find themselves coping with the pain and stress of their illness exacerbated by the stress of the critical care environment. Complementary and alternative medicine-related research reveals that complementary therapies, such as Reiki, relieve pain and anxiety and reduce symptoms of stress such as elevated blood pressure and pulse rates. Patients and health care professionals alike have become increasingly interested in complementary and alternative therapies that do not rely on expensive, invasive technology, and are holistic in focus. Reiki is cost-effective, noninvasive, and can easily be incorporated into patient care. The purpose of this article is to examine the science of Reiki therapy and to explore Reiki as a valuable nursing intervention.

  13. Challenges in critical care services in Sub-Saharan Africa: perspectives from Nigeria. (United States)

    Okafor, U V


    Critical care services in Nigeria and other West African countries had been hampered by economic reversals resulting in low wages, manpower flight overseas, government apathy towards funding of hospitals, and endemic corruption. Since then things have somewhat improved with the government's willingness to invest more in healthcare, and clampdown on resource diversion in some countries like Nigeria. Due to the health needs of these countries, including funding and preventive medicine, it may take a long time to reach reasonably high standards. Things are better than they were several years ago and that gives cause for optimism, especially with the debt cancellation by Western nations for most countries in the region. Since most of the earlier studies have been done by visiting doctors, mainly outside the West African subregion, this paper seeks to present a view of the challenges faced by providers of critical care services in the region, so that people do not have to rely on anecdotal evidence for future references.

  14. The Speaker Gender Gap at Critical Care Conferences. (United States)

    Mehta, Sangeeta; Rose, Louise; Cook, Deborah; Herridge, Margaret; Owais, Sawayra; Metaxa, Victoria


    To review women's participation as faculty at five critical care conferences over 7 years. Retrospective analysis of five scientific programs to identify the proportion of females and each speaker's profession based on conference conveners, program documents, or internet research. Three international (European Society of Intensive Care Medicine, International Symposium on Intensive Care and Emergency Medicine, Society of Critical Care Medicine) and two national (Critical Care Canada Forum, U.K. Intensive Care Society State of the Art Meeting) annual critical care conferences held between 2010 and 2016. Female faculty speakers. None. Male speakers outnumbered female speakers at all five conferences, in all 7 years. Overall, women represented 5-31% of speakers, and female physicians represented 5-26% of speakers. Nursing and allied health professional faculty represented 0-25% of speakers; in general, more than 50% of allied health professionals were women. Over the 7 years, Society of Critical Care Medicine had the highest representation of female (27% overall) and nursing/allied health professional (16-25%) speakers; notably, male physicians substantially outnumbered female physicians in all years (62-70% vs 10-19%, respectively). Women's representation on conference program committees ranged from 0% to 40%, with Society of Critical Care Medicine having the highest representation of women (26-40%). The female proportions of speakers, physician speakers, and program committee members increased significantly over time at the Society of Critical Care Medicine and U.K. Intensive Care Society State of the Art Meeting conferences (p gap at critical care conferences, with male faculty outnumbering female faculty. This gap is more marked among physician speakers than those speakers representing nursing and allied health professionals. Several organizational strategies can address this gender gap.

  15. Integrating advanced practice providers into medical critical care teams. (United States)

    McCarthy, Christine; O'Rourke, Nancy C; Madison, J Mark


    Because there is increasing demand for critical care providers in the United States, many medical ICUs for adults have begun to integrate nurse practitioners and physician assistants into their medical teams. Studies suggest that such advanced practice providers (APPs), when appropriately trained in acute care, can be highly effective in helping to deliver high-quality medical critical care and can be important elements of teams with multiple providers, including those with medical house staff. One aspect of building an integrated team is a practice model that features appropriate coding and billing of services by all providers. Therefore, it is important to understand an APP's scope of practice, when they are qualified for reimbursement, and how they may appropriately coordinate coding and billing with other team providers. In particular, understanding when and how to appropriately code for critical care services (Current Procedural Terminology [CPT] code 99291, critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 min; CPT code 99292, critical care, each additional 30 min) and procedures is vital for creating a sustainable program. Because APPs will likely play a growing role in medical critical care units in the future, more studies are needed to compare different practice models and to determine the best way to deploy this talent in specific ICU settings.

  16. Talking to Your Doctor

    Medline Plus

    Full Text Available ... You Talking to Your Doctor Science Education Resources Community Resources Clear Health A–Z Publications List More » ... can play an active role in your health care by talking to your doctor. Clear and honest ...

  17. Finding the Right Doctor (United States)

    ... certified hospital Communicating with Healthcare Professionals for Caregivers Consumer Health Care • Home • Health Insurance Information • Your Healthcare Team Introduction Finding the Right Doctor Talking to Your Doctor Getting a Second ...

  18. Diversity in the Emerging Critical Care Workforce: Analysis of Demographic Trends in Critical Care Fellows From 2004 to 2014. (United States)

    Lane-Fall, Meghan B; Miano, Todd A; Aysola, Jaya; Augoustides, John G T


    Diversity in the physician workforce is essential to providing culturally effective care. In critical care, despite the high stakes and frequency with which cultural concerns arise, it is unknown whether physician diversity reflects that of critically ill patients. We sought to characterize demographic trends in critical care fellows, who represent the emerging intensivist workforce. We used published data to create logistic regression models comparing annual trends in the representation of women and racial/ethnic groups across critical care fellowship types. United States Accreditation Council on Graduate Medical Education-approved residency and fellowship training programs. Residents and fellows employed by Accreditation Council on Graduate Medical Education-accredited training programs from 2004 to 2014. None. From 2004 to 2014, the number of critical care fellows increased annually, up 54.1% from 1,606 in 2004-2005 to 2,475 in 2013-2014. The proportion of female critical care fellows increased from 29.5% (2004-2005) to 38.3% (2013-2014) (p workforce reflect underrepresentation of women and racial/ethnic minorities. Trends highlight increases in women and Hispanics and stable or decreasing representation of non-Hispanic underrepresented minority critical care fellows. Further research is needed to elucidate the reasons underlying persistent underrepresentation of racial and ethnic minorities in critical care fellowship programs.

  19. The factors influencing burnout and job satisfaction among critical care nurses: a study of Saudi critical care nurses. (United States)

    Alharbi, Jalal; Wilson, Rhonda; Woods, Cindy; Usher, Kim


    The aim of the study was to explore the prevalence of burnout and job satisfaction among Saudi national critical care nurses. Burnout is caused by a number of factors, including personal, organisational and professional issues. Previous literature reports a strong relationship between burnout and job satisfaction among critical care nurses. Little is known about this phenomenon among Saudi national critical care nurses. A convenience sample of 150 Saudi national critical care nurses from three hospitals in Hail, Saudi Arabia were included in a cross-sectional survey. Saudi national critical care registered nurses reported moderate to high levels of burnout in the areas of emotional exhaustion and depersonalisation. Participants also reported a feeling of ambivalence and dissatisfaction with their jobs but were satisfied with the nature of their work. Saudi national critical care nurses experience moderate to high levels of burnout and low levels of job satisfaction. Burnout is a predictor of job satisfaction for Saudi national critical care nurses. These results provide clear evidence of the need for nurse managers and policy makers to devise strategies to help nurses better cope with a stressful work environment, thereby also improving job satisfaction among Saudi national critical care nurses. © 2016 John Wiley & Sons Ltd.

  20. Oral hygiene care in critically ill patients

    African Journals Online (AJOL)


    Nov 19, 2007 ... conditions, treatment interventions, equipment, and the patient's inability to attend to his or her ... practices for a critically ill patient include assessment of the oral cavity, brushing the teeth, moisturising the lips and mouth and ...

  1. Self-assessment of managerial knowledge and skills of medical doctors in primary health care

    Directory of Open Access Journals (Sweden)

    Aida Pilav


    Full Text Available Introduction: The aim of this paper was to evaluate the managerial knowledge and skills of mid-level managers – medical doctors in Medical center of the Canton Sarajevo.Methods: A cross-sectional study of the mid-level managers in the Medical center of the Canton Sarajevo was conducted using an originally developed questionnaire for self-assessment of managerial knowledge and skills. The respondents answered each of the questions using a 5-point Likert scale. Apart from the quantitative section, the respondents could present their observations concerning the educational needs in the health care system.Results: Almost 40% of the respondents said that the process of assessing health care needs is not conducted. No statistical significance was observed in the responses according to the length of service in a managerial position. In total, 41% of the respondents were not sure whether a plan exists, even though the development of these plans should be a principal managerial responsibility in the quality management. Managers who were longer in the position reported no plans for corrective actions. This result was in contrast with the answers obtained from the managers who were in the position for a shorter period. In addition, 91% of the respondents said that they regularly discuss problems with their employees.Conclusions: Self- assessment and assessment of managerial competencies should be regular activities in a health care organization, in order to monitor the knowledge and skills, as well as to make the development plans. The results of this study could serve as the basis for planning and developing the health management education in the Canton Sarajevo.

  2. Obstetric critical care services in South Africa

    African Journals Online (AJOL)

    time of their first pregnancy, and assisted reproductive technology that has made it ... transport between levels of care, unavailability of blood and blood products ... 0.24%. Severe obstetric haemorrhage, hypertension and sepsis were the most ...

  3. Doctor's Orders

    Institute of Scientific and Technical Information of China (English)



    @@ "To become a doctor is like becoming a bomb expert:It takes a long time to learn this skill; you must use care and intuition; and you must understand that your work has grave consequences for those around you,"said Amgalan Gamazhapov,an advanced medical student who studies traditional Chinese and Mongolian medicine at the Inner Mongolia Medical University.

  4. Doctor Down

    Directory of Open Access Journals (Sweden)

    N.V. Nagornaya


    Full Text Available The article presents the biographical data of John Langdon Down, his invaluable contribution to the development of rehabilitation programs for children with Down syndrome. The basis of these programs was the socialization of people with intellectual disabilities. In doctor Down’s rehabilitation center there were used methods, including health care, education, physical education, the formation of correct behavior.

  5. Pediatric Critical Care Nursing Research Priorities-Initiating International Dialogue. (United States)

    Tume, Lyvonne N; Coetzee, Minette; Dryden-Palmer, Karen; Hickey, Patricia A; Kinney, Sharon; Latour, Jos M; Pedreira, Mavilde L G; Sefton, Gerri R; Sorce, Lauren; Curley, Martha A Q


    To identify and prioritize research questions of concern to the practice of pediatric critical care nursing practice. One-day consensus conference. By using a conceptual framework by Benner et al describing domains of practice in critical care nursing, nine international nurse researchers presented state-of-the-art lectures. Each identified knowledge gaps in their assigned practice domain and then poised three research questions to fill that gap. Then, meeting participants prioritized the proposed research questions using an interactive multivoting process. Seventh World Congress on Pediatric Intensive and Critical Care in Istanbul, Turkey. Pediatric critical care nurses and nurse scientists attending the open consensus meeting. Systematic review, gap analysis, and interactive multivoting. The participants prioritized 27 nursing research questions in nine content domains. The top four research questions were 1) identifying nursing interventions that directly impact the child and family's experience during the withdrawal of life support, 2) evaluating the long-term psychosocial impact of a child's critical illness on family outcomes, 3) articulating core nursing competencies that prevent unstable situations from deteriorating into crises, and 4) describing the level of nursing education and experience in pediatric critical care that has a protective effect on the mortality and morbidity of critically ill children. The consensus meeting was effective in organizing pediatric critical care nursing knowledge, identifying knowledge gaps and in prioritizing nursing research initiatives that could be used to advance nursing science across world regions.


    Directory of Open Access Journals (Sweden)

    Rahul Bansal


    Full Text Available Abstract: This document provides insight on lifestyle and healthcare status of doctors based on key findings from a survey conducted in Meerut City, (U.P. India. Objectives: 1.To study the lifestyle pattern among the doctors of Allopathy and Ayurveda & teachers of local private Medical college, local private Dental college. 2. To study the (self-reported prevalence of common non-communicable diseases in the same. 3. To know the pattern of healthy lifestyle practices adopted by the doctors. Material & Methods: The Cross-sectional study was conducted with the help of a pre-designed and pre-tested questionnaire which was filled by the faculty of local private Medical College, Dental college, Ayurvedic doctors and local practicing doctors of allopathy and Ayurveda. Verbal consent was implied. A purposive sample of 240 doctors [60 each from Medical and Dental colleges and 60 each from allopathy private practitioners (p.p.allo. and ayurvedic private practitioners (p.p.ayur.] were given the questionnaire-and response rate was 84%. The data was entered in Microsoft excel 2007 to know the frequency of the various lifestyle pattern. Results: 47.5% of the doctors had raised B.M.I. (Body Mass Index- more than 25; 21% of the doctors were smokers, 10% were current drinkers and 32% were hypertensive. Only 2.5% were found to be diabetic in our study. About 52% of the doctors exercised regularly. 32.5% were trained for yoga. Conclusion:This study implies that a large proportion of doctors themselves do not follow the healthy lifestyle and are having lifestyle diseases like obesity, hypertension etc. Interestingly, there was not much difference between doctors doing private practice or teaching in Medical/Dental College.

  7. The role of doctors in provision of support for primary health care ...

    African Journals Online (AJOL)


    Nov 13, 2008 ... meaningful relationships between the visiting doctor and clinic staff. The current ... Doctors felt that a lack of essential equipment and drugs at the clinic limited the value of the ... by registered nurses working in PHC clinics, so provision of quality .... up, because most clinics are nearby their homes. So they ...

  8. Exploring UK health-care providers' engagement of trainee doctors in leadership. (United States)

    Miller, Christopher J; Till, Alex; McKimm, Judy


    The need for doctors at all levels to undergo some form of leadership development is well evidenced, but provision remains patchy and models underpinning such development are often inconsistent. This article sets out the findings of a literature review into leadership development opportunities for doctors in training in the UK.


    Directory of Open Access Journals (Sweden)

    AR Yong Rafidah


    Full Text Available Doctor-patient communication skills are important in family medicine and can be taught and learned. This paper summarisesthe salient contents and main methods of the teaching and learning of doctor-patient communication, especially thoseapplicable to the discipline.

  10. Just Care: Learning from and with Graduate Students in a Doctor of Nursing Practice Program (United States)

    Boquet, Elizabeth; Kazer, Meredith; Manister, Nancy; Lucas, Owen; Shaw, Michael; Madaffari, Valerie; Gannett, Cinthia


    In 2010, Fairfield University, a Jesuit Carnegie Masters Level 1 University located in the Northeast, established its first doctoral-level program: the Doctorate of Nursing Practice (DNP). In a developing program such as the DNP, some of the most pressing concerns of current rhetoric and writing in the disciplines align and interact with the…

  11. The Top Ten Websites in Critical Care Medicine Education Today. (United States)

    Wolbrink, Traci A; Rubin, Lucy; Burns, Jeffrey P; Markovitz, Barry


    The number of websites for the critical care provider is rapidly growing, including websites that are part of the Free Open Access Med(ical ed)ucation (FOAM) movement. With this rapidly expanding number of websites, critical appraisal is needed to identify quality websites. The last major review of critical care websites was published in 2011, and thus a new review of the websites relevant to the critical care clinician is necessary. A new assessment tool for evaluating critical care medicine education websites, the Critical Care Medical Education Website Quality Evaluation Tool (CCMEWQET), was modified from existing tools. A PubMed and Startpage search from 2007 to 2017 was conducted to identify websites relevant to critical care medicine education. These websites were scored based on the CCMEWQET. Ninety-seven websites relevant for critical care medicine education were identified and scored, and the top ten websites were described in detail. Common types of resources available on these websites included blog posts, podcasts, videos, online journal clubs, and interactive components such as quizzes. Almost one quarter of websites (n = 22) classified themselves as FOAM websites. The top ten websites most often included an editorial process, high-quality and appropriately attributed graphics and multimedia, scored much higher for comprehensiveness and ease of access, and included opportunities for interactive learning. Many excellent online resources for critical care medicine education currently exist, and the number is likely to continue to increase. Opportunities for improvement in many websites include more active engagement of learners, upgrading navigation abilities, incorporating an editorial process, and providing appropriate attribution for graphics and media.

  12. International comparisons in critical care: a necessity and challenge. (United States)

    Wunsch, Hannah; Rowan, Kathryn M; Angus, Derek C


    Understanding variation in critical care resources, and delivery of care between countries will allow for improved disaster planning, evaluation of research findings, and assessment of the utility of critical care itself. This review describes the available data for international comparisons and the many factors that need to be addressed for an appropriate interpretation of results. Recent studies on subgroups of critical care patients include data from many different countries. These new studies provide important information on the overall incidence of these disease states, but most of these international studies do not take into account the critical care resources of the countries being discussed. For an appropriate interpretation of findings the relevant baseline critical care resources, prevalence of diseases, and cultural practices, need to be quantified. The existence of these other factors prevents the use of a severity of illness scoring system alone to account for differences between countries. Many recent critical care studies include data from multiple countries. With continued movement towards international studies, and improvements in data collection systems, comparisons between countries are becoming easier. These findings need to be interpreted in the context of all the relevant country information.

  13. Critical care at extremes of temperature: effects on patients, staff and equipment. (United States)

    Hindle, Elise M; Henning, J D


    Modern travel and military operations have led to a significant increase in the need to provide medical care in extreme climates. Presently, there are few data on what happens to the doctor, their drugs and equipment when exposed to these extremes. A review was undertaken to find out the effects of 'extreme heat or cold' on anaesthesia and critical care; in addition, subject matter experts were contacted directly. Both extreme heat and extreme cold can cause a marked physiological response in a critically ill patient and the doctor treating these patients may also suffer a decrement in both physical and mental functioning. Equipment can malfunction when exposed to extremes of temperature and should ideally be stored and operated in a climatically controlled environment. Many drugs have a narrow range of temperatures in which they remain useable though some have been shown to remain effective if exposed to extremes of temperature for a short period of time. All personnel embarking on an expedition to an extreme temperature zone should be of sufficient physical robustness and ideally should have a period of acclimatisation which may help mitigate against some of the physiological effects of exposure to extreme heat or extreme cold. Expedition planners should aim to provide climatic control for drugs and equipment and should have logistical plans for replenishment of drugs and medical evacuation of casualties. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  14. Direct-to-consumer advertising: physicians' views of its effects on quality of care and the doctor-patient relationship. (United States)

    Murray, Elizabeth; Lo, Bernard; Pollack, Lance; Donelan, Karen; Lee, Ken


    The objective of the study was to determine physicians' views of the effects of Direct-to-Consumer Advertising (DTCA) on health service utilization, quality of care, and the doctor-patient relationship. Cross-sectional survey of a nationally representative sample of US physicians to determine their perceptions of the effects of patients discussing information from DTCA on time efficiency; requests for specific interventions; health outcomes; and the doctor-patient relationship. Physicians reported that more than half (56%) of patients who discussed information from DTCA in a visit did so because they wanted a specific intervention, such as a test, change in medication, or specialist referral. The physician deemed 49% of these requests clinically inappropriate. Physicians filled 69% of requests they deemed clinically inappropriate; 39% of physicians perceived DTCA as damaging to the time efficiency of the visit, and 13% saw it as helpful. Thirty-three percent of physicians thought discussing DTCA had improved the doctor-patient relationship; 8% felt it had worsened it. The effect on the relationship was strongly associated with doing what the patient wanted. DTCA can have good and bad effects on quality of care, the doctor-patient relationship, and health service utilization. The benefits might be maximized, and the harms minimized, by increasing the accuracy of information in advertisements; enhancing physicians' communication and negotiation skills; and encouraging patients to respect physicians' clinical expertise.

  15. Ethnic inequalities in doctor-patient communication regarding personal care plans: the mediating effects of positive mental wellbeing. (United States)

    Umeh, Kanayo F


    There is limited understanding of ethnic inequalities in doctor-patient communication regarding personal care plans (PCPs). This study investigated the mediating effects of positive mental wellbeing on differences in PCP-related doctor-patient communication amongst South Asian and Caucasian UK residents. Data from 10,980 respondents to the 2013 Health Survey for England was analysed using bootstrapping methods. Constructs from the WEMWBS (Warwick and Edinburgh Mental Wellbeing Scale) (Stewart-Brown, S., and K. Janmohamed. 2008. Warwick, UK) were assessed as mediators of relations between ethnicity and several doctor-patient communication variables, including PCP-related interactions; (a) had a PCP-related discussion about a long-term condition with a doctor/nurse, and (b) had this conversation within the past year, (c) agreed to a PCP with a health professional; and (d) talked to a doctor in the past 2 weeks. Bootstrapped mediation analysis (Hayes, A. F. 2013. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-based Approach. New York, NY: The Guilford Press) showed that three positive mind-sets mediated associations between ethnicity and doctor-patient contact, including PCP-related communication. Being able to make up one's mind (ab = -0.05; BC a CI [-0.14, 0.01]) mediated the effect of ethnicity on agreeing to a PCP, while having energy to spare (ab = 0.07; BC a CI [-0.04, 0.12]), and feeling good about oneself (ab = 0.03; BC a CI [0.01, 0.07]), mediated ethnic effects on talking to a doctor during the past fortnight. The mediating effect of reported energy persisted after controlling for medical history, perceived health, and other covariates. Ethnic disparities in doctor-patient interaction, including PCP-related communication, are partly explained by positive mental wellbeing. Gauging positive psychological moods in patients, particularly self-worth, self-perceived vigour and decisiveness, are relevant to

  16. Patient Continued Use of Online Health Care Communities: Web Mining of Patient-Doctor Communication. (United States)

    Wu, Bing


    In practice, online health communities have passed the adoption stage and reached the diffusion phase of development. In this phase, patients equipped with knowledge regarding the issues involved in health care are capable of switching between different communities to maximize their online health community activities. Online health communities employ doctors to answer patient questions, and high quality online health communities are more likely to be acknowledged by patients. Therefore, the factors that motivate patients to maintain ongoing relationships with online health communities must be addressed. However, this has received limited scholarly attention. The purpose of this study was to identify the factors that drive patients to continue their use of online health communities where doctor-patient communication occurs. This was achieved by integrating the information system success model with online health community features. A Web spider was used to download and extract data from one of the most authoritative Chinese online health communities in which communication occurs between doctors and patients. The time span analyzed in this study was from January 2017 to March 2017. A sample of 469 valid anonymous patients with 9667 posts was obtained (the equivalent of 469 respondents in survey research). A combination of Web mining and structural equation modeling was then conducted to test the research hypotheses. The results show that the research framework for integrating the information system success model and online health community features contributes to our understanding of the factors that drive patients' relationships with online health communities. The primary findings are as follows: (1) perceived usefulness is found to be significantly determined by three exogenous variables (ie, social support, information quality, and service quality; R 2 =0.88). These variables explain 87.6% of the variance in perceived usefulness of online health communities; (2

  17. Developing a Business Plan for Critical Care Pharmacy Services. (United States)

    Erstad, Brian L; Mann, Henry J; Weber, Robert J


    Critical care medicine has grown from a small group of physicians participating in patient care rounds in surgical and medical intensive care units (ICUs) to a highly technical, interdisciplinary team. Pharmacy's growth in the area of critical care is as exponential. Today's ICU requires a comprehensive pharmaceutical service that includes both operational and clinical services to meet patient medication needs. This article provides the elements for a business plan to justify critical care pharmacy services by describing the pertinent background and benefit of ICU pharmacy services, detailing a current assessment of ICU pharmacy services, listing the essential ICU pharmacy services, describing service metrics, and delineating an appropriate timeline for implementing an ICU pharmacy service. The structure and approach of this business plan can be applied to a variety of pharmacy services. By following the format and information listed in this article, the pharmacy director can move closer to developing patient-centered pharmacy services for ICU patients.

  18. Dynamics between doctors and managers in the Italian National Health Care System. (United States)

    Vicarelli, Giovanna M; Pavolini, Emmanuele


    This article focuses on the changes in the Italian NHS by concentrating on patterns in the managerialisation of doctors. It addresses a series of shortcomings in studies on the response by doctors to managerialisation. The first is a shortcoming of theoretical and analytical nature. It is necessary to adopt a broader perspective whereby analysis considers not only the interaction between doctors and managers, but also the public control and regulation agencies that operate in that field. The second shortcoming is a methodological one. The literature on managerialisation is more theoretical than applied. It is necessary to adopt a strategy based on a plurality of methodologies and sources in order to focus attention on a national case (Italy in the present study), discussing the changes over time (from the beginning of managerialisation until today) and considering different groups within the medical profession. The outcome is a complex picture of the dynamics between doctors and managers which foregrounds the managerial co-optation processes of a small group of national health service doctors, the transition from strategic adaptation to forms of resistance against managerialisation by the majority of Italian NHS doctors, and the emergence of restratification processes among self-employed doctors working with the NHS. © 2017 Foundation for the Sociology of Health & Illness.

  19. Doctors' experience of coordination across care levels and associated factors. A cross-sectional study in public healthcare networks of six Latin American countries. (United States)

    Vázquez, María-Luisa; Vargas, Ingrid; Garcia-Subirats, Irene; Unger, Jean-Pierre; De Paepe, Pierre; Mogollón-Pérez, Amparo Susana; Samico, Isabella; Eguiguren, Pamela; Cisneros, Angelica-Ivonne; Huerta, Adriana; Muruaga, María-Cecilia; Bertolotto, Fernando


    Improving coordination between primary care (PC) and secondary care (SC) has become a policy priority in recent years for many Latin American public health systems looking to reinforce a healthcare model based on PC. However, despite being a longstanding concern, it has scarcely been analyzed in this region. This paper analyses the level of clinical coordination between PC and SC experienced by doctors and explores influencing factors in public healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. A cross-sectional study was carried out based on a survey of doctors working in the study networks (348 doctors per country). The COORDENA questionnaire was applied to measure their experiences of clinical management and information coordination, and their related factors. Descriptive analyses were conducted and a multivariate logistic regression model was generated to assess the relationship between general perception of care coordination and associated factors. With some differences between countries, doctors generally reported limited care coordination, mainly in the transfer of information and communication for the follow-up of patients and access to SC for referred patients, especially in the case of PC doctors and, to a lesser degree, inappropriate clinical referrals and disagreement over treatments, in the case of SC doctors. Factors associated with a better general perception of coordination were: being a SC doctor, considering that there is enough time for coordination within consultation hours, job and salary satisfaction, identifying the PC doctor as the coordinator of patient care across levels, knowing the doctors of the other care level and trusting in their clinical skills. These results provide evidence of problems in the implementation of a primary care-based model that require changes in aspects of employment, organization and interaction between doctors, all key factors for coordination. Copyright © 2017 The Authors. Published

  20. Critical care clinician perceptions of factors leading to Medical Emergency Team review. (United States)

    Currey, Judy; Allen, Josh; Jones, Daryl


    The introduction of rapid response systems has reduced the incidence of in-hospital cardiac arrest; however, many instances of clinical deterioration are unrecognised. Afferent limb failure is common and may be associated with unplanned intensive care admissions, heightened mortality and prolonged length of stay. Patients reviewed by a Medical Emergency Team are inherently vulnerable with a high in-hospital mortality. To explore perceptions of intensive care unit (ICU) staff who attend deteriorating acute care ward patients regarding current problems, barriers and potential solutions to recognising and responding to clinical deterioration that culminates in a Medical Emergency Team review. A descriptive exploratory design was used. Registered intensive care nurses and medical staff (N=207) were recruited during a professional conference using purposive sampling for experience in attending deteriorating patients. Written response surveys were used to address the study aim. Data were analysed using content analysis. Four major themes were identified: Governance, Teamwork, Clinical Care Delivery and End of Life Care. Participants perceived there was a lack of sufficient and senior staff with the required theoretical knowledge; and inadequate assessment and critical thinking skills for anticipating, recognising and responding to clinical deterioration. Senior doctors were perceived to inappropriately manage End of Life Care issues and displayed Teamwork behaviours rendering ward clinicians feeling fearful and intimidated. A lack of System and Clinical Governance hindered identification of clinical deterioration. To improve patient safety related to recognising and responding to clinical deterioration, suboptimal care due to professionals' knowledge, skills and behaviours need addressing, along with End of Life Care and Governance. Copyright © 2017 Australian College of Critical Care Nurses Ltd. All rights reserved.

  1. The Role of Health Care Professionals in Breaking Bad News about Death: the Perspectives of Doctors, Nurses and Social Workers

    Directory of Open Access Journals (Sweden)

    Michal Rassin


    Full Text Available Background: The way a death is notified to family members has a long-term effect on their coping with their loss. The words caregivers use and the sentiments they express can stay with their hearers for the rest of theirlife. Aims: To study the views of three caregivers groups—doctors, nurses and social workers—as to their role in breaking a death news in an ED.Methods: One hundred and fifteen health care professionals participated in the research (51 nurses, 38 doctors and 26 social workers. They completed a 72-item questionnaire comprising behaviour descriptions, attitudes and statements. Content validation of the questionnaire was conducted by the help of experts group, and the internal reliability, measures in all its parts was 0.78 on average (α = 0.78.Results: Doctors gave a higher score than the other groups to their responsibility for breaking bad news (p<0.005 and to the content of the information they provide. Social workers scored the mental support given the family significantly higher than doctors and nurses did (p<0.000. Nurses scored the instrumental support given(tissues, water to drink significantly higher than doctors and social workers (p<0.000. Breaking bad news caused social workers more mental distress than it did either doctors or nurses. All three groups gave a high score to the emotional exhaustion, sadness and identification this task caused them. Nurses felt more fear at theprospect of a notifying a death and made more effort to escape the task.Conclusions: The findings of the study will help develop performance guidelines for notifying a death and provide input for simulation and other training workshops.

  2. Cost incentives for doctors

    DEFF Research Database (Denmark)

    Schottmüller, Christoph


    If doctors take the costs of treatment into account when prescribing medication, their objectives differ from their patients' objectives because the patients are insured. This misalignment of interests hampers communication between patient and doctor. Giving cost incentives to doctors increases...... welfare if (i) the doctor's examination technology is sufficiently good or (ii) (marginal) costs of treatment are high enough. If the planner can costlessly choose the extent to which doctors take costs into account, he will opt for less than 100%. Optimal health care systems should implement different...... degrees of cost incentives depending on type of disease and/or doctor....

  3. Family Stress in Pediatric Critical Care. (United States)

    Hagstrom, Sandra

    This mixed methods study explored stress in families whose children were hospitalized in the pediatric intensive care unit (PICU) for more than one week. The study aim was to describe sources of stress for families whose children require extended hospitalization in the PICU. Data collection included semi-structured interviews and completion of the Family Inventory of Life Events and Family System Stressor Strength Inventory. Themes reported in this paper are separation, not knowing, and the child's illness and distress. Additional research is needed to validate these findings in families of other cultures and structures, and in other PICUs. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Editorial | Michell | Southern African Journal of Critical Care

    African Journals Online (AJOL)

    Southern African Journal of Critical Care. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 32, No 2 (2016) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Editorial. Lance Michell. Abstract. Care or burn in ...

  5. Critical care outreach referrals: a mixed-method investigative study of outcomes and experiences. (United States)

    Pattison, Natalie; Eastham, Elizabeth


    To explore referrals to a critical care outreach team (CCOT), associated factors around patient management and survival to discharge, and the qualitative exploration of referral characteristics (identifying any areas for service improvement around CCOT). A single-centre mixed method study in a specialist hospital was undertaken, using an explanatory design: participant selection model. In this model, quantitative results (prospective and retrospective episode of care review, including modified early warning system (MEWS), time and delay of referral and patient outcomes for admission and survival) are further explained by qualitative (interview) data with doctors and nurses referring to outreach. Quantitative data were analysed using SPSS +17 and 19, and qualitative data were analysed using grounded theory principles. A large proportion of referrals (124/407 = 30·5%) were made by medical staff. For 97 (97/407 = 23·8%) referrals, there was a delay between the point at which patients deteriorated (as verified by retrospective record review and MEWS score triggers) and the time at when patients were referred. The average delay was 2·96 h (95% CI 1·97-3·95; SD 9·56). Timely referrals were associated with improved outcomes; however, no causal attribution can be made from the circumstances around CCOT referral. Qualitative themes included indications for referral, facilitating factors for referral, barriers to referral and consequences of referral, with an overarching core theory of reassurance. Outreach was seen as back-up and this core theory demonstrates the important, and somewhat less tangible, role outreach has in supporting ward staff to care for at-risk patients. Mapping outreach episodes of care and patient outcomes can help highlight areas for improvement. This study outlines reasons for referral and how outreach can facilitate patient pathways in critical illness. © 2011 The Authors. Nursing in Critical Care © 2011 British Association of Critical Care

  6. Smart medicine: how the changing role of doctors will revolutionize health care

    National Research Council Canada - National Science Library

    Hanson, William, M.D


    .... In Smart Medicine, William Hanson brings to life the fascinating true world of doctors and nurses and reveals the revolutionary changes that will soon be sweeping through the medical community...

  7. Intercultural doctor-patient communication in daily outpatient care: relevant communication skills

    NARCIS (Netherlands)

    Paternotte, E.; Scheele, F.; Seeleman, C.M.; Bank, L.; Scherpbier, A.J.; Dulmen, S. van


    INTRODUCTION: Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical consultations.

  8. Ultrasound for critical care physicians: tiny bubbles

    Directory of Open Access Journals (Sweden)

    Aslam K


    Full Text Available No abstract available. Article truncated after first page. A 59 year old woman with a past medical history significant for stage IV MALT lymphoma (after chemotherapy and in remission presented from a long term care facility for respiratory distress and altered mental status. The patient was in hypercarbic respiratory failure with a severe lactic acidosis. Her blood pressure deteriorated, she was begun on vasopressors and intubated. Pertinent labs demonstrated a white blood cell count of 0.9 X106 /ml, a hemoglobin of 7.1 g/dl, and a platelet count 66 X106 /ml. The patient was started on Cefepime and Linezolid presumptively for septic shock. Ultrasounds of her thorax were performed (Videos 1 & 2. What is the best explanation for the ultrasound findings shown above?1. Large pleural effusion; 2. Pneumothorax; 3. Consolidation due to pneumonia; 4. Ruptured diaphragm; 5. Lung abscess

  9. The Costs of Critical Care Telemedicine Programs (United States)

    Falk, Derik M.; Bonello, Robert S.; Kahn, Jeremy M.; Perencevich, Eli; Cram, Peter


    Background: Implementation of telemedicine programs in ICUs (tele-ICUs) may improve patient outcomes, but the costs of these programs are unknown. We performed a systematic literature review to summarize existing data on the costs of tele-ICUs and collected detailed data on the costs of implementing a tele-ICU in a network of Veterans Health Administration (VHA) hospitals. Methods: We conducted a systematic review of studies published between January 1, 1990, and July 1, 2011, reporting costs of tele-ICUs. Studies were summarized, and key cost data were abstracted. We then obtained the costs of implementing a tele-ICU in a network of seven VHA hospitals and report these costs in light of the existing literature. Results: Our systematic review identified eight studies reporting tele-ICU costs. These studies suggested combined implementation and first year of operation costs for a tele-ICU of $50,000 to $100,000 per monitored ICU-bed. Changes in patient care costs after tele-ICU implementation ranged from a $3,000 reduction to a $5,600 increase in hospital cost per patient. VHA data suggested a cost for implementation and first year of operation of $70,000 to $87,000 per ICU-bed, depending on the depreciation methods applied. Conclusions: The cost of tele-ICU implementation is substantial, and the impact of these programs on hospital costs or profits is unclear. Until additional data become available, clinicians and administrators should carefully weigh the clinical and economic aspects of tele-ICUs when considering investing in this technology. PMID:22797291

  10. Intercultural doctor-patient communication in daily outpatient care: relevant communication skills. (United States)

    Paternotte, Emma; Scheele, Fedde; Seeleman, Conny M; Bank, Lindsay; Scherpbier, Albert J J A; van Dulmen, Sandra


    Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical consultations. Doctor-patient consultations of Dutch doctors with non-Dutch patients were videotaped in a multi-ethnic hospital in the Netherlands. The consultations were analyzed using the validated MAAS-Global assessment list in combination with factors influencing ICC, as described in the literature. In total, 39 videotaped consultations were analyzed. The doctors proved to be capable of practising many communication skills, such as listening and empathic communication behaviour. Other skills were not practised, such as being culturally aware and checking the patient's language ability. We showed that doctors did practice some but not all the relevant ICC skills and that the ICC style of the doctors was mainly biomedically centred. Furthermore, we discussed the possible overlap between intercultural and patient-centred communication. Implications for practice could be to implement the relevant ICC skills in the existing communication training or develop a communication training with a patient-centred approach including ICC skills.

  11. Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses. (United States)

    Ng, George Wing Yiu; Pun, Jack Kwok Hung; So, Eric Hang Kwong; Chiu, Wendy Wai Hang; Leung, Avis Siu Ha; Stone, Yuk Han; Lam, Chung Ling; Lai, Sarah Pui Wa; Leung, Rowlina Pui Wah; Luk, Hing Wah; Leung, Anne Kit Hung; Au Yeung, Kin Wah; Lai, Kang Yiu; Slade, Diana; Chan, Engle Angela


    Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up. A mixed-methods design with quantitative and sequential qualitative components was used. Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices. The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases. Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context. © Article author(s) (or their employer(s) unless otherwise stated in the

  12. Intravenous Mistletoe Treatment in Integrative Cancer Care: A Qualitative Study Exploring the Procedures, Concepts, and Observations of Expert Doctors. (United States)

    Kienle, Gunver S; Mussler, Milena; Fuchs, Dieter; Kiene, Helmut


    Background. Mistletoe therapy (MT) is widely used in patient-centered integrative cancer care. The objective of this study was to explore the concepts, procedures, and observations of expert doctors, with a focus on intravenous MT. Method. A qualitative interview study was conducted with 35 highly experienced doctors specialized in integrative and anthroposophic medicine. Structured qualitative content analysis was applied. For triangulation, the results were compared with external evidence that was systematically collected, reviewed, and presented. Results. Doctors perform individualized patient assessments that lead to multimodal treatment approaches. The underlying goal is to help patients to live with and overcome disease. Mistletoe infusions are a means of accomplishing this goal. They are applied to stabilize disease, achieve responsiveness, induce fever, improve quality of life, and improve the tolerability of conventional cancer treatments. The doctors reported long-term disease stability and improvements in patients' general condition, vitality, strength, thermal comfort, appetite, sleep, pain from bone metastases, dyspnea in pulmonary lymphangitis carcinomatosa, fatigue, and cachexia; chemotherapy was better tolerated. Also patients' emotional and mental condition was reported to have improved. Conclusion. Individualized integrative cancer treatment including MT aims to help cancer patients to live well with their disease. Further research should investigate the reported observations.

  13. The study of knowledge, attitude and practice of medical law and ethics among doctors in a tertiary care hospital

    International Nuclear Information System (INIS)

    Tahira, Q.U.A.; Lodhi, S.; Haider, S.T.; Abaidullah, S.


    Objective: To assess the knowledge, attitude and practice regarding medical law and ethics among doctors of a medical unit in a tertiary care teaching hospital in Lahore. Study Design: Descriptive cross sectional study. Methodology: A three part self - administered structured questionnaire designed to test the knowledge and practices regarding medical law and ethics was distributed among doctors in a medical unit in Mayo Hospital, Lahore during September - October, 2012. Results: The 52 respondent doctors included in the study comprised of 20 (38.5%) house officers, 22 (42.3%) postgraduate residents and 10 (19.2%) consultants. In keeping with the Pakistan Medical and Den-tal Council code of ethics, the correct responses of house officers, postgraduate residents and consultants regarding knowledge of medical law and ethics were respectively 50%, 27.3% and 10% for patient's autonomy, 40%, 36.4% and 10% for adhering to patient's wishes, 10%, 63.6% and 50% for breaching confidentiality, 35%, 36.4% and 0% for informed consent, 10%, 22.7% and 10% for doing best regardless of patient's opinion, 5%, 31.8% and 10% for informing patient's relatives, 15%, 4.5% and 0% for treating violent patients. The practical application part of the questionnaire was a general reflection of the knowledge and attitudes. Conclusion: Most of the doctors were poorly acquainted with PMDC code of ethics. (author)

  14. Intravenous Mistletoe Treatment in Integrative Cancer Care: A Qualitative Study Exploring the Procedures, Concepts, and Observations of Expert Doctors

    Directory of Open Access Journals (Sweden)

    Gunver S. Kienle


    Full Text Available Background. Mistletoe therapy (MT is widely used in patient-centered integrative cancer care. The objective of this study was to explore the concepts, procedures, and observations of expert doctors, with a focus on intravenous MT. Method. A qualitative interview study was conducted with 35 highly experienced doctors specialized in integrative and anthroposophic medicine. Structured qualitative content analysis was applied. For triangulation, the results were compared with external evidence that was systematically collected, reviewed, and presented. Results. Doctors perform individualized patient assessments that lead to multimodal treatment approaches. The underlying goal is to help patients to live with and overcome disease. Mistletoe infusions are a means of accomplishing this goal. They are applied to stabilize disease, achieve responsiveness, induce fever, improve quality of life, and improve the tolerability of conventional cancer treatments. The doctors reported long-term disease stability and improvements in patients’ general condition, vitality, strength, thermal comfort, appetite, sleep, pain from bone metastases, dyspnea in pulmonary lymphangitis carcinomatosa, fatigue, and cachexia; chemotherapy was better tolerated. Also patients’ emotional and mental condition was reported to have improved. Conclusion. Individualized integrative cancer treatment including MT aims to help cancer patients to live well with their disease. Further research should investigate the reported observations.

  15. Social Media Engagement and the Critical Care Medicine Community. (United States)

    Barnes, Sean S; Kaul, Viren; Kudchadkar, Sapna R


    Over the last decade, social media has transformed how we communicate in the medical community. Microblogging through platforms such as Twitter has made social media a vehicle for succinct, targeted, and innovative dissemination of content in critical care medicine. Common uses of social media in medicine include dissemination of information, knowledge acquisition, professional networking, and patient advocacy. Social media engagement at conferences represents all of these categories and is often the first time health-care providers are introduced to Twitter. Most of the major critical care medicine conferences, journals, and societies leverage social media for education, research, and advocacy, and social media users can tailor the inflow of content based on their own interests. From these interactions, networks and communities are built within critical care medicine and beyond, overcoming the barriers of physical proximity. In this review, we summarize the history and current status of health-care social media as it relates to critical care medicine and provide a primer for those new to health-care social media with a focus on Twitter, one of the most popular microblogging platforms.

  16. The Impact of Telemedicine on Pediatric Critical Care Triage. (United States)

    Harvey, Jillian B; Yeager, Brooke E; Cramer, Christina; Wheeler, David; McSwain, S David


    To examine the relationship between pediatric critical care telemedicine consultation to rural emergency departments and triage decisions. We compare the triage location and provider rating of the accuracy of remote assessment for a cohort of patients who receive critical care telemedicine consultations and a similar group of patients receiving telephone consultations. Retrospective evaluation of consultations occurring between April 2012 and March 2016. Pediatric critical care telemedicine and telephone consultations in 52 rural healthcare settings in South Carolina. Pediatric patients receiving critical care telemedicine or telephone consultations. Telemedicine consultations. Data were collected from the consulting provider for 484 total consultations by telephone or telemedicine. We examined the providers' self-reported assessments about the consultation, decision-making, and triage outcomes. We estimate a logit model to predict triage location as a function of telemedicine consult age and sex. For telemedicine patients, the odds of triage to a non-ICU level of care are 2.55 times larger than the odds for patients receiving telephone consultations (p = 0.0005). Providers rated the accuracy of their assessments higher when consultations were provided via telemedicine. When patients were transferred to a non-ICU location following a telemedicine consultation, providers indicated that the use of telemedicine influenced the triage decision in 95.7% of cases (p telemedicine consultation to community hospitals is feasible and results in a reduction in PICU admissions. This study demonstrates an improvement in provider-reported accuracy of patient assessment via telemedicine compared with telephone, which may produce a higher comfort level with transporting patients to a lower level of care. Pediatric critical care telemedicine consultations represent a promising means of improving care and reducing costs for critically ill children in rural areas.

  17. Predictors of backrest elevation in critical care. (United States)

    Grap, Mary Jo; Munro, Cindy L; Bryant, Sandra; Ashtiani, Brooke


    Low backrest and supine positions are associated with increased mortality and ventilator associated pneumonia (VAP). Data are not available across ICU settings about the level of backrest position used and its relationship to enteral feeding and hemodynamic status. The purpose of this descriptive study was to document the level of backrest elevation and position and identify factors associated with and predict positioning in a medical, surgical and neuroscience intensive care unit. Data were collected randomly in each unit over a 6-week period, resulting in 506 observations for170 patients. Backrest elevation was determined by electronic bed read-out or bed frame elevation gauge. BP, HR and enteral feeding status were retrieved from the medical record. Results showed that mean backrest elevation was 19.2 degrees and 70% of subjects were supine. No difference in backrest elevation among units was found. Significant correlations between backrest elevation and systolic BP (r=0.15, P=0.006); and backrest and diastolic BP (r=0.13, P=0.02) were found. There was no difference in backrest elevation between patients being fed and not being fed. Differences in backrest elevation for intubated versus nonintubated patients approached significance (P=0.07) with intubated patients at lower backrest elevations. In summary, use of higher backrest elevations (>30 degrees ) is minimal, is not related to feeding and minimally related to hemodynamic status. Strategies to meet published recommendations for backrest elevation (30-45 degrees ) must include repeated feedback about nurse's use of backrest elevation and estimates of elevation.

  18. Examining critical care nurses' critical incident stress after in hospital cardiopulmonary resuscitation (CPR). (United States)

    Laws, T


    The object of this study was to determine if critical care nurses' emotional responses to having performed cardiopulmonary resuscitation were indicative of critical incident stress. A descriptive approach was employed using a survey questionnaire of 31 critical care nurses, with supportive interview data from 18 of those participants. Analysis of the data generated from the questionnaire indicated that the respondents experienced thought intrusion and avoidance behaviour. A majority of those interviewed disclosed that they had experienced a wide range of emotional stressors and physical manifestations in response to having performed the procedure. The findings from both questionnaire and interview data were congruent with signs of critical incident stress, as described in the literature. This has been found to be detrimental to employees' mental health status and, for this reason, employers have a duty of care to minimise the risk of its occurrence and to manage problems as they arise.

  19. Exploring critical thinking in critical care nursing education: a pilot study. (United States)

    Rogal, Sonya M; Young, Jeanne


    Critical care nurses process vast amounts of information and require well developed critical-thinking skills to make clinical decisions. Using a pretest posttest design, the critical-thinking skills of 31 postgraduate nurses were evaluated using the California Critical Thinking Skills Test (CCTST). For the total group, mean critical-thinking scores improved slightly over time. The CCTST revealed a mean pretest score of 18.5 and a mean posttest score of 19.7, both of which were higher than the established norms for the test. Overall, no significant difference was observed between pretest and posttest. However, statistical significance was observed posttest for nurses whose critical-thinking scores improved (p critical-thinking skills during the course of their study.

  20. An Official Critical Care Societies Collaborative Statement-Burnout Syndrome in Critical Care Health-care Professionals: A Call for Action. (United States)

    Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N


    Burnout syndrome (BOS) occurs in all types of health-care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health-care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health-care professionals and diminish the harmful consequences of BOS, both for critical care health-care professionals and for patients. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  1. Effects of Clown Doctors on child and caregiver anxiety at the entrance to the surgery care unit and separation from caregivers

    Directory of Open Access Journals (Sweden)

    Patrícia Arriaga


    Full Text Available This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care. Independent observational records using the modified Yale Preoperative Anxiety Scale instrument assessed children’s anxiety, while the State-Trait Anxiety Inventory measured caregiver’s state anxiety. In addition, caregivers assessed the children’s functional health problems by completing the Functional Status Questionnaire. Although no effects of Clown Doctors were found on children’s anxiety, results showed that both low functional health problems and Clown Doctors intervention were significant predictors of lower caregiver anxiety. Caregivers also reported being very satisfied with their intervention. Overall, this study demonstrated the positive role of Clown Doctors for caregivers at a specific paediatric hospital setting.

  2. Critical Thinking in Critical Care: Five Strategies to Improve Teaching and Learning in the Intensive Care Unit. (United States)

    Hayes, Margaret M; Chatterjee, Souvik; Schwartzstein, Richard M


    Critical thinking, the capacity to be deliberate about thinking, is increasingly the focus of undergraduate medical education, but is not commonly addressed in graduate medical education. Without critical thinking, physicians, and particularly residents, are prone to cognitive errors, which can lead to diagnostic errors, especially in a high-stakes environment such as the intensive care unit. Although challenging, critical thinking skills can be taught. At this time, there is a paucity of data to support an educational gold standard for teaching critical thinking, but we believe that five strategies, routed in cognitive theory and our personal teaching experiences, provide an effective framework to teach critical thinking in the intensive care unit. The five strategies are: make the thinking process explicit by helping learners understand that the brain uses two cognitive processes: type 1, an intuitive pattern-recognizing process, and type 2, an analytic process; discuss cognitive biases, such as premature closure, and teach residents to minimize biases by expressing uncertainty and keeping differentials broad; model and teach inductive reasoning by utilizing concept and mechanism maps and explicitly teach how this reasoning differs from the more commonly used hypothetico-deductive reasoning; use questions to stimulate critical thinking: "how" or "why" questions can be used to coach trainees and to uncover their thought processes; and assess and provide feedback on learner's critical thinking. We believe these five strategies provide practical approaches for teaching critical thinking in the intensive care unit.

  3. Acute care simulation training for foundation doctors: the perceived impact on practice in the workplace. (United States)

    Patel, P; Sockalingam, I


    High fidelity simulation allows training of foundation doctors in a safe, structured environment. We explored the perceived impact of such training on subsequent clinical practice. 82 doctors attended and 52% responded to a follow up questionnaire sent two months after their training. 88% felt better able to manage the acutely ill patient than they did before their training. All cited simulation training as a reason for this and 44% felt simulation training was the main contributor. The remainder cited clinical experience as the main contributor. 53% gave real clinical examples where they applied skills attributed to simulation training. Doctors reflected positively on simulation training sometime after the experience, demonstrated transference of learnt skills and felt more confident at work.

  4. [Analysis of an incident notification system and register in a critical care unit]. (United States)

    Murillo-Pérez, M A; García-Iglesias, M; Palomino-Sánchez, I; Cano Ruiz, G; Cuenca Solanas, M; Alted López, E


    To analyse the incident communicated through a notification system and register in a critical care unit. A cross-sectional descriptive study was conducted by performing an analysis of the records of incidents communicated anonymously and voluntarily from January 2007 to December 2013 in a critical care unit of adult patients with severe trauma. incident type and class, professional reports, and suggestions for improvement measures. A descriptive analysis was performed on the variables. Out of a total of 275 incidents reported, 58.5% of them were adverse events. Incident distributed by classes: medication, 33.7%; vascular access-drainage-catheter-sensor, 19.6%; devices-equipment, 13.3%, procedures, 11.5%; airway tract and mechanical ventilation, 10%; nursing care, 4.1%; inter-professional communication, 3%; diagnostic test, 3%; patient identification, 1.1%, and transfusion 0.7%. In the medication group, administrative errors accounted for a total of 62%; in vascular access-drainage-catheter-sensor group, central venous lines, a total of 27%; in devices and equipment group, respirators, a total of 46.9%; in airway self-extubations, a total of 32.1%. As regards to medication errors, 62% were incidents without damage. Incident notification by profession: doctors, 43%, residents, 5.6%, nurses, 51%, and technical assistants, 0.4%. Adverse events are the most communicated incidents. The events related to medication administration are the most frequent, although most of them were without damage. Nurses and doctors communicate the incidents with the same frequency. In order to highlight the low incident notification despite it being an anonymous and volunteer system, therefore, it is suggested to study measurements to increase the level of communication. Copyright © 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  5. Strategic Planning for Research in Pediatric Critical Care. (United States)

    Tamburro, Robert F; Jenkins, Tammara L; Kochanek, Patrick M


    To summarize the scientific priorities and potential future research directions for pediatric critical care research discussed by a panel of experts at the inaugural Strategic Planning Conference of the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Expert opinion expressed during the Strategic Planning Conference. Not applicable. Chaired by an experienced expert from the field, issues relevant to the conduct of pediatric critical care research were discussed and debated by the invited participants. Common themes and suggested priorities were identified and coalesced. Of the many pathophysiologic conditions discussed, the multiple organ dysfunction syndrome emerged as a topic in need of more study that is most relevant to the field. Additionally, the experts offered that the interrelationship and impact of critical illness on child development and family functioning are important research priorities. Consequently, long-term outcomes research was encouraged. The expert group also suggested that multidisciplinary conferences are needed to help identify key knowledge gaps to advance and direct research in the field. The Pediatric Critical Care and Trauma Scientist Development National K12 Program and the Collaborative Pediatric Critical Care Research Network were recognized as successful and important programs supported by the branch. The development of core data resources including biorepositories with robust phenotypic data using common data elements was also suggested to foster data sharing among investigators and to enhance disease diagnosis and discovery. Multicenter clinical trials and innovative study designs to address understudied and poorly understood conditions were considered important for field advancement. Finally, the growth of the pediatric critical care research workforce was offered as a priority that could be spawned in many ways including by expanded

  6. Clinical review: International comparisons in critical care - lessons learned. (United States)

    Murthy, Srinivas; Wunsch, Hannah


    Critical care medicine is a global specialty and epidemiologic research among countries provides important data on availability of critical care resources, best practices, and alternative options for delivery of care. Understanding the diversity across healthcare systems allows us to explore that rich variability and understand better the nature of delivery systems and their impact on outcomes. However, because the delivery of ICU services is complex (for example, interplay of bed availability, cultural norms and population case-mix), the diversity among countries also creates challenges when interpreting and applying data. This complexity has profound influences on reported outcomes, often obscuring true differences. Future research should emphasize determination of resource data worldwide in order to understand current practices in different countries; this will permit rational pandemic and disaster planning, allow comparisons of in-ICU processes of care, and facilitate addition of pre- and post-ICU patient data to better interpret outcomes.

  7. Bowel management systems in critical care: a service evaluation. (United States)

    Ritzema, Jennifer


    Aim Many patients who are critically ill develop faecal incontinence associated with diarrhoea, and require a bowel management system (BMS) to prevent skin excoriation. Following guidelines produced by the National Institute for Health and Care Excellence, early rehabilitation has resulted in a reduction in the number of days that patients receive mechanical ventilation. However, patients with a BMS are potentially mechanically ventilated for longer because they are cared for in bed. The aim of this evaluation was to investigate whether patients with a BMS are mechanically ventilated for longer than those without a BMS. Method This was a retrospective service evaluation, in which a database search was conducted to identify patients admitted to the critical care department in one healthcare organisation during 2013. The search was narrowed to identify patients admitted to the critical care department who had received advanced respiratory support (mechanical ventilation), to compare the mean number of mechanically ventilated days between patients with and without a BMS (n = 122). Data were analysed using the Mann-Whitney U test. Results There was a significant difference in the number of mechanically ventilated days (Pcritically ill patients with a BMS are placed in a sitting position for short periods of time. Further research should explore alternative bowel care options for patients who are critically ill.

  8. Intercultural doctor-patient communication in daily outpatient care: relevant communication skills.

    NARCIS (Netherlands)

    Paternotte, E.; Scheele, F.; Seeleman, C.M.; Bank, L.; Scherpbier, A.J.J.A.; Dulmen, A.M. van


    Introduction Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical

  9. A review of costing methodologies in critical care studies. (United States)

    Pines, Jesse M; Fager, Samuel S; Milzman, David P


    Clinical decision making in critical care has traditionally been based on clinical outcome measures such as mortality and morbidity. Over the past few decades, however, increasing competition in the health care marketplace has made it necessary to consider costs when making clinical and managerial decisions in critical care. Sophisticated costing methodologies have been developed to aid this decision-making process. We performed a narrative review of published costing studies in critical care during the past 6 years. A total of 282 articles were found, of which 68 met our search criteria. They involved a mean of 508 patients (range, 20-13,907). A total of 92.6% of the studies (63 of 68) used traditional cost analysis, whereas the remaining 7.4% (5 of 68) used cost-effectiveness analysis. None (0 of 68) used cost-benefit analysis or cost-utility analysis. A total of 36.7% (25 of 68) used hospital charges as a surrogate for actual costs. Of the 43 articles that actually counted costs, 37.2% (16 of 43) counted physician costs, 27.9% (12 of 43) counted facility costs, 34.9% (15 of 43) counted nursing costs, 9.3% (4 of 43) counted societal costs, and 90.7% (39 of 43) counted laboratory, equipment, and pharmacy costs. Our conclusion is that despite considerable progress in costing methodologies, critical care studies have not adequately implemented these techniques. Given the importance of financial implications in medicine, it would be prudent for critical care studies to use these more advanced techniques. Copyright 2002, Elsevier Science (USA). All rights reserved.

  10. Talking to Your Doctor

    Medline Plus

    Full Text Available ... can play an active role in your health care by talking to your doctor. Clear and honest ... Institute on Aging (NIA) Cancer Communication in Cancer Care , National Cancer Institute (NCI) Español Complementary and Integrative ...

  11. Development road of critical care medicine in China: reference, integration and improvement

    Directory of Open Access Journals (Sweden)

    Hai-tao ZHANG


    Full Text Available Fundamental critical care medicine (FCCM and specialty critical care medicine (SCCM have their own independent developmental itinerary and have made indelible contributions to intensive treatment in the long history of CCM. The experts in FCCM are usually dominant in the cross-sectional study for various severe illnesses, and lay emphases on balancing the relationship among the dysfunctional organs under the guidance of overall treatment concept. SCCM experts emphasize longitudinal in-depth study for a specialized subject or special disease in order to solve the principal problem of the severe illness under the guidance of its own principal. At present, the main challenge of CCM is to avoid the habitual linear thinking. It is necessary for the members of FCCM to learn the knowledge of different problems pertaining to various specialties from SCCM, thus FCCM doctors would be able to take care of patients suffering from derangements of specific organs. SCCM members also need to learn from FCCM for strengthening the concept of overall treatment, optimizing various treatment resources, and improving treatment effects. Members of FCCM and SCCM need to learn from each other, in order to integrate and improve treatment strategies together, so as to complement each other. This will broaden the knowledge of SCCM and deepen that of FCCM. The integration of knowledge and skill will enrich the connotation of the CCM.

  12. The emotional intelligence of registered nurses commencing critical care nursing

    Directory of Open Access Journals (Sweden)

    Yvette Nagel


    Conclusion: The EI of RNs commencing work in a critical care environment was indicative of a higher range of Global EI, with the well-being factor scoring the highest, followed by the emotionality factor, then self-control, with the sociability factor scoring the lowest.

  13. Early Identification of Circulatory Shock in Critical Care Transport (United States)


    disclosure and community consultation. Early Identification of Circulatory Shock in Critical Care Transport 2 Community consultation for two aircraft types (Eurocopter EC 135 and EC 145), in IFR weather conditions, and during both day and night operations. We calculated the

  14. What are the learning outcomes of a short postgraduate training course in dermatology for primary care doctors? (United States)


    Background There are increasing expectations on primary care doctors to shoulder a bigger share of care for patients with common dermatological problems in the community. This study examined the learning outcomes of a short postgraduate course in dermatology for primary care doctors. Methods A self-reported questionnaire developed by the research team was sent to the Course graduates. A retrospective design was adopted to compare their clinical practice characteristics before and after the Course. Differences in the ratings were analysed using the nonparametric Wilcoxon signed rank test to evaluate the effectiveness of the Course in various aspects. Results Sixty-nine graduates replied with a response rate of 42.9% (69/161). Most were confident of diagnosing (91.2%) and managing (88.4%) common dermatological problems after the Course, compared to 61.8% and 58.0% respectively before the Course. Most had also modified their approach and increased their attention to patients with dermatological problems. The number of patients with dermatological problems seen by the graduates per day showed significant increase after the Course, while the average percentage of referrals to dermatologists dropped from 31.9% to 23.5%. The proportion of graduates interested in following up patients with chronic dermatological problems increased from 60.3% to 77.9%. Conclusions Graduates of the Course reported improved confidence, attitudes and skills in treating common dermatological problems. They also reported to handle more patients with common dermatological problems in their practice and refer fewer patients. PMID:21575191

  15. A review of critical care nursing and disease outbreak preparedness. (United States)

    Makamure, Miranda; Makamure, Muriel; Mendiola, Williane; Renteria, Daisy; Repp, Melissa; Willden, Azshwee


    The impact of disease outbreaks continues to increase globally. As frontline staff, critical care nurses (CCNs) are more likely to be confronted with the need to care for affected patients. With different pathological diseases emerging, CCNs play an integral role in disease outbreaks. The advanced skill set of CCNs is pivotal in the management and care of patients during an outbreak. Lack of planning and preparation before disease outbreaks leads to detrimental patient outcomes. Panic, chaos, and fear for personal safety cause stress and anxiety for unprepared nurses. However, this problem can be resolved. Comprehensive planning, training, and education can better prepare intensive care unit nurses for disease outbreaks. This article reviews some of the current literature on intensive care unit nurse preparedness for disease outbreaks in the United States. This article also offers strategies that may be used to better prepare CCNs for disease outbreaks.

  16. Telemedicine to Reduce Medical Risk in Austere Medical Environments: The Virtual Critical Care Consultation (VC3) Service. (United States)

    Powell, Douglas; McLeroy, Robert D; Riesberg, Jamie; Vasios, William N; Miles, Ethan A; Dellavolpe, Jeffrey; Keenan, Sean; Pamplin, Jeremy C

    One of the core capabilities of prolonged field care is telemedicine. We developed the Virtual Critical Care Consult (VC3) Service to provide Special Operations Forces (SOF) medics with on-demand, virtual consultation with experienced critical care physicians to optimize management and improve outcomes of complicated, critically injured or ill patients. Intensive-care doctors staff VC3 continuously. SOF medics access this service via phone or e-mail. A single phone call reaches an intensivist immediately. An e-mail distribution list is used to share information such as casualty images, vital signs flowsheet data, and short video clips, and helps maintain situational awareness among the VC3 critical care providers and other key SOF medical leaders. This real-time support enables direct communication between the remote provider and the clinical subject matter expert, thus facilitating expert management from near the point of injury until definitive care can be administered. The VC3 pilot program has been extensively tested in field training exercises and validated in several real-world encounters. It is an immediately available capability that can reduce medical risk and is scalable to all Special Operations Command forces. 2016.

  17. Impact of shift work on critical care nurses. (United States)

    Pryce, Cheryl


    Shift work is a common practice in the health care field to maintain 24-hour patient care. The purpose of this article is to recognize the negative impact of shift work on critical care nurses, and identify strategies to mitigate these effects. A review of the literature was completed, using the search terms: 'shift work, 'critical care', impact, and health. The literature revealed that shift work has an adverse effect on the health of a nurse. Some of the health implications include stress, sleep deprivation, cardiovascular disease, gastrointestinal symptoms, and mental health illnesses. Furthermore, shift work impacts a nurse's social life and may result in patient harm. Strategies to reduce the negative impact of shift work will be focused on educating critical care nurses and managers. These strategies include frontline staff maintaining a moderate amount of exercise, sustaining a well-balanced diet, using relaxation techniques, reducing the use of cigarettes, working an eight-hour work day, and napping during scheduled breaks. Recommendations for managers include implementing quiet time at the workplace, providing a safe space for staff to nap during breaks, facilitating an eight-hour work day, and encouraging a multidisciplinary team approach when managing workload.

  18. Big Data and Data Science in Critical Care. (United States)

    Sanchez-Pinto, L Nelson; Luo, Yuan; Churpek, Matthew M


    The digitalization of the healthcare system has resulted in a deluge of clinical Big Data and has prompted the rapid growth of data science in medicine. Data science, which is the field of study dedicated to the principled extraction of knowledge from complex data, is particularly relevant in the critical care setting. The availability of large amounts of data in the intensive care unit, the need for better evidence-based care, and the complexity of critical illness makes the use of data science techniques and data-driven research particularly appealing to intensivists. Despite the increasing number of studies and publications in the field, so far there have been few examples of data science projects that have resulted in successful implementations of data-driven systems in the intensive care unit. However, given the expected growth in the field, intensivists should be familiar with the opportunities and challenges of Big Data and data science. In this paper, we review the definitions, types of algorithms, applications, challenges, and future of Big Data and data science in critical care. Copyright © 2018. Published by Elsevier Inc.

  19. Critical incidents connected to nurses’ leadership in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Elaine Cantarella Lima

    Full Text Available ABSTRACT Objective: The goal of this study is to analyze nurses’ leadership in intensive care units at hospitals in the state of São Paulo, Brazil, in the face of positive and negative critical incidents. Method: Exploratory, descriptive study, conducted with 24 nurses by using the Critical Incident Technique as a methodological benchmark. Results: Results were grouped into 61 critical incidents distributed into categories. Researchers came to the conclusion that leadership-related situations interfere with IC nurses’ behaviors. Among these situations they found: difficulty in the communication process; conflicts in the daily exercise of nurses’ activities; people management; and the setting of high quality care targets. Final considerations: Researchers identified a mixed leadership model, leading them to the conclusion that nurses’ knowledge and practice of contemporary leadership theories/styles are crucial because they facilitate the communication process, focusing on behavioral aspects and beliefs, in addition to valuing flexibility. This positively impacts the organization’s results.

  20. [Structural elements of critical thinking of nurses in emergency care]. (United States)

    Crossetti, Maria da Graça Oliveira; Bittencourt, Greicy Kelly Gouveia Dias; Lima, Ana Amélia Antunes; de Góes, Marta Georgina Oliveira; Saurin, Gislaine


    The objective of this study was to analyze the structural elements of critical thinking (CT) of nurses in the clinical decision-making process. This exploratory, qualitative study was conducted with 20 emergency care nurses in three hospitals in southern Brazil. Data were collected from April to June 2009, and a validated clinical case was applied from which nurses listed health problems, prescribed care and listed the structural elements of CT. Content analysis resulted in categories used to determine priority structural elements of CT, namely theoretical foundations and practical relationship to clinical decision making; technical and scientific knowledge and clinical experience, thought processes and clinical decision making: clinical reasoning and basis for clinical judgments of nurses: patient assessment and ethics. It was concluded that thinking critically is a skill that enables implementation of a secure and effective nursing care process.

  1. Structural elements of critical thinking of nurses in emergency care

    Directory of Open Access Journals (Sweden)

    Maria da Graça Oliveira Crossetti

    Full Text Available The objective of this study was to analyze the structural elements of critical thinking (CT of nurses in the clinical decision-making process. This exploratory, qualitative study was conducted with 20 emergency care nurses in three hospitals in southern Brazil. Data were collected from April to June 2009, and a validated clinical case was applied from which nurses listed health problems, prescribed care and listed the structural elements of CT. Content analysis resulted in categories used to determine priority structural elements of CT, namely theoretical foundations and practical relationship to clinical decision making; technical and scientific knowledge and clinical experience, thought processes and clinical decision making: clinical reasoning and basis for clinical judgments of nurses: patient assessment and ethics. It was concluded that thinking critically is a skill that enables implementation of a secure and effective nursing care process.

  2. The context influences doctors' support of shared decision-making in cancer care


    Shepherd, H L; Tattersall, M H N; Butow, P N


    Most cancer patients in westernised countries now want all information about their situation, good or bad, and many wish to be involved in decision-making. The attitudes to and use of shared decision-making (SDM) by cancer doctors is not well known. Australian cancer clinicians treating breast, colorectal, gynaecological, haematological, or urological cancer were surveyed to identify their usual approach to decision-making and their comfort with different decision-making styles when discussin...

  3. The context influences doctors' support of shared decision-making in cancer care. (United States)

    Shepherd, H L; Tattersall, M H N; Butow, P N


    Most cancer patients in westernised countries now want all information about their situation, good or bad, and many wish to be involved in decision-making. The attitudes to and use of shared decision-making (SDM) by cancer doctors is not well known. Australian cancer clinicians treating breast, colorectal, gynaecological, haematological, or urological cancer were surveyed to identify their usual approach to decision-making and their comfort with different decision-making styles when discussing treatment with patients. A response rate of 59% resulted in 624 complete surveys, which explored usual practice in discussing participation in decision-making, providing information, and perception of the role patients want to play. Univariate and multivariate analyses were performed to identify predictors of use of SDM. Most cancer doctors (62.4%) reported using SDM and being most comfortable with this approach. Differences were apparent between reported high comfort with SDM and less frequent usual practice. Multivariate analysis showed that specialisation in breast or urological cancers compared to other cancers (AOR 3.02), high caseload of new patients per month (AOR 2.81) and female gender (AOR 1.87) were each independently associated with increased likelihood of use of SDM. Barriers exist to the application of SDM by doctors according to clinical situation and clinician characteristics.

  4. When and Why Do Neonatal and Pediatric Critical Care Physicians Consult Palliative Care? (United States)

    Richards, Claire A; Starks, Helene; O'Connor, M Rebecca; Bourget, Erica; Lindhorst, Taryn; Hays, Ross; Doorenbos, Ardith Z


    Parents of children admitted to neonatal and pediatric intensive care units (ICUs) are at increased risk of experiencing acute and post-traumatic stress disorder. The integration of palliative care may improve child and family outcomes, yet there remains a lack of information about indicators for specialty-level palliative care involvement in this setting. To describe neonatal and pediatric critical care physician perspectives on indicators for when and why to involve palliative care consultants. Semistructured interviews were conducted with 22 attending physicians from neonatal, pediatric, and cardiothoracic ICUs in a single quaternary care pediatric hospital. Transcribed interviews were analyzed using content and thematic analyses. We identified 2 themes related to the indicators for involving palliative care consultants: (1) palliative care expertise including support and bridging communication and (2) organizational factors influencing communication including competing priorities and fragmentation of care. Palliative care was most beneficial for families at risk of experiencing communication problems that resulted from organizational factors, including those with long lengths of stay and medical complexity. The ability of palliative care consultants to bridge communication was limited by some of these same organizational factors. Physicians valued the involvement of palliative care consultants when they improved efficiency and promoted harmony. Given the increasing number of children with complex chronic conditions, it is important to support the capacity of ICU clinical teams to provide primary palliative care. We suggest comprehensive system changes and critical care physician training to include topics related to chronic illness and disability.

  5. A case study evaluation of a Critical Care Information System adoption using the socio-technical and fit approach. (United States)

    Yusof, Maryati Mohd


    Clinical information systems have long been used in intensive care units but reports on their adoption and benefits are limited. This study evaluated a Critical Care Information System implementation. A case study summative evaluation was conducted, employing observation, interview, and document analysis in operating theatres and 16-bed adult intensive care units in a 400-bed Malaysian tertiary referral centre from the perspectives of users (nurses and physicians), management, and information technology staff. System implementation, factors influencing adoption, fit between these factors, and the impact of the Critical Care Information System were evaluated after eight months of operation. Positive influences on system adoption were associated with technical factors, including system ease of use, usefulness, and information relevancy; human factors, particularly user attitude; and organisational factors, namely clinical process-technology alignment and champions. Organisational factors such as planning, project management, training, technology support, turnover rate, clinical workload, and communication were barriers to system implementation and use. Recommendations to improve the current system problems were discussed. Most nursing staff positively perceived the system's reduction of documentation and data access time, giving them more time with patients. System acceptance varied among doctors. System use also had positive impacts on timesaving, data quality, and clinical workflow. Critical Care Information Systems is crucial and has great potentials in enhancing and delivering critical care. However, the case study findings showed that the system faced complex challenges and was underutilised despite its potential. The role of socio-technical factors and their fit in realizing the potential of Critical Care Information Systems requires continuous, in-depth evaluation and stakeholder understanding and acknowledgement. The comprehensive and specific evaluation

  6. Sustaining staff nurse support for a patient care ergonomics program in critical care. (United States)

    Haney, Linda L; Wright, Laurette


    Applying management concepts from marketing and business sources can assist critical care units with establishing a planned change in the way nurses perform manual handling tasks, and thus, help insure that it is sustained.

  7. "Doctor, Make My Decisions": Decision Control Preferences, Advance Care Planning, and Satisfaction With Communication Among Diverse Older Adults. (United States)

    Chiu, Catherine; Feuz, Mariko A; McMahan, Ryan D; Miao, Yinghui; Sudore, Rebecca L


    Culturally diverse older adults may prefer varying control over medical decisions. Decision control preferences (DCPs) may profoundly affect advance care planning (ACP) and communication. To determine the DCPs of diverse, older adults and whether DCPs are associated with participant characteristics, ACP, and communication satisfaction. A total of 146 participants were recruited from clinics and senior centers in San Francisco. We assessed DCPs using the control preferences scale: doctor makes all decisions (low), shares with doctor (medium), makes own decisions (high). We assessed associations between DCPs and demographics; prior advance directives; ability to make in-the-moment goals of care decisions; self-efficacy, readiness, and prior asked questions; and satisfaction with patient-doctor communication (on a five-point Likert scale), using Chi-square and Kruskal-Wallis analysis of variance. Mean age was 71 ± 10 years, 53% were non-white, 47% completed an advance directive, and 70% made goals of care decisions. Of the sample, 18% had low DCPs, 33% medium, and 49% high. Older age was the only characteristic associated with DCPs (low: 75 ± 11 years, medium: 69 ± 10 years, high: 70 ± 9 years, P = 0.003). DCPs were not associated with ACP, in-the-moment decisions, or communication satisfaction. Readiness was the only question-asking behavior associated (low: 3.8 ± 1.2, medium: 4.1 ± 1.2, high: 4.3 ± 1.2, P = 0.05). Nearly one-fifth of diverse, older adults want doctors to make their medical decisions. Older age and lower readiness to ask questions were the only demographic variables significantly associated with low DCPs. Yet, older adults with low DCPs still engaged in ACP, asked questions, and reported communication satisfaction. Clinicians can encourage ACP and questions for all patients, but should assess DCPs to provide the desired amount of decision support. Copyright © 2016 American Academy of Hospice and Palliative Medicine. All

  8. Tree analysis modeling of the associations between PHQ-9 depressive symptoms and doctor diagnosis of depression in primary care. (United States)

    Chin, Weng-Yee; Wan, Eric Yuk Fai; Dowrick, Christopher; Arroll, Bruce; Lam, Cindy Lo Kuen


    The aim of this study was to explore the relationship between patient self-reported Patient Health Questionnaire-9 (PHQ-9) symptoms and doctor diagnosis of depression using a tree analysis approach. This was a secondary analysis on a dataset obtained from 10 179 adult primary care patients and 59 primary care physicians (PCPs) across Hong Kong. Patients completed a waiting room survey collecting data on socio-demographics and the PHQ-9. Blinded doctors documented whether they thought the patient had depression. Data were analyzed using multiple logistic regression and conditional inference decision tree modeling. PCPs diagnosed 594 patients with depression. Logistic regression identified gender, age, employment status, past history of depression, family history of mental illness and recent doctor visit as factors associated with a depression diagnosis. Tree analyses revealed different pathways of association between PHQ-9 symptoms and depression diagnosis for patients with and without past depression. The PHQ-9 symptom model revealed low mood, sense of worthlessness, fatigue, sleep disturbance and functional impairment as early classifiers. The PHQ-9 total score model revealed cut-off scores of >12 and >15 were most frequently associated with depression diagnoses in patients with and without past depression. A past history of depression is the most significant factor associated with the diagnosis of depression. PCPs appear to utilize a hypothetical-deductive problem-solving approach incorporating pre-test probability, with different associated factors for patients with and without past depression. Diagnostic thresholds may be too low for patients with past depression and too high for those without, potentially leading to over and under diagnosis of depression.

  9. Clinical examination, critical care ultrasonography and outcomes in the critically ill

    DEFF Research Database (Denmark)

    Hiemstra, Bart; Eck, Ruben J; Koster, Geert


    PURPOSE: In the Simple Intensive Care Studies-I (SICS-I), we aim to unravel the value of clinical and haemodynamic variables obtained by physical examination and critical care ultrasound (CCUS) that currently guide daily practice in critically ill patients. We intend to (1) measure all available...... patient used for guiding diagnostics, prognosis and interventions. Repeated evaluations of these sets of variables are needed for continuous improvement of the diagnostic and prognostic models. Future plans include: (1) more advanced imaging; (2) repeated clinical and haemodynamic measurements; (3...... clinical and haemodynamic variables, (2) train novices in obtaining values for advanced variables based on CCUS in the intensive care unit (ICU) and (3) create an infrastructure for a registry with the flexibility of temporarily incorporating specific (haemodynamic) research questions and variables...

  10. Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses. (United States)

    Sacco, Tara L; Ciurzynski, Susan M; Harvey, Megan Elizabeth; Ingersoll, Gail L


    Although critical care nurses gain satisfaction from providing compassionate care to patients and patients' families, the nurses are also at risk for fatigue. The balance between satisfaction and fatigue is considered professional quality of life. To establish the prevalence of compassion satisfaction and compassion fatigue in adult, pediatric, and neonatal critical care nurses and to describe potential contributing demographic, unit, and organizational characteristics. In a cross-sectional design, nurses were surveyed by using a demographic questionnaire and the Professional Quality of Life Scale to measure levels of compassion fatigue and compassion satisfaction. Nurses (n = 221) reported significant differences in compassion satisfaction and compassion fatigue on the basis of sex, age, educational level, unit, acuity, change in nursing management, and major systems change. Understanding the elements of professional quality of life can have a positive effect on work environment. The relationship between professional quality of life and the standards for a healthy work environment requires further investigation. Once this relationship is fully understood, interventions to improve this balance can be developed and tested. ©2015 American Association of Critical-Care Nurses.

  11. Assessing burden in families of critical care patients. (United States)

    Kentish-Barnes, Nancy; Lemiale, Virginie; Chaize, Marine; Pochard, Frédéric; Azoulay, Elie


    To provide critical care clinicians with information on validated instruments for assessing burden in families of critical care patients. PubMed (1979-2009). We included all quantitative studies that used a validated instrument to evaluate the prevalence of, and risk factors for, burden on families. We extracted the descriptions of the instruments used and the main results. Family burden after critical illness can be detected reliably and requires preventive strategies and specific treatments. Using simple face-to-face interviews, intensivists can learn to detect poor comprehension and its determinants. Instruments for detecting symptoms of anxiety, depression, or stress can be used reliably even by physicians with no psychiatric training. For some symptoms, the evaluation should take place at a distance from intensive care unit discharge or death. Experience with families of patients who died in the intensive care unit and data from the literature have prompted studies of bereaved family members and the development of interventions aimed at decreasing guilt and preventing complicated grief. We believe that burden on families should be assessed routinely. In clinical studies, using markers for burden measured by validated tools may provide further evidence that effective communication and efforts to detect and to prevent symptoms of stress, anxiety, or depression provide valuable benefits to families.

  12. Informed consent for and regulation of critical care research. (United States)

    Lemaire, François


    Critical care is a special area in which research needs to take place, because of the severity of the diseases which are treated there, but it is also a place where research faces a lot of hurdles and difficulties. The main cause of difficulties is the consent issue, as most patients cannot consent for themselves. Recently, all national legislations in the countries of the European Union have been modified to include the provisions of directive 2001/20. This review article provides a summary of the recent literature concerning the issue of consent for clinical care research such as how the surrogate consent reflects the view of the patient and how time consuming and inaccurate can be the consultation of a community before the start of a trial with a waiver of consent. Another hurdle to research is the rigidity of our legislations concerning clinical research, especially the absence of a simplified way for low or no-risk research. This article shows how this situation is potentially deleterious and how it could ultimately forbid low-risk research. Critical research remains a domain in which research on patients is difficult and controversial. Regulation can be difficult to implement, largely inadequate or uselessly complicated. Intensive care physicians need to keep pressure on politicians and lawmakers to constantly explain the necessity and specificities of critical care research.

  13. A comparison of critical care research funding and the financial burden of critical illness in the United States. (United States)

    Coopersmith, Craig M; Wunsch, Hannah; Fink, Mitchell P; Linde-Zwirble, Walter T; Olsen, Keith M; Sommers, Marilyn S; Anand, Kanwaljeet J S; Tchorz, Kathryn M; Angus, Derek C; Deutschman, Clifford S


    To estimate federal dollars spent on critical care research, the cost of providing critical care, and to determine whether the percentage of federal research dollars spent on critical care research is commensurate with the financial burden of critical care. The National Institutes of Health Computer Retrieval of Information on Scientific Projects database was queried to identify funded grants whose title or abstract contained a key word potentially related to critical care. Each grant identified was analyzed by two reviewers (three if the analysis was discordant) to subjectively determine whether it was definitely, possibly, or definitely not related to critical care. Hospital and total costs of critical care were estimated from the Premier Database, state discharge data, and Medicare data. To estimate healthcare expenditures associated with caring for critically ill patients, total costs were calculated as the combination of hospitalization costs that included critical illness as well as additional costs in the year after hospital discharge. Of 19,257 grants funded by the National Institutes of Health, 332 (1.7%) were definitely related to critical care and a maximum of 1212 (6.3%) grants were possibly related to critical care. Between 17.4% and 39.0% of total hospital costs were spent on critical care, and a total of between $121 and $263 billion was estimated to be spent on patients who required intensive care. This represents 5.2% to 11.2%, respectively, of total U.S. healthcare spending. The proportion of research dollars spent on critical care is lower than the percentage of healthcare expenditures related to critical illness.

  14. Specialist palliative care nursing and the philosophy of palliative care: a critical discussion. (United States)

    Robinson, Jackie; Gott, Merryn; Gardiner, Clare; Ingleton, Christine


    Nursing is the largest regulated health professional workforce providing palliative care across a range of clinical settings. Historically, palliative care nursing has been informed by a strong philosophy of care which is soundly articulated in palliative care policy, research and practice. Indeed, palliative care is now considered to be an integral component of nursing practice regardless of the specialty or clinical setting. However, there has been a change in the way palliative care is provided. Upstreaming and mainstreaming of palliative care and the dominance of a biomedical model with increasing medicalisation and specialisation are key factors in the evolution of contemporary palliative care and are likely to impact on nursing practice. Using a critical reflection of the authors own experiences and supported by literature and theory from seminal texts and contemporary academic, policy and clinical literature, this discussion paper will explore the influence of philosophy on nursing knowledge and theory in the context of an evolving model of palliative care.

  15. Ethical issues in pediatric emergency mass critical care. (United States)

    Antommaria, Armand H Matheny; Powell, Tia; Miller, Jennifer E; Christian, Michael D


    As a result of recent events, including natural disasters and pandemics, mass critical care planning has become a priority. In general, planning involves limiting the scope of disasters, increasing the supply of medical resources, and allocating scarce resources. Entities at varying levels have articulated ethical frameworks to inform policy development. In spite of this increased focus, children have received limited attention. Children require special attention because of their unique vulnerabilities and needs. In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations.Steering Committee members established subgroups by topic area and performed literature reviews of MEDLINE and Ovid databases. Draft documents were subsequently developed and revised based on the feedback from the Task Force. The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010. This document reflects expert input from the Task Force in addition to the most current medical literature. The Ethics Subcommittee recommends that surge planning seek to provide resources for children in proportion to their percentage of the population or preferably, if data are available, the percentage of those affected by the disaster. Generally, scarce resources should be allocated on the basis of need, benefit, and the conservation of resources. Estimates of need, benefit, and resource utilization may be more subjective or objective. While the

  16. Power imbalance and consumerism in the doctor-patient relationship: health care providers' experiences of patient encounters in a rural district in India. (United States)

    Fochsen, Grethe; Deshpande, Kirti; Thorson, Anna


    The aim of this study is to explore health care providers' experiences and perceptions of their encounters with male and female patients in a rural district in India with special reference to tuberculosis (TB) care. The authors conducted semistructured interviews with 22 health care providers, 17 men and 5 women, from the public and private health care sectors. Findings reveal that doctors adopted an authoritarian as well as a consumerist approach in the medical encounter, indicating that power imbalances in the doctor-patient relationship are negotiable and subject to change. Gender was identified as an influencing factor of the doctor's dominance. A patient-centered approach, acknowledging patients' own experiences and shared decision making, is called for and should be included in TB control activities. This seems to be especially important for female patients, whose voices were not heard in the medical encounter.

  17. Respiratory Acid-Base Disorders in the Critical Care Unit. (United States)

    Hopper, Kate


    The incidence of respiratory acid-base abnormalities in the critical care unit (CCU) is unknown, although respiratory alkalosis is suspected to be common in this population. Abnormal carbon dioxide tension can have many physiologic effects, and changes in Pco 2 may have a significant impact on outcome. Monitoring Pco 2 in CCU patients is an important aspect of critical patient assessment, and identification of respiratory acid-base abnormalities can be valuable as a diagnostic tool. Treatment of respiratory acid-base disorders is largely focused on resolution of the primary disease, although mechanical ventilation may be indicated in cases with severe respiratory acidosis. Published by Elsevier Inc.

  18. Outcome measures for adult critical care: a systematic review. (United States)

    Hayes, J A; Black, N A; Jenkinson, C; Young, J D; Rowan, K M; Daly, K; Ridley, S


    1. To identify generic and disease specific measures of impairment, functional status and health-related quality of life that have been used in adult critical care (intensive and high-dependency care) survivors. 2. To review the validity, reliability and responsiveness of the measures in adult critical care survivors. 3. To consider the implications for future policy and to make recommendations for further methodological research. 4. To review what is currently known of the outcome of adult critical care. Searches of electronic databases (MEDLINE, EMBASE, CINAHL, PsycLIT, The Cochrane Library and SIGLE) from 1970 to August 1998. Manual searches of five journals (1985-98) not indexed in electronic databases and relevant conference proceedings (1993-98). Reference lists of six existing reviews, plus snowballing from reference lists of all relevant articles identified. Randomised trials, non-randomised trials (cohort studies) and case series that included data on outcomes after discharge from adult (16 years and over) critical care. If reported, the following data were extracted from each paper: patient characteristics (age, gender, severity of illness, diagnostic category) number of patients eligible for study, follow-up period, number of deaths before follow-up, number and proportion of survivors included in follow-up method of presentation of outcome data - proportion normal as defined by reference values, or aggregate value (e.g. mean or median), or aggregate values plus an indication of variance (e.g. standard deviation or inter-quartile range). Evidence for three measurement properties was sought for each outcome measure that had been used in at least two studies - their validity, reliability and responsiveness in adult critical care. If the authors did not report these aspects explicitly, an attempt was made to use the data provided to provide these measurement properties. For measures that were used in at least ten studies, information on actual reported

  19. Patient's dignity in intensive care unit: A critical ethnography. (United States)

    Bidabadi, Farimah Shirani; Yazdannik, Ahmadreza; Zargham-Boroujeni, Ali


    Maintaining patient's dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units. The aim of this study was to uncover the cultural factors that impeded maintaining patients' dignity in the cardiac surgery intensive care unit. The study was conducted using a critical ethnographic method proposed by Carspecken. Participants and research context: Participants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace. Ethical Consideration: Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained. The findings of the study fell into the following main themes: "Presence: the guarantee for giving enough attention to patients' self-esteem", "Instrumental and objectified attitudes", "Adherence to the human equality principle: value-action gap", "Paternalistic conduct", "Improper language", and "Non-interactive communication". The final assertion was "Reductionism as a major barrier to the maintaining of patient's dignity". The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches. Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.

  20. Critical thinking, delegation, and missed care in nursing practice. (United States)

    Bittner, Nancy Phoenix; Gravlin, Gayle


    The aim of this study was to understand how nurses use critical thinking to delegate nursing care. Nurses must synthesize large amounts of information and think through complex and often emergent clinical situations when making critical decisions about patient care, including delegation. A qualitative, descriptive study was used in this article. Before delegating, nurses reported considering patient condition, competency, experience, and workload of unlicensed assistive personnel (UAP). Nurses expected UAP to report significant findings and have higher level knowledge, including assessment and prioritizing skills. Successful delegation was dependent on the relationship between the RN and the UAP, communication, system support, and nursing leadership. Nurses reported frequent instances of missed or omitted routine care. Findings from this project provide insight into factors that influence delegation effectiveness. These can guide CNOs and frontline nurse leaders to focus on implementing strategies to mitigate the consequence of missed care. Ineffective delegation of basic nursing care can result in poor patient outcomes, potentially impacting quality measures, satisfaction, and reimbursement for the institution.

  1. Three factors critical for end-of-life care. (United States)

    Franey, S G


    Appropriate care of persons with life-threatening illnesses requires a different, perhaps higher level of response from organized healthcare than has been typical in the past. This involves three critical components: Leaders must be committed, visible advocates of high-quality end-of-life care. This enables them to plan changes, deploy resources, and integrate this commitment throughout the organization's strategic plan. Ensuring appropriate care of the dying requires adequate human and financial resources. First, the organization must fully identify the educational and service needs of patients, families, and care givers experiencing life-threatening illnesses. The organization must work well with other community-based organizations to address identified needs. Senior managers can improve care by personally commissioning teams, acknowledging success, and rewarding performance. Finally, organizational goals, strategies, and performance objectives must be shaped by a commitment to ensure appropriate care of the dying. Our commitment to the dying must be based on our values. An organizational "statement of rights and responsibilities" is one way of providing a visible expression of the mission, core values, and mutual responsibilities among care givers and patients, residents, HMO members, and clients.

  2. Impressions of Action and Critical Action Learning: Exploring the Leadership Development of Senior Doctors in an English Healthcare Organization (United States)

    McCray, Janet; Warwick, Rob; Palmer, Adam


    This paper aims to explore the influence of one cycle of a learning set experience in a postgraduate medical leadership development programme. It does so from two perspectives: first, from the self-reports of nine senior doctors working in leadership roles in England in the National Health Service; and second from a researcher perspective as we…

  3. Increasing Registered Nurse Retention Using Mentors in Critical Care Services. (United States)

    Schroyer, Coreena C; Zellers, Rebecca; Abraham, Sam


    Recruiting and training 1 newly hired registered nurse can cost thousands of dollars. With a high percentage of these newly hired nurses leaving their first place of employment within their first year, the financial implications may be enormous. It is imperative that health care facilities invest in recruiting and retention programs that retain high-quality nurses. Mentorship programs in retaining and easing the transition to practice for new graduate nurses, re-entry nurses, and nurses new to a specialty area are critical in nurse retention. Discussion in this study includes the effect of implementing a mentor program into the critical care services area of a 325-bed not-for-profit community hospital in northern Indiana. Based on this study, nurses with a mentor were retained at a 25% higher rate than those not mentored. Implementation of a mentor program reduced the training cost to the facility and increased retention and morale.

  4. Win-win-win: collaboration advances critical care practice. (United States)

    Spence, Deb; Fielding, Sandra


    Against a background of increasing interest in education post registration, New Zealand nurses are working to advance their professional practice. Because the acquisition of highly developed clinical capabilities requires a combination of nursing experience and education, collaboration between clinicians and nurse educators is essential. However, the accessibility of relevant educational opportunities has been an ongoing issue for nurses outside the country's main centres. Within the framework of a Master of Health Science, the postgraduate certificate (critical care nursing) developed between Auckland University of Technology and two regional health providers is one such example. Students enrol in science and knowledge papers concurrently then, in the second half of the course, are supported within their practice environment to acquire advanced clinical skills and to analyse, critique and develop practice within their specialty. This paper provides an overview of the structure and pr month, distance education course focused on developing the context of critical care nursing.

  5. The role of melatonin in anaesthesia and critical care

    Directory of Open Access Journals (Sweden)

    Madhuri S Kurdi


    Full Text Available Melatonin is a neurohormone secreted by the pineal gland. It is widely present in both plant and animal sources. In several countries, it is sold over the counter as tablets and as food supplement or additive. Currently, it is most often used to prevent jet lag and to induce sleep. It has been and is being used in several clinical trials with different therapeutic approaches. It has sedative, analgesic, anti-inflammatory, anti-oxidative and chronobiotic effects. In the present review, the potential therapeutic benefits of melatonin in anaesthesia and critical care are presented. This article aims to review the physiological properties of melatonin and how these could prove useful for several clinical applications in perioperative management, critical care and pain medicine. The topic was handsearched from textbooks and journals and electronically from PubMed, and Google scholar using text words.

  6. The role of melatonin in anaesthesia and critical care. (United States)

    Kurdi, Madhuri S; Patel, Tushar


    Melatonin is a neurohormone secreted by the pineal gland. It is widely present in both plant and animal sources. In several countries, it is sold over the counter as tablets and as food supplement or additive. Currently, it is most often used to prevent jet lag and to induce sleep. It has been and is being used in several clinical trials with different therapeutic approaches. It has sedative, analgesic, anti-inflammatory, anti-oxidative and chronobiotic effects. In the present review, the potential therapeutic benefits of melatonin in anaesthesia and critical care are presented. This article aims to review the physiological properties of melatonin and how these could prove useful for several clinical applications in perioperative management, critical care and pain medicine. The topic was handsearched from textbooks and journals and electronically from PubMed, and Google scholar using text words.

  7. Does good critical thinking equal effective decision-making among critical care nurses? A cross-sectional survey. (United States)

    Ludin, Salizar Mohamed


    A critical thinker may not necessarily be a good decision-maker, but critical care nurses are expected to utilise outstanding critical thinking skills in making complex clinical judgements. Studies have shown that critical care nurses' decisions focus mainly on doing rather than reflecting. To date, the link between critical care nurses' critical thinking and decision-making has not been examined closely in Malaysia. To understand whether critical care nurses' critical thinking disposition affects their clinical decision-making skills. This was a cross-sectional study in which Malay and English translations of the Short Form-Critical Thinking Disposition Inventory-Chinese Version (SF-CTDI-CV) and the Clinical Decision-making Nursing Scale (CDMNS) were used to collect data from 113 nurses working in seven critical care units of a tertiary hospital on the east coast of Malaysia. Participants were recruited through purposive sampling in October 2015. Critical care nurses perceived both their critical thinking disposition and decision-making skills to be high, with a total score of 71.5 and a mean of 48.55 for the SF-CTDI-CV, and a total score of 161 and a mean of 119.77 for the CDMNS. One-way ANOVA test results showed that while age, gender, ethnicity, education level and working experience factors significantly impacted critical thinking (pnurses' critical thinking and clinical decision-making (r=0.637, p=0.001). While this small-scale study has shown a relationship exists between critical care nurses' critical thinking disposition and clinical decision-making in one hospital, further investigation using the same measurement tools is needed into this relationship in diverse clinical contexts and with greater numbers of participants. Critical care nurses' perceived high level of critical thinking and decision-making also needs further investigation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. An environmental scan of quality indicators in critical care. (United States)

    Valiani, Sabira; Rigal, Romain; Stelfox, Henry T; Muscedere, John; Martin, Claudio M; Dodek, Peter; Lamontagne, François; Fowler, Robert; Gheshmy, Afshan; Cook, Deborah J; Forster, Alan J; Hébert, Paul C


    We performed a directed environmental scan to identify and categorize quality indicators unique to critical care that are reported by key stakeholder organizations. We convened a panel of experts ( n = 9) to identify key organizations that are focused on quality improvement or critical care, and reviewed their online publications and website content for quality indicators. We identified quality indicators specific to the care of critically ill adult patients and then categorized them according to the Donabedian and the Institute of Medicine frameworks. We also noted the organizations' rationale for selecting these indicators and their reported evidence base. From 28 targeted organizations, we identified 222 quality indicators, 127 of which were unique. Of the 127 indicators, 63 (32.5%) were safety indicators and 61 (31.4%) were effectiveness indicators. The rationale for selecting quality indicators was supported by consensus for 58 (26.1%) of the 222 indicators and by published research evidence for 45 (20.3%); for 119 indicators (53.6%), the rationale was not reported or the reader was referred to other organizations' reports. Of the 127 unique quality indicators, 27 (21.2%) were accompanied by a formal grading of evidence, whereas for 52 (40.9%), no reference to evidence was provided. There are many quality indicators related to critical care that are available in the public domain. However, owing to a paucity of rationale for selection, supporting evidence and results of implementation, it is not clear which indicators should be adopted for use. Copyright 2017, Joule Inc. or its licensors.

  9. Critical care admission of South African (SA) surgical patients ...

    African Journals Online (AJOL)

    Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study. D.L. Skinner, K de Vasconcellos, R Wise, T.M. Esterhuizen, C Fourie, A Goolam Mahomed, P.D. Gopalan, I Joubert, H Kluyts, L.R. Mathivha, B Mrara, J.P. Pretorius, G Richards, O Smith, M.G.L. Spruyt, R.M. Pearse, ...

  10. Pediatric Critical Care Telemedicine Program: A Single Institution Review. (United States)

    Hernandez, Maria; Hojman, Nayla; Sadorra, Candace; Dharmar, Madan; Nesbitt, Thomas S; Litman, Rebecca; Marcin, James P


    Rural and community emergency departments (EDs) often receive and treat critically ill children despite limited access to pediatric expertise. Increasingly, pediatric critical care programs at children's hospitals are using telemedicine to provide consultations to these EDs with the goal of increasing the quality of care. We conducted a retrospective review of a pediatric critical care telemedicine program at a single university children's hospital. Between the years 2000 and 2014, we reviewed all telemedicine consultations provided to children in rural and community EDs, classified the visits using a comprehensive evidence-based set of chief complaints, and reported the consultations' impact on patient disposition. We also reviewed the total number of pediatric ED visits to calculate the relative frequency with which telemedicine consultations were provided. During the study period, there were 308 consultations provided to acutely ill and/or injured children for a variety of chief complaints, most commonly for respiratory illnesses, acute injury, and neurological conditions. Since inception, the number of consultations has been increasing, as has the number of participating EDs (n = 18). Telemedicine consultations were conducted on 8.6% of seriously ill children, the majority of which resulted in admission to the receiving hospital (n = 150, 49%), with a minority of patients requiring transport to the university children's hospital (n = 103, 33%). This single institutional, university children's hospital-based review demonstrates that a pediatric critical care telemedicine program used to provide consultations to seriously ill children in rural and community EDs is feasible, sustainable, and used relatively infrequently, most typically for the sickest pediatric patients.

  11. The Critical Care Communication project: improving fellows' communication skills. (United States)

    Arnold, Robert M; Back, Anthony L; Barnato, Amber E; Prendergast, Thomas J; Emlet, Lillian L; Karpov, Irina; White, Patrick H; Nelson, Judith E


    The aim of this study was to develop an evidence-based communication skills training workshop to improve the communication skills of critical care fellows. Pulmonary and critical care fellows (N = 38) participated in a 3-day communication skills workshop between 2008 and 2010 involving brief didactic talks, faculty demonstration of skills, and faculty-supervised small group skills practice sessions with simulated families. Skills included the following: giving bad news, achieving consensus on goals of therapy, and discussing the limitations of life-sustaining treatment. Participants rated their skill levels in a pre-post survey in 11 core communication tasks using a 5-point Likert scale. Of 38 fellows, 36 (95%) completed all 3 days of the workshop. We compared pre and post scores using the Wilcoxon signed rank test. Overall, self-rated skills increased for all 11 tasks. In analyses by participant, 95% reported improvement in at least 1 skill; with improvement in a median of 10 of 11 skills. Ninety-two percent rated the course as either very good/excellent, and 80% recommended that it be mandatory for future fellows. This 3-day communication skills training program increased critical care fellows' self-reported family meeting communication skills. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Functional bowel disorders in primary care: factors associated with health-related quality of life and doctor consultation. (United States)

    Lee, Victoria; Guthrie, Else; Robinson, Andrew; Kennedy, Anne; Tomenson, Barbara; Rogers, Anne; Thompson, David


    The role of psychological factors in irritable bowel syndrome (IBS) remains unclear, particularly in a primary care setting, where relatively little research on this common and costly condition has been carried out. The aim of this study was to investigate the relative contribution of physical and psychological factors to health-related quality of life and health-care utilization in patients with functional bowel disease (IBS-like symptoms) in primary care. We also wished to establish the relevance of formal diagnostic criteria to IBS in the primary care setting. This study used a cross-sectional design. Four hundred twenty patients with functional bowel disorders in primary care completed a series of measures, including bowel symptom status and severity, severity of psychological distress, personality, and quality of life. The number of visits to a general practitioner (GP) in the previous 12 months was recorded. The following variables were independently and highly significantly associated with health-related quality of life in patients with functional bowel disorders in primary care: total psychological symptom score, diarrhea severity, abdominal pain for >12 weeks, and abdominal distension. A similar pattern emerged between patients who met meet Rome II criteria for IBS and patients who did not meet Rome II criteria for IBS. Relatively few variables (either physical or psychological) had a major impact on the number of GP consultations, with the exception of frequency of bowel movements. This study confirms that psychological factors are significantly associated with health-related quality of life in patients with IBS in primary care. Physical symptom severity is also important. Relatively few symptom measures, either physical or psychological, have a major impact on doctor consultation rates in primary care.

  13. Burnout syndrome among non-consultant hospital doctors in Ireland: relationship with self-reported patient care. (United States)

    Sulaiman, Che Fatehah Che; Henn, Patrick; Smith, Simon; O'Tuathaigh, Colm M P


    Intensive workload and limited training opportunities for Irish non-consultant hospital doctors (NCHDs) has a negative effect on their health and well-being, and can result in burnout. Burnout affects physician performance and can lead to medical errors. This study examined the prevalence of burnout syndrome among Irish NCHDs and its association with self-reported medical error and poor quality of patient care. A cross-sectional quantitative survey-based design. All teaching hospitals affiliated with University College Cork. NCHDs of all grades and specialties. The following instruments were completed by all participants: Maslach Burnout Inventory-Human Service Survey (MBI-HSS), assessing three categories of burnout syndrome: Emotional exhaustion (EE), Personal Achievement (PA) and Depersonalization (DP); questions related to self-reported medical errors/poor patient care quality and socio-demographic information. Self-reported measures of burnout and poor quality of patient care. Prevalence of burnout among physicians (n = 265) was 26.4%. There was a significant gender difference for EE and DP, but none for PA. A positive weak correlation was observed between EE and DP with medical error or poor patient care. A negative association was reported between PA and medical error and reduced quality of patient care. Burnout is prevalent among NCHDs in Ireland. Burnout syndrome is associated with self-reported medical error and quality of care in this sample population. Measures need to be taken to address this issue, with a view to protecting health of NCHDs and maintaining quality of patient care. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail:

  14. Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals (United States)

    Mogre, Victor; Scherpbier, Albert J J A; Stevens, Fred; Aryee, Paul; Cherry, Mary Gemma; Dornan, Tim


    Objective To determine what, how, for whom, why, and in what circumstances educational interventions improve the delivery of nutrition care by doctors and other healthcare professionals work. Design Realist synthesis following a published protocol and reported following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multidisciplinary team searched MEDLINE, CINAHL, ERIC, EMBASE, PsyINFO, Sociological Abstracts, Web of Science, Google Scholar and Science Direct for published and unpublished (grey) literature. The team identified studies with varied designs; appraised their ability to answer the review question; identified relationships between contexts, mechanisms and outcomes (CMOs); and entered them into a spreadsheet configured for the purpose. The final synthesis identified commonalities across CMO configurations. Results Over half of the 46 studies from which we extracted data originated from the USA. Interventions that improved the delivery of nutrition care improved skills and attitudes rather than just knowledge; provided opportunities for superiors to model nutrition care; removed barriers to nutrition care in health systems; provided participants with local, practically relevant tools and messages; and incorporated non-traditional, innovative teaching strategies. Operating in contexts where student and qualified healthcare professionals provided nutrition care in developed and developing countries, these interventions yielded health outcomes by triggering a range of mechanisms, which included feeling competent, feeling confident and comfortable, having greater self-efficacy, being less inhibited by barriers in healthcare systems and feeling that nutrition care was accepted and recognised. Conclusions These findings show how important it is to move education for nutrition care beyond the simple acquisition of knowledge. They show how educational interventions embedded within systems of healthcare can improve

  15. Nursing care in a high-technological environment: Experiences of critical care nurses. (United States)

    Tunlind, Adam; Granström, John; Engström, Åsa


    Management of technical equipment, such as ventilators, infusion pumps, monitors and dialysis, makes health care in an intensive care setting more complex. Technology can be defined as items, machinery and equipment that are connected to knowledge and management to maximise efficiency. Technology is not only the equipment itself, but also the knowledge of how to use it and the ability to convert it into nursing care. The aim of this study is to describe critical care nurses' experience of performing nursing care in a high technology healthcare environment. Qualitative, personal interviews were conducted during 2012 with eight critical care nurses in the northern part of Sweden. Interview transcripts were analysed using qualitative content analysis. Three themes with six categories emerged. The technology was described as a security that could facilitate nursing care, but also one that could sometimes present obstacles. The importance of using the clinical gaze was highlighted. Nursing care in a high technological environment must be seen as multi-faceted when it comes to how it affects CCNs' experience. The advanced care conducted in an ICU could not function without high-tech equipment, nor could care operate without skilled interpersonal interaction and maintenance of basal nursing. That technology is seen as a major tool and simultaneously as a barrier to patient-centred care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. August 2013 critical care journal club: less is more

    Directory of Open Access Journals (Sweden)

    Raschke RA


    Full Text Available No abstract available. Article truncated at 150 words. Our August journal club reviewed failed efforts to impact the mortality of critical illness over the past 25 years. We looked at six landmark randomized controlled trials with certain things in common. They each addressed treatment of a major aspect of critical illness. Each was well-supported by previous literature, and biologically plausible. Each resulted in a statistically-significant mortality benefit, and was published in a well-respected journal. And each had an immediate, and in many cases, lasting effect on the bedside practice of critical care. Yet the positive result of each of these six studies was subsequently convincingly refuted. It is important to note, that these studies make up a good part of what we’ve learned in critical care over the past 25 years. There have been some influential positive studies as well, but a great deal of effort has been spent implementing evidence-based practice, based on studies that were later …

  17. [Burnout and perceived health in Critical Care nursing professionals]. (United States)

    Ríos Risquez, M I; Peñalver Hernández, F; Godoy Fernández, C


    To assess the level of burnout syndrome in a sample of critical care nursing professionals and analyze its relation with the perception of general health and other sociodemographic and work characteristics. Cross-sectional descriptive study. SITE: Intensive Care Unit of the University Hospital Morales Meseguer, Murcia-Spain. Three evaluation tools were used. These included a sociodemographic and work survey, the validated Maslach Burnout Inventory (MBI) questionnaires and the General Health Questionnaire (GHQ-28) in order to assess professional burnout and the general health condition perceived, respectively. Only 42 out of the 56 questionnaires included in the study were valid. This means an answering rate of 75%. The mean score obtained on the emotional tiredness dimension (25.45 6 11.15) stands out. About 42.9% of the sample presented psychological or psychosomatic symptoms that could require specialized care. Correlation between burnout and general health perception was statistically significant (r = 0.536; p burnout found was moderate to high among critical care nursing professionals. A total of 11.9% of the studied sample had a high score in the 3 dimensions of the burnout syndrome: emotional tiredness, depersonalization, and lack of personal job performance. Burnout and health levels found indicate high vulnerability in the sample studied and the need to establish prevention/intervention programs in this work context.

  18. February 2016 critical care case of the month

    Directory of Open Access Journals (Sweden)

    Stewart TM


    Full Text Available No abstract available. Article truncated after the first page. A 32 year-old, previously healthy, female hospital visitor had been participating in a family care conference regarding her critically ill grandmother admitted to the cardiac intensive care unit. During the care conference, she felt unwell and had some mild chest discomfort; she collapsed and cardiopulmonary resuscitation (CPR was initiated (1. Upon arrival of the code team, she was attached to the monitor and mask ventilation was initiated. Her initial rhythm is shown in Figure 1. In addition to DC cardioversion which of the following should be administered immediately? 1. Lidocaine; 2. Magnesium sulfate; 3. Procainamide ; 4. 1 and 3; 5. All of the above. ...

  19. Do doctors' attachment styles and emotional intelligence influence patients' emotional expressions in primary care consultations? An exploratory study using multilevel analysis. (United States)

    Cherry, M Gemma; Fletcher, Ian; Berridge, Damon; O'Sullivan, Helen


    To investigate whether and how doctors' attachment styles and emotional intelligence (EI) might influence patients' emotional expressions in general practice consultations. Video recordings of 26 junior doctors consulting with 173 patients were coded using the Verona Coding Definition of Emotional Sequences (VR-CoDES). Doctors' attachment style was scored across two dimensions, avoidance and anxiety, using the Experiences in Close Relationships: Short Form questionnaire. EI was assessed with the Mayer-Salovey-Caruso Emotional Intelligence Test. Multilevel Poisson regressions modelled the probability of patients' expressing emotional distress, considering doctors' attachment styles and EI and demographic and contextual factors. Both attachment styles and EI were significantly associated with frequency of patients' cues, with patient- and doctor-level explanatory variables accounting for 42% of the variance in patients' cues. The relative contribution of attachment styles and EI varied depending on whether patients' presenting complaints were physical or psychosocial in nature. Doctors' attachment styles and levels of EI are associated with patients' emotional expressions in primary care consultations. Further research is needed to investigate how these two variables interact and influence provider responses and patient outcomes. Understanding how doctors' psychological characteristics influence PPC may help to optimise undergraduate and postgraduate medical education. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Suicide in doctors and wives of doctors. (United States)

    Sakinofsky, I


    This paper re-examines the widespread belief that doctors have a proneness for suicide greater than the general population. The Standardized Mortality Ratio for male physicians is 335 and for single women doctors 257. Doctors' wives have an even greater risk: their SMR is 458. These rates for doctors are higher than for most other professional groups (except pharmacists) and the rate for doctors' wives far exceeds that for wives of other professionals. The intrinsic causes of the physician's high occupational mortality include his knowledge of toxicology and ready access to lethal drugs, so that impulsive suicide is more often successful. Professional stress and overwork, particularly the unrelenting responsibility for decisions upon which the lives of others may depend, have been inculpated. These stresses interact with the decline in the doctors' self-respect and with a personality that is prestige-oriented and independent. Some physicians turn in their frustration to alcohol/and or drugs, accelerating the process of deterioration. The high suicide rate in doctors' wives appears to be the result of unrequited needs for caring and dependency which the doctors' career demands and personality deny them.

  1. History of pulmonary critical care nursing and where we are going. (United States)

    Lareau, Suzanne C; Mealer, Meredith


    Pulmonary critical care nurses have played a prominent role in the ICUs from the inception of critical care units. This article describes how the history of pulmonary critical care nursing has evolved and discusses a few of the challenges in the years to come: stress imposed by working in a critical care environment, enhancing the care of patients by altering patterns of sedation and promoting early mobilization, and dealing with increasing infection rates.

  2. Awareness of doctors of health care and possible therapy methods for alcohol and drug dependant patients in Latvia

    Directory of Open Access Journals (Sweden)

    Dave V.


    Full Text Available Aim is to investigate the knowledge of Latvian doctors about addiction treatment and healthcare possibilities in Latvia, to compare which methods are the best known to physicians, and which are offered to addicted patients. Work material and methods. Questionnaire was developed by researchers themselves, it contains 14 questions (about demographical data, treatment methods and their application. 250 questionnaires were distributed, 158 (63, 2% were received. Results. Average age of participants – 43.7 years. 31,0% of respondents are psychiatrists, 13,3% – addiction specialists, 34,8% – other specialists (general practitioners, internists, health care doctors, neurologists and others, 12,0% – psychotherapists, 4,4% – surgeons, 1,9% – dentists and 1,9% – paediatricians. The best known were detoxification (98,2% and suggestion (892% methods. The least known methods for drug addicts were substitution therapy (73,4% and rehabilitation communities (73,4%. The most recommended treatment method was Minnesota programme – 108 (68,4% and detoxification 99 (62,7%, the least recommended – substitution therapy – 29 (18,5%. Conclusions. 17,1% of respondents do not meet patients with addiction problems, but 20,3% of respondents don’t recommend any of treatment methods. Although 73%-98% of respondents have information about treatment methods, only 18%-68% of respondents offer them.

  3. Role-meanings as a critical factor in understanding doctor managers' identity work and different role identities. (United States)

    Cascón-Pereira, Rosalía; Chillas, Shiona; Hallier, Jerry


    This study examines "identity work" among hybrid doctor-managers (DMs) in the Spanish National Health System to make sense of their managerial roles. In particular, the meanings underlying DMs experience of their hybrid role are investigated using a Grounded Theory methodology, exposing distinctions in role-meanings. Our findings provide evidence that using different social sources of comparison (senior managers or clinicians) to construct the meaning of managerial roles leads to different role-meanings and role identities, which are the source of the two established types of DM in the literature, the reluctant and the enthusiast. The contribution is twofold: our findings lead us to theorize DMs' identity work processes by adding an overlooked role-meaning dimension to identity work; and raise practical reflections for those who wish to develop enthusiast doctor managers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Reproducibility of clinical research in critical care: a scoping review. (United States)

    Niven, Daniel J; McCormick, T Jared; Straus, Sharon E; Hemmelgarn, Brenda R; Jeffs, Lianne; Barnes, Tavish R M; Stelfox, Henry T


    The ability to reproduce experiments is a defining principle of science. Reproducibility of clinical research has received relatively little scientific attention. However, it is important as it may inform clinical practice, research agendas, and the design of future studies. We used scoping review methods to examine reproducibility within a cohort of randomized trials examining clinical critical care research and published in the top general medical and critical care journals. To identify relevant clinical practices, we searched the New England Journal of Medicine, The Lancet, and JAMA for randomized trials published up to April 2016. To identify a comprehensive set of studies for these practices, included articles informed secondary searches within other high-impact medical and specialty journals. We included late-phase randomized controlled trials examining therapeutic clinical practices in adults admitted to general medical-surgical or specialty intensive care units (ICUs). Included articles were classified using a reproducibility framework. An original study was the first to evaluate a clinical practice. A reproduction attempt re-evaluated that practice in a new set of participants. Overall, 158 practices were examined in 275 included articles. A reproduction attempt was identified for 66 practices (42%, 95% CI 33-50%). Original studies reported larger effects than reproduction attempts (primary endpoint, risk difference 16.0%, 95% CI 11.6-20.5% vs. 8.4%, 95% CI 6.0-10.8%, P = 0.003). More than half of clinical practices with a reproduction attempt demonstrated effects that were inconsistent with the original study (56%, 95% CI 42-68%), among which a large number were reported to be efficacious in the original study and to lack efficacy in the reproduction attempt (34%, 95% CI 19-52%). Two practices reported to be efficacious in the original study were found to be harmful in the reproduction attempt. A minority of critical care practices with research published

  5. Behavior observation of major noise sources in critical care wards. (United States)

    Xie, Hui; Kang, Jian; Mills, Gary H


    This study aimed to investigate the behavior patterns of typical noise sources in critical care wards and relate their patterns to health care environment in which the sources adapt themselves in several different forms. An effective observation approach was designed for noise behavior in the critical care environment. Five descriptors have been identified for the behavior observations, namely, interval, frequency, duration, perceived loudness, and location. Both the single-bed and the multiple-bed wards at the selected Critical Care Department were randomly observed for 3 inconsecutive nights, from 11:30 pm to 7:00 am the following morning. The Matlab distribution fitting tool was applied afterward to plot several types of distributions and estimate the corresponding parameters. The lognormal distribution was considered the most appropriate statistical distribution for noise behaviors in terms of the interval and duration patterns. The turning of patients by staff was closely related to the increasing occurrences of noises. Among the observed noises, talking was identified with the highest frequency, shortest intervals, and the longest durations, followed by monitor alarms. The perceived loudness of talking in the nighttime wards was classified into 3 levels (raised, normal, and low). Most people engaged in verbal communication in the single-bed wards that occurred around the Entrance Zone, whereas talking in the multiple-bed wards was more likely to be situated in the Staff Work Zone. As expected, more occurrences of noises along with longer duration were observed in multiple-bed wards rather than single-bed wards. "Monitor plus ventilator alarms" was the most commonly observed combination of multiple noises. © 2013 Elsevier Inc. All rights reserved.

  6. Intubation Success in Critical Care Transport: A Multicenter Study. (United States)

    Reichert, Ryan J; Gothard, Megan; Gothard, M David; Schwartz, Hamilton P; Bigham, Michael T


    Tracheal intubation (TI) is a lifesaving critical care skill. Failed TI attempts, however, can harm patients. Critical care transport (CCT) teams function as the first point of critical care contact for patients being transported to tertiary medical centers for specialized surgical, medical, and trauma care. The Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement Collaborative uses a quality metric database to track CCT quality metric performance, including TI. We sought to describe TI among GAMUT participants with the hypothesis that CCT would perform better than other prehospital TI reports and similarly to hospital TI success. The GAMUT Database is a global, voluntary database for tracking consensus quality metric performance among CCT programs performing neonatal, pediatric, and adult transports. The TI-specific quality metrics are "first attempt TI success" and "definitive airway sans hypoxia/hypotension on first attempt (DASH-1A)." The 2015 GAMUT Database was queried and analysis included patient age, program type, and intubation success rate. Analysis included simple statistics and Pearson chi-square with Bonferroni-adjusted post hoc z tests (significance = p success was lowest in neonates (59.3%, 617 attempts), better in pediatrics (81.7%, 519 attempts), and best in adults (87%, 2900 attempts), p success versus pediatric- and neonatal-focused teams (86.9% vs. 63.5%, p success (86.5% vs. 75.3%, p success are higher in adult patients and adult-focused CCT teams. TI success rates are higher in CCT than other prehospital settings, but lower than in-hospital success TI rates. Identifying factors influencing TI success among high performers should influence best practice strategies for TI.

  7. Doctors and pharmaceutical industry. (United States)

    Beran, Roy G


    The pharmaceutical industry is seen as seducing doctors by providing expensive gifts, subsidising travel and underwriting practice expenses in return for those doctors prescribing products that otherwise they would not use. This paints doctors in a very negative light; suggests doctors are available to the highest bidder; implies doctors do not adequately act as independent agents; and that doctors are driven more by self-interest than by patient needs. Similar practices, in other industries, are accepted as normal business behaviour but it is automatically assumed to be improper if the pharmaceutical industry supports doctors. Should the pharmaceutical industry withdraw educational grants then there would be: fewer scientific meetings; reduced attendance at conferences; limited post graduate education; and a depreciated level of maintenance of professional standards. To suggest that doctors prescribe inappropriately in return for largesse maligns their integrity but where there is no scientific reason to choose between different treatments then there can be little argument against selecting the product manufactured by a company that has invested in the doctor and the question arises as to whether this represents bad medicine? This paper will examine what constitutes non-professional conduct in response to inducements by the pharmaceutical industry. It will review: conflict of interest; relationships between doctors and pharma and the consequences for patients; and the need for critical appraisal before automatically decrying this relationship while accepting that there remain those who do not practice ethical medicine.

  8. Critical Care Delivery: The Importance of Process of Care and ICU Structure to Improved Outcomes: An Update From the American College of Critical Care Medicine Task Force on Models of Critical Care. (United States)

    Weled, Barry J; Adzhigirey, Lana A; Hodgman, Tudy M; Brilli, Richard J; Spevetz, Antoinette; Kline, Andrea M; Montgomery, Vicki L; Puri, Nitin; Tisherman, Samuel A; Vespa, Paul M; Pronovost, Peter J; Rainey, Thomas G; Patterson, Andrew J; Wheeler, Derek S


    In 2001, the Society of Critical Care Medicine published practice model guidelines that focused on the delivery of critical care and the roles of different ICU team members. An exhaustive review of the additional literature published since the last guideline has demonstrated that both the structure and process of care in the ICU are important for achieving optimal patient outcomes. Since the publication of the original guideline, several authorities have recognized that improvements in the processes of care, ICU structure, and the use of quality improvement science methodologies can beneficially impact patient outcomes and reduce costs. Herein, we summarize findings of the American College of Critical Care Medicine Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery; 2) Process improvement is the backbone of achieving high-quality ICU outcomes; 3) Standardized protocols including care bundles and order sets to facilitate measurable processes and outcomes should be used and further developed in the ICU setting; and 4) Institutional support for comprehensive quality improvement programs as well as tele-ICU programs should be provided.

  9. Ten good reasons to practice ultrasound in critical care. (United States)

    Lichtenstein, Daniel; van Hooland, Simon; Elbers, Paul; Malbrain, Manu L N G


    Over the past decade, critical care ultrasound has gained its place in the armamentarium of monitoring tools. A greater understanding of lung, abdominal, and vascular ultrasound plus easier access to portable machines have revolutionised the bedside assessment of our ICU patients. Because ultrasound is not only a diagnostic test, but can also be seen as a component of the physical exam, it has the potential to become the stethoscope of the 21st century. Critical care ultrasound is a combination of simple protocols, with lung ultrasound being a basic application, allowing assessment of urgent diagnoses in combination with therapeutic decisions. The LUCI (Lung Ultrasound in the Critically Ill) consists of the identification of ten signs: the bat sign (pleural line); lung sliding (seashore sign); the A-lines (horizontal artefact); the quad sign and sinusoid sign indicating pleural effusion; the fractal and tissue-like sign indicating lung consolidation; the B-lines and lung rockets indicating interstitial syndromes; abolished lung sliding with the stratosphere sign suggesting pneumothorax; and the lung point indicating pneumothorax. Two more signs, the lung pulse and the dynamic air bronchogram, are used to distinguish atelectasis from pneumonia. The BLUE protocol (Bedside Lung Ultrasound in Emergency) is a fast protocol (respiratory failure. With this protocol, it becomes possible to differentiate between pulmonary oedema, pulmonary embolism, pneumonia, chronic obstructive pulmonary disease, asthma, and pneumothorax, each showing specific ultrasound patterns and profiles. The FALLS protocol (Fluid Administration Limited by Lung Sonography) adapts the BLUE protocol to be used in patients with acute circulatory failure. It makes a sequential search for obstructive, cardiogenic, hypovolemic, and distributive shock using simple real-time echocardiography in combination with lung ultrasound, with the appearance of B-lines considered to be the endpoint for fluid therapy

  10. Communication skills training curriculum for pulmonary and critical care fellows. (United States)

    McCallister, Jennifer W; Gustin, Jillian L; Wells-Di Gregorio, Sharla; Way, David P; Mastronarde, John G


    The Accreditation Council for Graduate Medical Education requires physicians training in pulmonary and critical care medicine to demonstrate competency in interpersonal communication. Studies have shown that residency training is often insufficient to prepare physicians to provide end-of-life care and facilitate patient and family decision-making. Poor communication in the intensive care unit (ICU) can adversely affect outcomes for critically ill patients and their family members. Despite this, communication training curricula in pulmonary and critical care medicine are largely absent in the published literature. We evaluated the effectiveness of a communication skills curriculum during the first year of a pulmonary and critical care medicine fellowship using a family meeting checklist to provide formative feedback to fellows during ICU rotations. We hypothesized that fellows would demonstrate increased competence and confidence in the behavioral skills necessary for facilitating family meetings. We evaluated a 12-month communication skills curriculum using a pre-post, quasiexperimental design. Subjects for this study included 11 first-year fellows who participated in the new curriculum (intervention group) and a historical control group of five fellows who had completed no formal communication curriculum. Performance of communication skills and self-confidence in family meetings were assessed for the intervention group before and after the curriculum. The control group was assessed once at the beginning of their second year of fellowship. Fellows in the intervention group demonstrated significantly improved communication skills as evaluated by two psychologists using the Family Meeting Behavioral Skills Checklist, with an increase in total observed skills from 51 to 65% (P ≤ 0.01; Cohen's D effect size [es], 1.13). Their performance was also rated significantly higher when compared with the historical control group, who demonstrated only 49% of observed skills

  11. "The Doctor Needs to Know": Acceptability of Smartphone Location Tracking for Care Coordination. (United States)

    Liss, David T; Serrano, Eloisa; Wakeman, Julie; Nowicki, Christine; Buchanan, David R; Cesan, Ana; Brown, Tiffany


    Care coordination can be highly challenging to carry out. When care is fragmented across health systems and providers, there is an increased likelihood of hospital readmissions and wasteful health care spending. During and after care transitions, smartphones have the potential to bolster information transfer and care coordination. However, little research has examined patients' perceptions of using smartphones to coordinate care. This study's primary objective was to explore patient acceptability of a smartphone app that could facilitate care coordination in a safety net setting. Our secondary objective was to identify how clinicians and other members of primary care teams could use this app to coordinate care. This qualitative study was conducted at a federally qualified health center in metropolitan Chicago, IL. We conducted four focus groups (two in English, two in Spanish) with high-risk adults who owned a smartphone and received services from an organizational care management program. We also conducted structured interviews with clinicians and a group interview with care managers. Focus groups elicited patients' perceptions of a smartphone app designed to: (1) identify emergency department (ED) visits and inpatient stays using real-time location data; (2) send automated notifications (ie, alerts) to users' phones, asking whether they were a patient in the hospital; and (3) send automated messages to primary care teams to notify them about patients' confirmed ED visits and inpatient stays. Focus group transcripts were coded based on emergent themes. Clinicians and care managers were asked about messages they would like to receive from the app. Five main themes emerged in patient focus group discussions. First, participants expressed a high degree of willingness to use the proposed app during inpatient stays. Second, participants expressed varying degrees of willingness to use the app during ED visits, particularly for low acuity ED visits. Third, participants

  12. Family satisfaction with critical care: measurements and messages. (United States)

    Rothen, Hans U; Stricker, Kay H; Heyland, Daren K


    Family satisfaction in the ICU reflects the extent to which perceived needs and expectations of family members of critically ill patients are met by healthcare professionals. Here, we present recently developed tools to assess family satisfaction, with a special focus on their psychometric properties. Assessing family satisfaction, however, is not of much use if it is not followed by interpretation of the results and, if needed, consecutive measures to improve care of the patients and their families, or improvement in communication and decision-making. Accordingly, this review will outline recent findings in this field. Finally, possible areas of future research are addressed. To assess family satisfaction in the ICU, several domains deserve attention. They include, among others, care of the patient, counseling and emotional support of family members, information and decision-making. Overall, communication between physicians or nurses and members of the family remains a key topic, and there are many opportunities to improve. They include not only communication style, timing and appropriate wording but also, for example, assessments to see if information was adequately received and also understood. Whether unfulfilled needs of individual members of the family or of the family as a social system result in negative long-term sequels remains an open question. Assessing and analyzing family satisfaction in the ICU ultimately will support healthcare professionals in their continuing effort to improve care of critically ill patients and their families.

  13. Call 4 Concern: patient and relative activated critical care outreach. (United States)

    Odell, Mandy; Gerber, Karin; Gager, Melanie

    Patients can experience unexpected deterioration in their physiological condition that can lead to critical illness, cardiac arrest, admission to the intensive care unit and death. While ward staff can identify deterioration through monitoring physiological signs, these signs can be missed, interpreted incorrectly or mismanaged. Rapid response systems using early warning scores can fail if staff do not follow protocols or do not notice or manage deterioration adequately. Nurses often notice deterioration intuitively because of their knowledge of individual patients. Patients and their relatives have the greatest knowledge of patients, and can often pick up subtle signs physiological deterioration before this is identified by staff or monitoring systems. However, this ability has been largely overlooked. Call 4 Concern (C4C) is a scheme where patients and relatives can call critical care teams directly if they are concerned about a patient's condition- it is believed to be the first of its kind in the UK. A C4C feasibility project ran for six months, covering patients being transferred from the intensive care unit to general wards. C4C has the potential to prevent clinical deterioration and is valued by patients and relatives. Concerns of ward staff could be managed through project management. As it is relatively new, this field offers further opportunities for research.

  14. [Comparing the perspectives of primary care doctors in the Canary Islands and Alberta (Canada)]. (United States)

    Mahtani-Chugani, Vinita; López-Hijazo, Asunción; Manca, Donna; Sanz-Alvarez, Emilio


    To examine the advantages and disadvantages of two different Health Care Systems from the perspective of Primary Care (PC) physicians. Qualitative research based on the analysis of documents written as diaries for the study. Primary Care in the Canary Islands (Spain) and Alberta (Canada) CONTEXT AND PARTICIPANTS: Intentional sample to identify different profiles of physicians. Participants were asked to write a document describing their work activities, including the impact of the organisational system and on their personal life. Two representatives of the health care system were asked to write a detailed description about how PC is organised in their country. Nine diaries were collected (5 from the Canary Islands and 4 from Alberta). Ritchie & Spencer framework was used for the analysis. In Alberta, physicians have access to more complementary tests; they can offer hospital care; they have to sort out administrative work; they can choose were to work; and can specialise in different types of health care services. In the Canary Islands physicians can have paid holidays and the administrative issues do not depend on them, patients have a physician assigned and seem to have more institutional support. The results of this study allow us to constructively analyse the role of PC physicians, assess the advantages and re-think the disadvantages related to how we work in order to learn from other health care systems. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  15. Caring for patients of Islamic denomination: Critical care nurses' experiences in Saudi Arabia. (United States)

    Halligan, Phil


    To describe the critical care nurses' experiences in caring for patients of Muslim denomination in Saudi Arabia. Caring is known to be the essence of nursing but many health-care settings have become more culturally diverse. Caring has been examined mainly in the context of Western cultures. Muslims form one of the largest ethnic minority communities in Britain but to date, empirical studies relating to caring from an Islamic perspective is not well documented. Research conducted within the home of Islam would provide essential truths about the reality of caring for Muslim patients. Phenomenological descriptive. Methods. Six critical care nurses were interviewed from a hospital in Saudi Arabia. The narratives were analysed using Colaizzi's framework. The meaning of the nurses' experiences emerged as three themes: family and kinship ties, cultural and religious influences and nurse-patient relationship. The results indicated the importance of the role of the family and religion in providing care. In the process of caring, the participants felt stressed and frustrated and they all experienced emotional labour. Communicating with the patients and the families was a constant battle and this acted as a further stressor in meeting the needs of their patients. The concept of the family and the importance and meaning of religion and culture were central in the provision of caring. The beliefs and practices of patients who follow Islam, as perceived by expatriate nurses, may have an effect on the patient's health care in ways that are not apparent to many health-care professionals and policy makers internationally. Readers should be prompted to reflect on their clinical practice and to understand the impact of religious and cultural differences in their encounters with patients of Islam denomination. Policy and all actions, decisions and judgments should be culturally derived.

  16. Talking to Your Doctor

    Medline Plus

    Full Text Available ... Lines Health Services Locator NIH Clinical Research Trials and You Talking to Your Doctor Science ... More » Quick Links NIH News in Health NIH Research Matters NIH Record Research & Training Medical Research Initiatives ...

  17. Talking to Your Doctor

    Medline Plus

    Full Text Available ... Health Literacy Clear & Simple Clear Health from NIH Cultural Respect Language Access Talking to Your Doctor Plain ... Health Care Providers About Complementary Health Approaches , National Center for Complementary and Integrative Health (NCCIH) Diabetes Questions ...

  18. Daptomycin experience in critical care patients: results from a registry. (United States)

    Brown, Jack E; Fominaya, Cory; Christensen, Keith J; McConnell, Scott A; Lamp, Kenneth C


    Vancomycin is often the drug of choice in critically ill patients with gram-positive infections, although circumstances often prevent its use. In these situations, clinicians are frequently left with limited data regarding alternative agents. To describe patients with reported sepsis receiving daptomycin in a critical care unit. This multicenter, noncomparative, noninterventional study identified patients in critical care units, using the Cubicin Outcomes Registry and Experience (CORE) 2005-2009 registry. A descriptive account of patient characteristics, infectious etiology, outcomes at the end of daptomycin therapy, and 30-day mortality is reported. Nonevaluable patients were excluded from the efficacy analysis but included in the safety analysis. We identified 128 patients, 98 (77%) of whom were evaluable for efficacy. Patient characteristics for the efficacy population were 55 (56%) males, 30 (31%) aged 66 years or older, 38 (39%) had creatinine clearance less than 30 mL/min, and 27 (28%) were on dialysis. Common underlying diseases included acute or chronic renal failure 44 (45%), hypertension 40 (41%), and diabetes 27 (28%). Seventy-two (73%) patients were bacteremic. The most common pathogens found were methicillin-resistant Staphylococcus aureus (32%), vancomycin-resistant Enterococcus faecium (21%), and coagulase-negative staphylococci (20%). Prior to daptomycin, antibiotics were used in 84 (86%) patients, most commonly vancomycin (65/84; 77%). The median (range) initial daptomycin dose was 6 mg/kg (3-10) and duration of 10 days (1-58). Overall success rate was 70% (31% cured; 39% improved). Twelve adverse events possibly related to daptomycin were reported in 9 of 128 (7%) patients in the safety population; 4 of these in 4 (3%) patients were serious. The mortality rate within 30 days of completing daptomycin was 42 of 128 (33%) patients. These data provide preliminary results on the use of daptomycin in critically ill patients with complicated conditions

  19. [The process of professional qualification for the critical care nurse]. (United States)

    Santana, Neuranides; Fernandes, Josicélia Dumêt


    Study of qualitative approach based on the dialectic historical materialism, that aimed at analizing the conformation of professional credentialing process of the critical care nurse of a hospital in Salvador, BA, Brazil. The subjects were 29 nurses. The analysis was based on the Analysis of Content, with the technique of Thematic Analysis, directed by the dialectic method. Three categories correlated to credentialing were generated: technological sophistication; individual and the collective organizational and as product and instrument of the work process. The results demonstrated that the institution estimulates the credentialing process; however the administrative politicies make it difficult the effectuation of the process of credentialing of the nurses.

  20. [Social skills in emergency and critical care professionals of a regional public hospital]. (United States)

    Leal Costa, C; Luján Cebrián, I; Gascón García, J; Ferrer Villalonga, L; Van-der Hofstadt Román, C J


    To assess the social skills of health care professionals in the emergency and critical care units of the regional hospital Vega Baja and analyze the association between a series of sociodemographic and professionals variables and social skills. A cross-sectional, descriptive study. Two evaluation tools were used. These included a sociodemographic and professional variables questionnaire, and the Elena Gismero's Social Skills Scale (SSS). A response rate of 82.6% was obtained. Considering the standards made by the author in SSS validation, it can be seen that the sample has obtained a medium-high score in each one of the aspects. Significant differences have been found when considering the sociodemographic variable gender as an independent variable with the complete score of SSS (F=6.555; p=0.013), and with the scale dimensions, self-expression in social situations (F=4.468; p=0.039) and making a demand (F=7.982; p=0.007). In each one of the SSS dimensions, the sample has obtained a slightly higher score than the standard sample and it within the 50-69 percentile. This indicates the existence of a medium-high level of Social Skill. The doctors score higher than the nurses, although these differences are not statistically significant. Copyright © 2010 Elsevier España, S.L. y SEEIUC. All rights reserved.

  1. Clinical review: Ethics and end-of-life care for critically ill patients in China. (United States)

    Li, Li Bin


    Critical care medicine in China has made great advances in recent decades. This has led to an unavoidable issue: end-of-life ethics. With advances in medical technology and therapeutics allowing the seemingly limitless maintenance of life, the exact time of death of an individual patient is often determined by the decision to limit life support. How to care for patients at the end of life is not only a medical problem but also a social, ethical, and legal issue. A lot of factors, besides culture, come into play in determining a person's ethical attitudes or behaviors, such as experience, education, religion, individual attributes, and economic considerations. Chinese doctors face ethical problems similar to those of their Western counterparts; however, since Chinese society is different from that of Western countries in cultural traditions, customs, religious beliefs, and ethnic backgrounds, there is a great difference between China and the Western world in regard to ethics at the end of life, and there is also a huge controversy within China.

  2. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. (United States)

    Chapman, Elizabeth N; Kaatz, Anna; Carnes, Molly


    Although the medical profession strives for equal treatment of all patients, disparities in health care are prevalent. Cultural stereotypes may not be consciously endorsed, but their mere existence influences how information about an individual is processed and leads to unintended biases in decision-making, so called "implicit bias". All of society is susceptible to these biases, including physicians. Research suggests that implicit bias may contribute to health care disparities by shaping physician behavior and producing differences in medical treatment along the lines of race, ethnicity, gender or other characteristics. We review the origins of implicit bias, cite research documenting the existence of implicit bias among physicians, and describe studies that demonstrate implicit bias in clinical decision-making. We then present the bias-reducing strategies of consciously taking patients' perspectives and intentionally focusing on individual patients' information apart from their social group. We conclude that the contribution of implicit bias to health care disparities could decrease if all physicians acknowledged their susceptibility to it, and deliberately practiced perspective-taking and individuation when providing patient care. We further conclude that increasing the number of African American/Black physicians could reduce the impact of implicit bias on health care disparities because they exhibit significantly less implicit race bias.

  3. Relational continuity with primary and secondary care doctors: a qualitative study of perceptions of users of the Catalan national health system. (United States)

    Waibel, Sina; Vargas, Ingrid; Coderch, Jordi; Vázquez, María-Luisa


    In the current context of increasingly fragmented healthcare systems where patients are seen by multiple doctors in different settings, patients' relational continuity with one doctor is regaining relevance; however little is known about relational continuity with specialists. The aim of this study is to explore perceptions of relational continuity with primary care and secondary care doctors, its influencing factors and consequences from the viewpoint of users of the Catalan national health system (Spain). We conducted a descriptive-interpretative qualitative study using a two-stage theoretical sample; (i) contexts: three healthcare areas in the Catalan national health system with differing characteristics; (ii) informants: users 18 years or older attended to at both care levels. Sample size (n = 49) was reached by saturation. Data were collected by individual semi-structured interviews, which were audio recorded and transcribed. A thematic content analysis was carried out segmenting data by study area, and leaving room for new categories to emerge from the data. Patients across the areas studied generally experienced consistency of primary care doctors (PCD), alongside some inconsistency of specialists. Consistency of specialists did not seem to be relevant to some patients when their clinical information was shared and used. Patients who experienced consistency and frequent visits with the same PCD or specialist described and valued having established an ongoing relationship characterised by personal trust and mutual accumulated knowledge. Identified consequences were diverse and included, for example, facilitated diagnosis or improved patient-doctor communication. The ascription to a PCD, a health system-related factor, facilitated relational continuity with the PCD, whereas organizational factors (for instance, the size of the primary care centre) favoured consistency of PCD and specialists. Doctor-related factors (for example, high technical competence or

  4. Duty of care or a matter of conduct -- can a doctor refuse a person in need of urgent medical attention? (United States)

    Dean, Jessica; Mahar, Patrick; Loh, Erwin; Ludlow, Karinne


    Medical practitioners may have their particular skills called upon outside a direct professional context. The responsibilities of medical practitioners outside their defined scope of clinical practice may not be clear to all clinicians. To consider the possible legal consequences of a doctor refusing to assist a person in need of urgent medical attention both in terms of medical negligence and professional misconduct. Where an established clinical relationship does not exist, and a doctor does not wish to render aid, three particular scenarios may arise. A doctor may actively deny being a doctor, passively avoid identifying themselves as a doctor or acknowledge being a doctor, but refuse to render assistance. Aside from any ethical issues, how a doctor chooses to act and represent themselves may lead to different legal ramifications. There exists significant variation in state provisions relating to legal obligations to render aid, which may benefit from review and revision at a national level.

  5. Patient perception of smartphone usage by doctors

    Directory of Open Access Journals (Sweden)

    Kerry G


    Full Text Available Georgina Kerry,1 Shyam Gokani,2 Dara Rasasingam,2 Alexander Zargaran,3 Javier Ash,2 Aaina Mittal2 1College of Medical and Dental Sciences, University of Birmingham, Birmingham, 2Faculty of Medicine, Imperial College London, London, 3Faculty of Medicine, St George’s University of London, London, UK Abstract: Technological advancements have revolutionized modern medicine and smartphones are now ubiquitous among health care professionals. The ability to look up information promptly is invaluable to doctors and medical students alike, but there is an additional contiguous benefit to patients. Queries can be answered more accurately through fingertip access to evidence-based medicine, and physicians have instant access to emergency care protocols. However, is consideration always extended to the patient’s perception of the use of smartphones by doctors? Do patients know why we use smartphones to assist us in their care? What do they think when they see a doctor using a smartphone?An independent question, conducted within a wider service evaluation (ethical approval not required, full verbal and written electronic consent provided by all patients at St. Mary’s Hospital, London, indicated that although the majority (91.0% of patients owned a smartphone, many (61.6% did not agree that the use of smartphones at work by doctors is professional. This highlights the potential for damage to the doctor–patient relationship. There is a risk that these patients will disconnect with care services with possible detriment to their health. Additionally, it is notable that a larger proportion of those patients aged >70 years found the use of smartphones by doctors at work unprofessional, compared with patients aged <70 years.Adequate communication between the doctor and patient is critical in ensuring that doctors can make use of modern technology to provide the best possible care and that patients are comfortable with this and do not feel isolated or

  6. Developing a Family-Centered Care Model for Critical Care After Pediatric Traumatic Brain Injury. (United States)

    Moore, Megan; Robinson, Gabrielle; Mink, Richard; Hudson, Kimberly; Dotolo, Danae; Gooding, Tracy; Ramirez, Alma; Zatzick, Douglas; Giordano, Jessica; Crawley, Deborah; Vavilala, Monica S


    This study examined the family experience of critical care after pediatric traumatic brain injury in order to develop a model of specific factors associated with family-centered care. Qualitative methods with semi-structured interviews were used. Two level 1 trauma centers. Fifteen mothers of children who had an acute hospital stay after traumatic brain injury within the last 5 years were interviewed about their experience of critical care and discharge planning. Participants who were primarily English, Spanish, or Cantonese speaking were included. None. Content analysis was used to code the transcribed interviews and develop the family-centered care model. Three major themes emerged: 1) thorough, timely, compassionate communication, 2) capacity building for families, providers, and facilities, and 3) coordination of care transitions. Participants reported valuing detailed, frequent communication that set realistic expectations and prepared them for decision making and outcomes. Areas for capacity building included strategies to increase provider cultural humility, parent participation in care, and institutional flexibility. Coordinated care transitions, including continuity of information and maintenance of partnerships with families and care teams, were highlighted. Participants who were not primarily English speaking reported particular difficulty with communication, cultural understanding, and coordinated transitions. This study presents a family-centered traumatic brain injury care model based on family perspectives. In addition to communication and coordination strategies, the model offers methods to address cultural and structural barriers to meeting the needs of non-English-speaking families. Given the stress experienced by families of children with traumatic brain injury, careful consideration of the model themes identified here may assist in improving overall quality of care to families of hospitalized children with traumatic brain injury.

  7. Variation in critical care services across North America and Western Europe

    NARCIS (Netherlands)

    Wunsch, Hannah; Angus, Derek C.; Harrison, David A.; Collange, Olivier; Fowler, Robert; Hoste, Eric A. J.; de Keizer, Nicolette F.; Kersten, Alexander; Linde-Zwirble, Walter T.; Sandiumenge, Alberto; Rowan, Kathryn M.


    Objective: Critical care represents a large percentage of healthcare spending in developed countries. Yet, little is known regarding international variation in critical care services. We sought to understand differences in critical care delivery by comparing data on the distribution of services in

  8. Self-reported medical care seeking behaviour of doctors in Nigeria

    African Journals Online (AJOL)

    A.E. Fawibe


    May 14, 2016 ... b Department of Family Medicine, University of Ilorin Teaching ... Purpose: This work was therefore designed to study the medical care ... for their health problems and find it difficult to adopt the role ..... Conflict of interest. None ...

  9. The compatibility of future doctors' career intentions with changing health care demands

    NARCIS (Netherlands)

    van Offenbeek, M.A.G.; Kiewiet, D.J.; Oosterhuis, M.

    Background: In the Netherlands the medical education system is in the process of being transformed to establish a more demand-oriented health care system. This transformation may entail the occupational restructuring of the medical profession. Meanwhile, on the supply side, the career intentions of

  10. Chiropractic Health Care: A National Study of Cost of Education, Service Utilization, Number of Practicing Doctors of Chiropractic, and Other Key Policy Issues. Volumes I-II. (United States)

    von Kuster, Thomas, Jr.

    Results from the first federally sponsored study of the chiropractic health care profession are presented, and a broad range of facts and issues of concern to policy-makers, the profession, and the public are described. The two-year project included three national surveys of: service providers (doctors of chiropractic in practice more than two…

  11. Rethinking critical reflection on care: late modern uncertainty and the implications for care ethics. (United States)

    Vosman, Frans; Niemeijer, Alistair


    Care ethics as initiated by Gilligan, Held, Tronto and others (in the nineteen eighties and nineties) has from its onset been critical towards ethical concepts established in modernity, like 'autonomy', alternatively proposing to think from within relationships and to pay attention to power. In this article the question is raised whether renewal in this same critical vein is necessary and possible as late modern circumstances require rethinking the care ethical inquiry. Two late modern realities that invite to rethink care ethics are complexity and precariousness. Late modern organizations, like the general hospital, codetermined by various (control-, information-, safety-, accountability-) systems are characterized by complexity and the need for complexity reduction, both permeating care practices. By means of a heuristic use of the concept of precariousness, taken as the installment of uncertainty, it is shown that relations and power in late modern care organizations have changed, precluding the use of a straightforward domination idea of power. In the final section a proposition is made how to rethink the care ethical inquiry in order to take late modern circumstances into account: inquiry should always be related to the concerns of people and practitioners from within care practices.

  12. The critical components of an electronic care plan tool for primary care: an exploratory qualitative study

    Directory of Open Access Journals (Sweden)

    Lisa Rotenstein


    Full Text Available Background A critical need exists for effective electronic tools that facilitate multidisciplinary care for complex patients in patient-centered medical homes. Objective To identify the essential components of a primary care (PC based electronic care plan (ECP tool that facilitates coordination of care for complex patients. Methods Three focus groups and nine semi-structured interviews were conducted at an academic PC practice in order to identify the ideal components of an ECP. Results Critical components of an ECP identified included: 1 patient background information, including patient demographics, care team member designation and key patient contacts, 2 user- and patient-centric task management functionalities, 3 a summary of a patient’s care needs linked to the responsible member of the care team and 4 integration with the electronic medical record. We then designed an ECP mockup incorporating these components. Conclusion Our investigation identified key principles that healthcare software developers can integrate into PC and patient-centered ECP tools.

  13. The effect of Health smart cards for Quality Health care services ( doctor martyr Beheshti medical research center in Qom

    Directory of Open Access Journals (Sweden)

    Saeed zarandi


    Full Text Available The main objective of this study was to investigate the effect of the use health smart card on the aspects quality of healthcare services in doctor martyr beheshti medical research center in qom . With regard to the measures taken in the context of the establishment of this card in Qom and the lack of previous experience in this province, one of the concerns of the authorities to investigate the performance and capabilities of the card and its effects on the quality of health services is affecting the present study is to respond to this concerns. This research method is descriptive and applied to the target population of physicians, nurses and medical record experts employed at the Medical Center have formed a martyr Beheshti Qom due to more awareness cognitive advantages associated with its use of smart cards have given. The population is equal to the number of 444 and 124 questionnaire for data analysis is used. The sampling method used in this research was stratified random sampling conducted in the respective classes. Spss software for data analysis & exploratory factor analysis & confirmed, Kolmogorov-Smirnov Test, Wilcoxon Test & matrix of factors were used. The analysis results showed that Health Smart Cards for quality of health care services positive and significant effects on Dimension quality of the reliability & Tangibles . Analysis of demographic variables that influence opinions about the quality of health care Health Smart Cards significantly related to gender and education level, and also no experience discussed the variables significantly associated with age.

  14. Barbados Insulin Matters (BIM) study: Perceptions on insulin initiation by primary care doctors in the Caribbean island of Barbados. (United States)

    Taylor, Charles Grafton; Taylor, Gordon; Atherley, Anique; Hambleton, Ian; Unwin, Nigel; Adams, Oswald Peter


    With regards to insulin initiation in Barbados we explored primary care doctor (PCD) perception, healthcare system factors and predictors of PCD reluctance to initiate insulin. PCDs completed a questionnaire based on the theory of planned behaviour (TPB) and a reluctance to initiate insulin scale. Using linear regression, we explored the association between TPB domains and the reluctance to initiate insulin scale. Of 161 PCDs, 70% responded (75 private and 37 public sector). The majority felt initiating insulin was uncomplicated (68%) and there was benefit if used before complications developed (68%), but would not use it until absolutely necessary (58%). More private than public sector PCDs (p<0.05) thought that the healthcare system allowed enough flexibility of time for education (68 vs 38%) and initiating insulin was easy (63 vs 35%), but less thought system changes would help initiating insulin (42 vs 70%). Reasons for reluctance to initiate insulin included patient nonadherence (83%) and reluctance (63%). Only the attitudes and belief domain of the TPB was associated with the reluctance to initiate insulin scale (p<0.001). Interventions focusing on PCD attitudes and beliefs and restructuring services inclusive of the use of diabetes specialist nurses are required. Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  15. Standardizing communication from acute care providers to primary care providers on critically ill adults. (United States)

    Ellis, Kerri A; Connolly, Ann; Hosseinnezhad, Alireza; Lilly, Craig M


    To increase the frequency of communication of patient information between acute and primary care providers. A secondary objective was to determine whether higher rates of communication were associated with lower rates of hospital readmission 30 days after discharge. A validated instrument was used for telephone surveys before and after an intervention designed to increase the frequency of communication among acute care and primary care providers. The communication intervention was implemented in 3 adult intensive care units from 2 campuses of an academic medical center. The frequency of communication among acute care and primary care providers, the perceived usefulness of the intervention, and its association with 30-day readmission rates were assessed for 202 adult intensive care episodes before and 100 episodes after a communication intervention. The frequency of documented communication increased significantly (5/202 or 2% before to 72/100 or 72% after the intervention; P communication was considered useful by every participating primary care provider. Rates of rehospitalization at 30 days were lower for the intervention group than the preintervention group, but the difference was not statistically significant (41/202 or 23% vs 16/88 or 18% of discharged patients; P = .45; power 0.112 at P = .05). The frequency of communication episodes that provide value can be increased through standardized processes. The key aspects of this effective intervention were setting the expectation that communication should occur, documenting when communication has occurred, and reviewing that documentation during multiprofessional rounds. ©2015 American Association of Critical-Care Nurses.

  16. Attitudes toward surrogacy among doctors working in reproductive medicine and obstetric care in Sweden. (United States)

    Stenfelt, Camilla; Armuand, Gabriela; Wånggren, Kjell; Skoog Svanberg, Agneta; Sydsjö, Gunilla


    To investigate attitudes and opinions towards surrogacy among physicians working within obstetrics and reproductive medicine in Sweden. Physicians working within medically assisted reproduction (MAR), antenatal care and obstetrics were invited to participate in a cross-sectional nationwide survey study. The study-specific questionnaire measured attitudes and experiences in three domains: attitudes towards surrogacy, assessment of prospective surrogate mothers, and antenatal and obstetric care for surrogate mothers. Of the 103 physicians who participated (response rate 74%), 63% were positive or neutral towards altruistic surrogacy being introduced in Sweden. However, only 28% thought that it should be publicly financed. Physicians working at fertility clinics were more positive towards legalization as well as public financing of surrogacy compared than were those working within antenatal and delivery care. The majority of the physicians agreed that surrogacy involves the risk of exploitation of women's bodies (60%) and that there is a risk that the commissioning couple might pay the surrogate mother "under the table" (82%). They also expressed concerns about potential surrogate mothers not being able to understand fully the risks of entering pregnancy on behalf of someone else. There is a relatively strong support among physicians working within obstetrics and reproductive medicine for the introduction of surrogacy in Sweden. However, the physicians expressed concerns about the surrogate mothers' health as well as the risk of coercion. Further discussions about legalization of surrogacy should include views from individuals within a wide field of different medical professions and laymen. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  17. Direct-to-consumer advertising: public perceptions of its effects on health behaviors, health care, and the doctor-patient relationship. (United States)

    Murray, Elizabeth; Lo, Bernard; Pollack, Lance; Donelan, Karen; Lee, Ken


    To determine public perceptions of the effect of direct-to-consumer advertising (DTCA) of prescription medications on health behaviors, health care utilization, the doctor-patient relationship, and the association between socioeconomic status and these effects. Cross-sectional survey of randomly selected, nationally representative sample of the US public using computer-assisted telephone interviewing. numbers and proportions of respondents in the past 12 months who, as a result of DTCA, requested preventive care or scheduled a physician visit; were diagnosed with condition mentioned in advertisement; disclosed health concerns to a doctor; felt enhanced confidence or sense of control; perceived an effect on the doctor-patient relationship; requested a test, medication change, or specialist referral; or manifested serious dissatisfaction after a visit to a doctor. As a result of DTCA, 14% of respondents disclosed health concerns to a physician, 6% requested preventive care, 5% felt more in control during a physician visit; 5% made requests for a test, medication change, or specialist referral, and 3% received the requested intervention. One percent of patients reported negative outcomes, including worsened treatment, serious dissatisfaction with the visit, or that the physician acted challenged. Effects of DTCA were greater for respondents with low socioeconomic status. DTCA has positive and negative effects on health behaviors, health service utilization, and the doctor-patient relationship that are greatest on people of low socioeconomic status. The benefits of DTCA in terms of encouraging hard-to-reach sections of the population to seek preventive care must be balanced against increased health care costs caused by clinically inappropriate requests generated by DTCA.

  18. Developing the PLA critical care medicine is critical for advancing the level of battle wound treatment in the new era

    Directory of Open Access Journals (Sweden)

    Wei-qin LI


    Full Text Available Critical care medicine is an emerging unique specialty developed from the later 20th century, since then, it has been enriched with theoretical and practical experiences and becomes the most active subject in the field of clinical medicine. Critical care medicine of the PLA has attained significant achievements in the treatment and research of severe trauma, sepsis, severe heat stroke, multiple organ failure and severe acute pancreatitis. Besides, it stands in the leading position in the organ function maintenance of critically ill patients, continuous hemofiltration and nutrition support in China. Furthermore, critical care medicine plays an important role in the rescue of critically ill patients, medical support and disaster relief. As the relationship between battle wound rescue system and critical care medicine has been increasingly close, transition in the form of war in the new period brings new tasks to battle wound treatment constantly. Combined with the characteristics of information-oriented war condition in the future, developing the PLA critical care medicine and advancing the level of battle wound treatment in the new period point out the direction for the future work of critical care medicine. DOI: 10.11855/j.issn.0577-7402.2017.02.01

  19. From Doctor to Nurse Triage in the Danish Out-of-Hours Primary Care Service

    DEFF Research Database (Denmark)

    Moth, Grete; Huibers, Linda; Vedsted, Peter


    Introduction. General practitioners (GP) answer calls to the Danish out-of-hours primary care service (OOH) in Denmark, and this is a subject of discussions about quality and cost-effectiveness. The aim of this study was to estimate changes in fee costs if nurses substituted the GPs. Methods. We...... employed nurses would be needed. Fewer telephone consultations may result in an increase of face-to-face contacts, resulting in an increase of 23.6% in costs fees. Under optimal circumstances (e.g., a lower demand for OOH services, a high telephone termination rate, and unchanged GP fees) the costs could...

  20. Family centred care before and during life-sustaining treatment withdrawal in intensive care: A survey of information provided to families by Australasian critical care nurses


    Ranse, K; Bloomer, M; Coombs, M; Endacott, R


    publisher: Elsevier articletitle: Family centred care before and during life-sustaining treatment withdrawal in intensive care: A survey of information provided to families by Australasian critical care nurses journaltitle: Australian Critical Care articlelink: content_type: article copyright: © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  1. Clinical decision regret among critical care nurses: a qualitative analysis. (United States)

    Arslanian-Engoren, Cynthia; Scott, Linda D


    Decision regret is a negative cognitive emotion associated with experiences of guilt and situations of interpersonal harm. These negative affective responses may contribute to emotional exhaustion in critical care nurses (CCNs), increased staff turnover rates and high medication error rates. Yet, little is known about clinical decision regret among CCNs or the conditions or situations (e.g., feeling sleepy) that may precipitate its occurrence. To examine decision regret among CCNs, with an emphasis on clinical decisions made when nurses were most sleepy. A content analytic approach was used to examine the narrative descriptions of clinical decisions by CCNs when sleepy. Six decision regret themes emerged that represented deviations in practice or performance behaviors that were attributed to fatigued CCNs. While 157 CCNs disclosed a clinical decision they made at work while sleepy, the prevalence may be underestimated and warrants further investigation. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Mindful meditation: healing burnout in critical care nursing. (United States)

    Davies, William Richard


    The nursing profession is experiencing a crisis in both manpower and the ability to fend off the deleterious effects of burnout. Nursing professionals face extraordinary stress in our present medical environment, and studies have frequently found moderate-to-high levels of burnout among nurses. Nurses experience burnout for a variety of reasons, some inherent to the profession and others related to our 21st-century values that have necessitated multiple breadwinners within the household. Mindful meditation represents a complementary therapy that has shown promise in the reduction of negative stress and those extraneous factors that lead to burnout. A mindful, meditative practice can be another tool with which critical care nurses can regain the control of their careers and personal lives. The purpose of this article is to describe nurse burnout, identify those factors that contribute to burnout, and offer a solution to a continuing problem for nurses.

  3. Perianesthesia nursing-beyond the critical care skills. (United States)

    Ead, Heather


    Provision of patient care within the perianesthesia specialty is demanding in nature. Although a nurse may be well equipped with the assessment, planning, and critical thinking skills required for these fast-paced areas, there are other competencies to be developed. These include skills in mentorship, communication, crisis management, and competency as an ambassador of patient safety. Barriers to developing these skills may include a high patient acuity and turnover, a sense of isolation from other departments, and strong hierarchical structures. However, there are resources and strategies that nurses can leverage to facilitate development of these less-technical, "softer" skills. In this article, the author reviews some of the unique demands commonly seen within the perianesthesia specialty. Methods to address these challenges are shared to facilitate an enjoyable career in this dynamic environment. Copyright © 2014 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  4. Review article: Critical Care Airway Management eLearning modules. (United States)

    Doshi, Deepak; McCarthy, Sally; Mowatt, Elizabeth; Cahill, Angela; Peirce, Bronwyn; Hawking, Geoff; Osborne, Ruth; Hibble, Belinda; Ebbs, Katharine


    The Australasian College for Emergency Medicine (ACEM) has recently launched the Critical Care Airway Management eLearning modules to support emergency medicine trainees in developing their airway management skills in the ED. A team of emergency physicians and trainees worked collaboratively to develop the eLearning resources ensuring extensive stakeholder consultation. A comprehensive resource manual was written to provide learners with knowledge that underpins the modules. ACEM provided project coordination as well as administrative and technical team support to the production. Although specifically developed with early ACEM trainees in mind, it is envisaged the resources will be useful for all emergency clinicians. The project was funded by the Australian Commonwealth Department of Health. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  5. Patient outcomes for the chronically critically ill: special care unit versus intensive care unit. (United States)

    Rudy, E B; Daly, B J; Douglas, S; Montenegro, H D; Song, R; Dyer, M A


    The purpose of this study was to compare the effects of a low-technology environment of care and a nurse case management case delivery system (special care unit, SCU) with the traditional high-technology environment (ICU) and primary nursing care delivery system on the patient outcomes of length of stay, mortality, readmission, complications, satisfaction, and cost. A sample of 220 chronically critically ill patients were randomly assigned to either the SCU (n = 145) or the ICU (n = 75). Few significant differences were found between the two groups in length of stay, mortality, or complications. However, the findings showed significant cost savings in the SCU group in the charges accrued during the study period and in the charges and costs to produce a survivor. The average total cost of delivering care was $5,000 less per patient in the SCU than in the traditional ICU. In addition, the cost to produce a survivor was $19,000 less in the SCU. Results from this 4-year clinical trial demonstrate that nurse case managers in a SCU setting can produce patient outcomes equal to or better than those in the traditional ICU care environment for long-term critically ill patients.

  6. Relationship between job burnout, psychosocial factors and health care-associated infections in critical care units. (United States)

    Galletta, Maura; Portoghese, Igor; D'Aloja, Ernesto; Mereu, Alessandra; Contu, Paolo; Coppola, Rosa Cristina; Finco, Gabriele; Campagna, Marcello


    Burnout is a serious problem for critical care unit workers because they are exposed to chronic psychosocial stressors, including high responsibility, advanced technology and high patient acuity. Recent evidence showed that staff burnout was directly associated with hospital infections, thus affecting quality and safety of care provided. The research aim was to investigate how burnout was associated with some psychosocial factors and with health care-associated infections in hospitalised patients. A total of 130 healthcare professionals from critical care units completed a self-reported questionnaire. The infection data were collected prospectively over a six-month period. The results showed that emotional exhaustion was related to cynicism due to high work demands. Cynicism affected team communication, which in turn was positively related to team efficacy, thus acting as a mediator. Finally, team efficacy was negatively related to infections. The study showed that emotional exhaustion and cynicism were related to psychosocial aspects, which in turn had a significant impact on healthcare-associated infections. Our findings suggest how burnout can indirectly affect healthcare-related infections as a result of the quality of teamwork. Thus, reducing burnout can be a good strategy to decrease infections, thus increasing workers' well-being while improving patient care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Attitudes of anesthesiology residents toward critical care medicine training. (United States)

    Durbin, C G; McLafferty, C L


    The number of anesthesiology residents pursuing critical care medicine (CCM) fellowship training has been decreasing in recent years. A significant number of training positions remain unfilled each year. Possible causes of this decline were evaluated by surveying residents regarding their attitudes toward practice and training in CCM. All 38 anesthesiology programs having accredited CCM fellowships were surveyed. Four of these and one program without CCM fellowships were used to develop the survey instrument. Four programs without CCM fellowships and 34 programs with CCM fellowships make up the survey group. Returned were 640 surveys from 37 (97%) programs accounting for over 30% of the possible residents. Resident interest in pursuing CCM training decreased as year of residency increased (P questions suggested resident concerns with the following: stress of chronic care, financial consequences of additional year of training, ICU call frequency and load, ICU role ambiguity, and shared decision-making in the ICU. A recurring question was, "Are there jobs (outside of academics) for anesthesiologist intensivists?" Most residents knew a CCM anesthesiologist they admired and knew that there were unfilled fellowship positions available. Defining the job market, improving curriculum and teaching, supporting deferment of student loans, and introducing residents and medical students to the ICU earlier may increase the interest in CCM practice among anesthesiology residents.

  8. Effect of caring behavior on disposition toward critical thinking of nursing students. (United States)

    Pai, Hsiang-Chu; Eng, Cheng-Joo; Ko, Hui-Ling


    The purpose of this study was to explore the relationship between caring behavior and the disposition toward critical thinking of nursing students in clinical practice. A structural equation model was used to test the hypothesized relationship between caring behavior and critical thinking skills. Caring is the core of nursing practice, and the disposition toward critical thinking is needed for competent nursing care. In a fast-paced and complex environment, however, "caring" may be lost. Because nursing students will become professional nurses, it is essential to explore their caring behaviors and critical thinking skills and to understand how to improve their critical thinking skills based on their caring behavior. A cross-sectional study was used, with convenience sampling of students who were participating in associate degree nursing programs at 3 colleges of nursing. The following instruments were used: critical thinking disposition inventory Chinese version and caring behaviors scale. The study found that individuals with a higher frequency of caring behaviors had a higher score on critical thinking about nursing practice (β = .44, t = 5.14, P critical thinking. The findings of this study revealed the importance of caring behavior and its relationship with the disposition toward critical thinking. Thus, it is recommended that nursing education should emphasize a curriculum related to caring behavior to improve the disposition toward critical thinking of nursing students. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Critical incidents connected to nurses' leadership in Intensive Care Units. (United States)

    Lima, Elaine Cantarella; Bernardes, Andrea; Baldo, Priscila Lapaz; Maziero, Vanessa Gomes; Camelo, Silvia Helena Henriques; Balsanelli, Alexandre Pazetto


    The goal of this study is to analyze nurses' leadership in intensive care units at hospitals in the state of São Paulo, Brazil, in the face of positive and negative critical incidents. Exploratory, descriptive study, conducted with 24 nurses by using the Critical Incident Technique as a methodological benchmark. Results were grouped into 61 critical incidents distributed into categories. Researchers came to the conclusion that leadership-related situations interfere with IC nurses' behaviors. Among these situations they found: difficulty in the communication process; conflicts in the daily exercise of nurses' activities; people management; and the setting of high quality care targets. Researchers identified a mixed leadership model, leading them to the conclusion that nurses' knowledge and practice of contemporary leadership theories/styles are crucial because they facilitate the communication process, focusing on behavioral aspects and beliefs, in addition to valuing flexibility. This positively impacts the organization's results. Analisar a liderança do enfermeiro em Centros de Terapia Intensiva de hospitais localizados no interior do estado de São Paulo, diante de incidentes críticos positivos e negativos. Estudo exploratório, descritivo, realizado com 24 enfermeiros, que utilizou a Técnica do Incidente Crítico como referencial metodológico. Os resultados foram agrupados em 61 incidentes críticos distribuídos em categorias. Identificou-se que situações relacionadas à liderança interferem no comportamento do enfermeiro de Terapia Intensiva, dentre elas: dificuldade no processo de comunicação, conflitos existentes no dia a dia do exercício profissional, gerenciamento de pessoas e estabelecimento de metas para o alcance da assistência qualificada. Encontrou-se um modelo misto de liderança, o que permite concluir que o conhecimento e a prática dos enfermeiros acerca de teorias/estilos contemporâneos de liderança tornam-se fundamentais, pois

  10. Impact on mortality of prompt admission to critical care for deteriorating ward patients: an instrumental variable analysis using critical care bed strain. (United States)

    Harris, Steve; Singer, Mervyn; Sanderson, Colin; Grieve, Richard; Harrison, David; Rowan, Kathryn


    To estimate the effect of prompt admission to critical care on mortality for deteriorating ward patients. We performed a prospective cohort study of consecutive ward patients assessed for critical care. Prompt admissions (within 4 h of assessment) were compared to a 'watchful waiting' cohort. We used critical care strain (bed occupancy) as a natural randomisation event that would predict prompt transfer to critical care. Strain was classified as low, medium or high (2+, 1 or 0 empty beds). This instrumental variable (IV) analysis was repeated for the subgroup of referrals with a recommendation for critical care once assessed. Risk-adjusted 90-day survival models were also constructed. A total of 12,380 patients from 48 hospitals were available for analysis. There were 2411 (19%) prompt admissions (median delay 1 h, IQR 1-2) and 9969 (81%) controls; 1990 (20%) controls were admitted later (median delay 11 h, IQR 6-26). Prompt admissions were less frequent (p care. In the risk-adjust survival model, 90-day mortality was similar. After allowing for unobserved prognostic differences between the groups, we find that prompt admission to critical care leads to lower 90-day mortality for patients assessed and recommended to critical care.

  11. Effect of the essentials of critical care orientation (ECCO) program on the development of nurses' critical thinking skills. (United States)

    Kaddoura, Mahmoud A


    It is essential for nurses to develop critical thinking skills to ensure their ability to provide safe and effective care to patients with complex and variable needs in ever-changing clinical environments. To date, very few studies have been conducted to examine how nursing orientation programs develop the critical thinking skills of novice critical care nurses. Strikingly, no research studies could be found about the American Association of Critical Care Nurses Essentials of Critical Care Orientation (ECCO) program and specifically its effect on the development of nurses' critical thinking skills. This study explored the perceptions of new graduate nurses regarding factors that helped to develop their critical thinking skills throughout their 6-month orientation program in the intensive care unit. A convenient non-probability sample of eight new graduates was selected from a hospital that used the ECCO program. Data were collected with demographic questionnaires and semi-structured interviews. An exploratory qualitative research method with content analysis was used to analyze the data. The study findings showed that new graduate nurses perceived that they developed critical thinking skills that improved throughout the orientation period, although there were some challenges in the ECCO program. This study provides data that could influence the development and implementation of future nursing orientation programs. Copyright 2010, SLACK Incorporated.

  12. [Family doctor-centred care in Baden-Wuerttemberg: concept and results of a controlled evaluation study]. (United States)

    Gerlach, Ferdinand M; Szecsenyi, Joachim


    Pursuant to Section 73b, volume V of the German Social Security Code (SGB V), the agreement on family doctor-centred care (HzV), which went into effect in Baden-Wuerttemberg on July 1, 2008, provides for spatially inclusive and comprehensive medical coverage. The most important elements of the agreement are: the voluntary registration of family practices and patients, the strengthening of the coordinative function of family practices, the fulfilment of certain training, quality and qualification requirements, the standardised remuneration system and the use of specified practice software for billing and the prescription of drugs. The aim of this complex intervention is to strengthen family medicine, improve health care, in particular for patients with chronic disease, and to limit primary health care costs while improving its quality wherever possible. This first controlled nationwide evaluation examines the question whether these objectives were met in the early phase (2008 to 2011) and, if so, to what extent. Four work packages were defined: 1. differences in health care processes (utilisation, contact to specialists, hospitalisations, drug prescriptions); 2. developments in practice teams and of patient satisfaction; 3. deployment of specially trained health care assistants in family practices (VERAH); 4. implementation of the DEGAM (German Society of General Practice and Family Medicine) heart failure guideline. To the extent that it was possible to use the statutory health insurance company AOK Baden-Wuerttemberg's routine data, an adjusted comparison of the target variables was made for HzV- and non-HzV-insured patients between the first and second or between the third and fourth quarters of 2008, and between the first and second or third and fourth quarters of 2010. HzV participants were older, had a higher disease burden (Charlson Index 1.45 vs. 1.19), and were attended to more intensively than patients receiving routine care (1.7 more contacts with the

  13. 'I deal with the small things': the doctor-patient relationship and professional identity in GPs' stories of cancer care. (United States)

    Johansen, May-Lill; Holtedahl, Knut Arne; Davidsen, Annette Sofie; Rudebeck, Carl Edvard


    An important part of GPs' work consists of attending to the everyday and existential conditions of human being. In these life world aspects, biomedicine is often not the relevant theory to guide the GP; nevertheless they are a part of GPs' professional domain. In cancer care, previous studies have shown that GPs with a biomedical perspective on medicine could feel subordinate to specialists, and that doctors with a curative focus could see disease progression as a personal failure. The aim of this study was to explore in depth the experiences of being a GP for people with advanced cancer. Fourteen Norwegian GPs were interviewed about accompanying patients through a cancer illness. Their stories were analysed using a narrative approach. The GPs expressed a strong commitment to these patients, a loyalty which in some cases could be weakened due to judgements of distant specialists. In view of the GPs' close knowledge of their patients' background and history this subordination was a paradox, mirroring a hierarchy of medical knowledge. The GPs had an ideal of honesty and openness about death, which they sometimes failed. To reach the ideal of honesty, clinicians would have to abandon the biomedical ideal of mastering human nature through interventions and acknowledge the fundamental uncertainty and finiteness of human life. GPs may learn from being with their patients that bodily and existential suffering are connected, and thus learn implicitly to overlook the body-mind dualism. This practical wisdom lacks a theoretical anchoring, which is a problem not only for general practice.

  14. Analysis of team types based on collaborative relationships among doctors, home-visiting nurses and care managers for effective support of patients in end-of-life home care. (United States)

    Fujita, Junko; Fukui, Sakiko; Ikezaki, Sumie; Otoguro, Chizuru; Tsujimura, Mayuko


    To define the team types consisting of doctors, home-visiting nurses and care managers for end-of-life care by measuring the collaboration relationship, and to identify the factors related to the team types. A questionnaire survey of 43 teams including doctors, home-visiting nurses and care managers was carried out. The team types were classified based on mutual evaluations of the collaborative relationships among the professionals. To clarify the factors between team types with the patient characteristics, team characteristics and collaboration competency, univariate analysis was carried out with the Fisher's exact test or one-way analysis and multiple comparison analysis. Three team types were classified: the team where the collaborative relationships among all healthcare professionals were good; the team where the collaborative relationships between the doctors and care managers were poor; and the team where the collaborative relationships among all of the professionals were poor. There was a statistically significant association between the team types and the following variables: patient's dementia level, communication tool, professionals' experience of working with other team members, home-visiting nurses' experience of caring for dying patients, care managers' background qualifications, doctor's face-to-face cooperation with other members and home-visiting nurses' collaborative practice. It is suggested that a collaborative relationship would be fostered by more experience of working together, using communication tools and enhancing each professional's collaboration competency. Geriatr Gerontol Int 2017; 17: 1943-1950. © 2017 Japan Geriatrics Society.

  15. Practical strategies for increasing efficiency and effectiveness in critical care education. (United States)

    Joyce, Maurice F; Berg, Sheri; Bittner, Edward A


    Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.

  16. The carbon footprint of acute care: how energy intensive is critical care? (United States)

    Pollard, A S; Paddle, J J; Taylor, T J; Tillyard, A


    Climate change has the potential to threaten human health and the environment. Managers in healthcare systems face significant challenges to balance carbon mitigation targets with operational decisions about patient care. Critical care units are major users of energy and hence more evidence is needed on their carbon footprint. The authors explore a methodology which estimates electricity use and associated carbon emissions within a Critical Care Unit (CCU). A bottom-up model was developed and calibrated which predicted the electricity consumed and carbon emissions within a CCU based on the type of patients treated and working practices in a case study in Cornwall, UK. The model developed was able to predict the electricity consumed within CCU with an error of 1% when measured against actual meter readings. Just under half the electricity within CCU was used for delivering care to patients and monitoring their condition. A model was developed which accurately predicted the electricity consumed within a CCU based on patient types, medical devices used and working practice. The model could be adapted to enable it to be used within hospitals as part of their planning to meet carbon reduction targets. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  17. War is the Enemy of Health. Pulmonary, Critical Care, and Sleep Medicine in War-Torn Syria. (United States)

    Sahloul, Mohammed Z; Monla-Hassan, Jaber; Sankari, Abdulghani; Kherallah, Mazen; Atassi, Bassel; Badr, Safwan; Abbara, Aula; Sparrow, Annie


    The Syrian crisis, now in its fifth year, has created an unprecedented strain on health services and systems due to the protracted nature of the warfare, the targeting of medics and health care infrastructure, the exodus of physicians and nurses, the shortage of medical supplies and medications, and the disruption of medical education and training. Within a few short years, the life expectancy of resident Syrians has declined by 20 years. Over the first 4 years of the conflict, more than 75,000 civilians died from injuries incurred in the violence. More than twice as many civilians, including many women and children, have died prematurely of infectious and noninfectious chronic diseases for want of adequate health care. Doctors, local administrators, and nongovernmental organizations are struggling to manage the consequences of the conflict under substandard conditions, often using unorthodox methods of health care delivery in field hospitals and remotely by telehealth communication. Much-needed medical supplies are channeled through dangerous routes across the borders from Lebanon, Jordan, and Turkey. Physicians in the United States and other western nations have helped Syrian physicians make the most of the situation by providing training on introducing innovations in technology and treatment. Portable ultrasound machines have been introduced and are being used extensively in the management of trauma and shock. This report, prepared by members of the Syrian American Medical Society, documents current needs for health care relief within Syria, focusing on pulmonary, critical care, and sleep medicine, and some of the efforts currently underway to meet those needs.

  18. ICU telemedicine and critical care mortality: a national effectiveness study (United States)

    Kahn, Jeremy M; Le, Tri Q.; Barnato, Amber E.; Hravnak, Marilyn; Kuza, Courtney C.; Pike, Francis; Angus, Derek C.


    Background Intensive care unit (ICU) telemedicine is an increasingly common strategy for improving the outcome of critical care, but its overall impact is uncertain. Objectives To determine the effectiveness of ICU telemedicine in a national sample of hospitals and quantify variation in effectiveness across hospitals. Research design We performed a multi-center retrospective case-control study using 2001–2010 Medicare claims data linked to a national survey identifying United States hospitals adopting ICU telemedicine. We matched each adopting hospital (cases) to up to 3 non-adopting hospitals (controls) based on size, case-mix and geographic proximity during the year of adoption. Using ICU admissions from 2 years before and after the adoption date, we compared outcomes between case and control hospitals using a difference-in-differences approach. Results 132 adopting case hospitals were matched to 389 similar non-adopting control hospitals. The pre- and post-adoption unadjusted 90-day mortality was similar in both case hospitals (24.0% vs. 24.3%, p=0.07) and control hospitals (23.5% vs. 23.7%, ptelemedicine adoption was associated with a small relative reduction in 90-day mortality (ratio of odds ratios: 0.96, 95% CI = 0.95–0.98, ptelemedicine effect across individual hospitals (median ratio of odds ratios: 1.01; interquartile range 0.85–1.12; range 0.45–2.54). Only 16 case hospitals (12.2%) experienced statistically significant mortality reductions post-adoption. Hospitals with a significant mortality reduction were more likely to have large annual admission volumes (ptelemedicine adoption resulted in a small relative overall mortality reduction, there was heterogeneity in effect across adopting hospitals, with large-volume urban hospitals experiencing the greatest mortality reductions. PMID:26765148

  19. The MIMIC Code Repository: enabling reproducibility in critical care research. (United States)

    Johnson, Alistair Ew; Stone, David J; Celi, Leo A; Pollard, Tom J


    Lack of reproducibility in medical studies is a barrier to the generation of a robust knowledge base to support clinical decision-making. In this paper we outline the Medical Information Mart for Intensive Care (MIMIC) Code Repository, a centralized code base for generating reproducible studies on an openly available critical care dataset. Code is provided to load the data into a relational structure, create extractions of the data, and reproduce entire analysis plans including research studies. Concepts extracted include severity of illness scores, comorbid status, administrative definitions of sepsis, physiologic criteria for sepsis, organ failure scores, treatment administration, and more. Executable documents are used for tutorials and reproduce published studies end-to-end, providing a template for future researchers to replicate. The repository's issue tracker enables community discussion about the data and concepts, allowing users to collaboratively improve the resource. The centralized repository provides a platform for users of the data to interact directly with the data generators, facilitating greater understanding of the data. It also provides a location for the community to collaborate on necessary concepts for research progress and share them with a larger audience. Consistent application of the same code for underlying concepts is a key step in ensuring that research studies on the MIMIC database are comparable and reproducible. By providing open source code alongside the freely accessible MIMIC-III database, we enable end-to-end reproducible analysis of electronic health records. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  20. Critical Care Nurses' Reasons for Poor Attendance at a Continuous Professional Development Program. (United States)

    Viljoen, Myra; Coetzee, Isabel; Heyns, Tanya


    Society demands competent and safe health care, which obligates professionals to deliver quality patient care using current knowledge and skills. Participation in continuous professional development programs is a way to ensure quality nursing care. Despite the importance of continuous professional development, however, critical care nurse practitioners' attendance rates at these programs is low. To explore critical care nurses' reasons for their unsatisfactory attendance at a continuous professional development program. A nominal group technique was used as a consensus method to involve the critical care nurses and provide them the opportunity to reflect on their experiences and challenges related to the current continuous professional development program for the critical care units. Participants were 14 critical care nurses from 3 critical care units in 1 private hospital. The consensus was that the central theme relating to the unsatisfactory attendance at the continuous professional development program was attitude. In order of importance, the 4 contributing priorities influencing attitude were communication, continuous professional development, time constraints, and financial implications. Attitude relating to attending a continuous professional development program can be changed if critical care nurses are aware of the program's importance and are involved in the planning and implementation of a program that focuses on the nurses' individual learning needs. ©2016 American Association of Critical-Care Nurses.

  1. Notes on critical care-review of seminal management and leadership papers in the United Kingdom. (United States)

    Coombs, Maureen


    Review of recent critical care provision reveals substantial changes in clinical unit operating, and policy drivers influencing international critical care delivery. Practitioners who have worked in healthcare environments over this time, will have witnessed substantial shifts in healthcare policy, changes in professional body guidance and greater service evaluation have impacted on critical care management and leadership. This paper offers a personal perspective on seminal management and leadership papers published in the critical care literature over the past decade. Presenting a range of national and international work that utilise diverse approaches, ten key papers are highlighted that have impacted in the United Kingdom setting. Through this, the influence of the modernisation agenda, the increasing significance of outcome studies, and the need for flexible, interdependent practice emerges. A key message to surface from this paper is the need for all in critical care to engage with, and understand the wider implications of management and leadership change for critical care delivery.

  2. Mapping the Characteristics of Critical Care Facilities: Assessment, Distribution, and Level of Critical Care Facilities from Central India. (United States)

    Saigal, Saurabh; Sharma, Jai Prakash; Pakhare, Abhijit; Bhaskar, Santosh; Dhanuka, Sanjay; Kumar, Sanjay; Sabde, Yogesh; Bhattacharya, Pradip; Joshi, Rajnish


    In low- and middle-income countries such as India, where health systems are weak, the number of available Critical Care Unit (Intensive Care Unit [ICU]) beds is expected to be low. There is no study from the Indian subcontinent that has reported the characteristics and distribution of existing ICUs. We performed this study to understand the characteristics and distribution of ICUs in Madhya Pradesh (MP) state of Central India. We also aimed to develop a consensus scoring system and internally validate it to define levels of care and to improve health system planning and to strengthen referral networks in the state. We obtained a list of potential ICU facilities from various sources and then performed a cross-sectional survey by visiting each facility and determining characteristics for each facility. We collected variables with respect to infrastructure, human resources, equipment, support services, procedures performed, training courses conducted, and in-place policies or standard operating procedure documents. We identified a total of 123 ICUs in MP. Of 123 ICUs, 35 were level 1 facilities, 74 were level 2 facilities, and only 14 were level 3 facilities. Overall, there were 0.17 facilities per 100,000 population (95* confidence interval [CI] 0.14-0.20 per 100,000 populations). There were a total of 1816 ICU beds in the state, with an average of 2.5 beds per 100,000 population (95* CI 2.4-2.6 per 100,000 population). Of the total number of ICU beds, 250 are in level 1, 1141 are in level 2, and 425 are in level 3 facilities. This amounts to 0.34, 1.57, and 0.59 ICU beds per 100,000 population for levels 1, 2, and 3, respectively. This study could just be an eye opener for our healthcare authorities at both state and national levels to estimate the proportion of ICU beds per lac population. Similar mapping of intensive care services from other States will generate national data that is hitherto unknown.

  3. Fluid Therapy: Double-Edged Sword during Critical Care? (United States)

    Benes, Jan; Kirov, Mikhail; Kuzkov, Vsevolod; Lainscak, Mitja; Molnar, Zsolt; Voga, Gorazd; Monnet, Xavier


    Fluid therapy is still the mainstay of acute care in patients with shock or cardiovascular compromise. However, our understanding of the critically ill pathophysiology has evolved significantly in recent years. The revelation of the glycocalyx layer and subsequent research has redefined the basics of fluids behavior in the circulation. Using less invasive hemodynamic monitoring tools enables us to assess the cardiovascular function in a dynamic perspective. This allows pinpointing even distinct changes induced by treatment, by postural changes, or by interorgan interactions in real time and enables individualized patient management. Regarding fluids as drugs of any other kind led to the need for precise indication, way of administration, and also assessment of side effects. We possess now the evidence that patient centered outcomes may be altered when incorrect time, dose, or type of fluids are administered. In this review, three major features of fluid therapy are discussed: the prediction of fluid responsiveness, potential harms induced by overzealous fluid administration, and finally the problem of protocol-led treatments and their timing.

  4. The standardization debate: A conflation trap in critical care electroencephalography. (United States)

    Ng, Marcus C; Gaspard, Nicolas; Cole, Andrew J; Hoch, Daniel B; Cash, Sydney S; Bianchi, Matt; O'Rourke, Deirdre A; Rosenthal, Eric S; Chu, Catherine J; Westover, M Brandon


    Persistent uncertainty over the clinical significance of various pathological continuous electroencephalography (cEEG) findings in the intensive care unit (ICU) has prompted efforts to standardize ICU cEEG terminology and an ensuing debate. We set out to understand the reasons for, and a satisfactory resolution to, this debate. We review the positions for and against standardization, and examine their deeper philosophical basis. We find that the positions for and against standardization are not fundamentally irreconcilable. Rather, both positions stem from conflating the three cardinal steps in the classic approach to EEG, which we term "description", "interpretation", and "prescription". Using real-world examples we show how this conflation yields muddled clinical reasoning and unproductive debate among electroencephalographers that is translated into confusion among treating clinicians. We propose a middle way that judiciously uses both standardized terminology and clinical reasoning to disentangle these critical steps and apply them in proper sequence. The systematic approach to ICU cEEG findings presented herein not only resolves the standardization debate but also clarifies clinical reasoning by helping electroencephalographers assign appropriate weights to cEEG findings in the face of uncertainty. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  5. Advancements in the critical care management of status epilepticus. (United States)

    Bauerschmidt, Andrew; Martin, Andrew; Claassen, Jan


    Status epilepticus has a high morbidity and mortality. There are little definitive data to guide management; however, new recent data continue to improve understanding of management options of status epilepticus. This review examines recent advancements regarding the critical care management of status epilepticus. Recent studies support the initial treatment of status epilepticus with early and aggressive benzodiazepine dosing. There remains a lack of prospective randomized controlled trials comparing different treatment regimens. Recent data support further study of intravenous lacosamide as an urgent-control therapy, and ketamine and clobazam for refractory status epilepticus. Recent data support the use of continuous EEG to help guide treatment for all patients with refractory status epilepticus and to better understand epileptic activity that falls on the ictal-interictal continuum. Recent data also improve our understanding of the relationship between periodic epileptic activity and brain injury. Many treatments are available for status epilepticus and there are much new data guiding the use of specific agents. However, there continues to be a lack of prospective data supporting specific regimens, particularly in cases of refractory status epilepticus.

  6. Lung transplant curriculum in pulmonary/critical care fellowship training. (United States)

    Hayes, Don; Diaz-Guzman, Enrique; Berger, Rolando; Hoopes, Charles W


    Lung transplantation is an evolving specialty with the number of transplants growing annually. A structured lung transplant curriculum was developed for Pulmonary/Critical Care (Pulm/CC) fellows. Scores on pulmonary in-training examinations (ITE) 2 years prior to and 3 years after implementation were reviewed as well as completion of satisfaction surveys. The mean pulmonary ITE score of 1st-year fellows increased from 54.2 ± 2.5 to 63.6 ± 1.2 (M ± SD), p = .002, whereas mean pulmonary ITE score for 2nd-year fellows increased from 63.0 ± 3.0 to 70.7 ± 1.2, p = .019. The combined mean pulmonary ITE score increased from 58.6 ± 2.3 to 67.1 ± 1.2, p = .001. Satisfaction surveys revealed that fellow perception of the curriculum was that the experience contributed to an overall improvement in their knowledge base and clinical skills while opportunity to perform transbronchial biopsies was available. A structured educational lung transplant curriculum was associated with improved performance on the pulmonary ITE and was perceived by fellows to be beneficial in their education and training while providing opportunities for fellows to perform transbronchial biopsies.

  7. Impact of Hypobarism During Simulated Transport on Critical Care Air Transport Team Performance (United States)


    AFRL-SA-WP-SR-2017-0008 Impact of Hypobarism During Simulated Transport on Critical Care Air Transport Team Performance Dina...July 2014 – November 2016 4. TITLE AND SUBTITLE Impact of Hypobarism During Simulated Transport on Critical Care Air Transport Team Performance 5a...During Critical Care Air Transport Team Advanced Course validation, three-member teams consisting of a physician, nurse, and respiratory therapist

  8. Critical Care nurses' understanding of the NHS knowledge and skills framework. An interpretative phenomenological analysis. (United States)

    Stewart, Laura F M; Rae, Agnes M


    This small-scale research study aimed to explore Critical Care nurses' understanding of the National Health Service (NHS) Knowledge and Skills Framework (KSF) in relationship to its challenges and their nursing role. The NHS KSF is central to the professional development of nurses in Critical Care and supports the effective delivery of health care in the UK. KSF was implemented in 2004 yet engagement seems lacking with challenges often identified. This qualitative study adopted an Interpretative Phenomenological Analysis framework. Data were collected from five Critical Care nurses using semi-structured interviews that were transcribed for analysis. Two super-ordinate themes of 'engagement' and 'theory-practice gap' were identified. Six subthemes of 'fluency', 'transparency', 'self-assessment', 'achieving for whom', 'reflection' and 'the nursing role' further explained the super-ordinate themes. Critical Care nurses demonstrated layers of understanding about KSF. Challenges identified were primarily concerned with complex language, an unclear process and the use of reflective and self-assessment skills. Two theory-practice gaps were found. Critical Care nurses understood the principles of KSF but they either did not apply or did not realize they applied these principles. They struggled to relate KSF to Critical Care practice and felt it did not capture the 'essence' of their nursing role in Critical Care. Recommendations were made for embedding KSF into Critical Care practice, using education and taking a flexible approach to KSF to support the development and care delivery of Critical Care nurses. © 2012 The Authors. Nursing in Critical Care © 2012 British Association of Critical Care Nurses.

  9. Attitudes toward euthanasia among doctors in a tertiary care hospital in South India: A cross sectional study

    Directory of Open Access Journals (Sweden)

    Sneha Kamath


    Conclusions: A majority of the doctors in this study supported euthanasia for the relief of unbearable pain and suffering. Religion and speciality appear to be significant in determining attitudes toward euthanasia.

  10. Prevention of birth defects in the pre-conception period: knowledge and practice of health care professionals (nurses and doctors in a city of Southern Brazil

    Directory of Open Access Journals (Sweden)

    Flávia Romariz Ferreira


    Full Text Available Background: Some congenital defects can be prevented in the pregestational stage. However, many health professionals are not prepared to provide counselling to couples regarding the same. Objective: This study aimed to assess the performance of doctors and nurses from a primary health-care unit in Florianopolis, Brazil, in preventing birth defects in the preconception period based on the recommendations of the Control Center of Disease Prevention. Materials and Methods: This descriptive cross sectional study was performed at a tertiary referral center. In this study, a semi-structured questionnaire was provided to 160 health professionals comprising doctors and nurses who were actively involved in providing primary health care in family health programs. The non-parametric Chi-square (χ2 test was used to analyse the data obtained through multiple choice questions. Results: Our results showed that although 81.9% of health professionals provided health-care assistance based on protocols, and only 46.2% professionals were aware of the presence of the topic in the protocol. Of the recommendations provided by the Control Center of Disease Prevention, the use of folic acid was the most prescribed. However, this prescription was not statistically different between nurses and doctors (P=0.85. Conclusion: This study identified the fragile nature in these professional’s knowledge about the prevention of birth defects in pre-conception period, as evidenced by the inconsistency in their responses.

  11. Critical care management of major disasters: a practical guide to disaster preparation in the intensive care unit. (United States)

    Corcoran, Shawn P; Niven, Alexander S; Reese, Jason M


    Recent events and regulatory mandates have underlined the importance of medical planning and preparedness for catastrophic events. The purpose of this review is to provide a brief summary of current commonly identified threats, an overview of mass critical care management, and a discussion of resource allocation to provide the intensive care unit (ICU) director with a practical guide to help prepare and coordinate the activities of the multidisciplinary critical care team in the event of a disaster.

  12. Disclosure of Traditional and Complementary Medicine Use and Its Associated Factors to Medical Doctor in Primary Care Clinics in Kuching Division, Sarawak, Malaysia. (United States)

    Johny, Anak Kelak; Cheah, Whye Lian; Razitasham, Safii


    The decision by the patients to disclose traditional and complementary medicine (TCM) use to their doctor is an important area to be explored. This study aimed to determine the disclosure of TCM use and its associated factors to medical doctor among primary care clinic attendees in Kuching Division, Sarawak. It was a cross-sectional study using questionnaire, interviewer administered questionnaire. A total of 1130 patients were screened with 80.2% reporting using TCM. Logistic regression analysis revealed that being female (AOR = 3.219, 95% CI: 1.385, 7.481), perceived benefits that TCM can prevent complication of illness (AOR = 3.999, 95% CI: 1.850, 8.644) and that TCM is more gentle and safer (AOR = 4.537, 95% CI: 2.332, 8.828), perceived barriers of not having enough knowledge about TCM (AOR = 0.530, 95% CI: 0.309, 0.910), patient dissatisfaction towards healthcare providers being too business-like and impersonal (AOR = 0.365, 95% CI: 0.199, 0.669) and paying more for healthcare than one can afford (AOR = 0.413, 95% CI: 0.250, 0.680), and accessibility of doctors (AOR = 3.971, 95% CI: 2.245, 7.023) are the predictors of disclosure of TCM use. An open communication between patients and doctor is important to ensure safe implementation and integration of both TCM and medical treatment.

  13. Doctors on display: the evolution of television's doctors


    Tapper, Elliot B.


    Doctors have been portrayed on television for over 50 years. In that time, their character has undergone significant changes, evolving from caring but infallible supermen with smoldering good looks and impeccable bedside manners to drug-addicted, sex-obsessed antiheroes. This article summarizes the major programs of the genre and explains the pattern of the TV doctors' character changes. Articulated over time in the many permutations of the doctor character is a complex, constant conversation...

  14. Do HCAHPS Doctor Communication Scores Reflect the Communication Skills of the Attending on Record? A Cautionary Tale from a Tertiary-Care Medical Service. (United States)

    Velez, Vicente J; Kaw, Roop; Hu, Bo; Frankel, Richard M; Windover, Amy K; Bokar, Dan; Rish, Julie M; Rothberg, Michael B


    Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores measure patient satisfaction with hospital care. It is not known if these reflect the communication skills of the attending physician on record. The Four Habits Coding Scheme (4HCS) is a validated instrument that measures bedside physician communication skills according to 4 habits, namely: investing in the beginning, eliciting the patient's perspective, demonstrating empathy, and investing in the end. To investigate whether the 4HCS correlates with provider HCAHPS scores. Using a cross-sectional design, consenting hospitalist physicians (n = 28), were observed on inpatient rounds during 3 separate encounters. We compared hospitalists' 4HCS scores with their doctor communication HCAHPS scores to assess the degree to which these correlated with inpatient physician communication skills. We performed sensitivity analysis excluding scores returned by patients cared for by more than 1 hospitalist. A total of 1003 HCAHPS survey responses were available. Pearson correlation between 4HCS and doctor communication scores was not significant, at 0.098 (-0.285, 0.455; P = 0.619). Also, no significant correlations were found between each habit and HCAHPS. When including only scores attributable to 1 hospitalist, Pearson correlation between the empathy habit and the HCAHPS respect score was 0.515 (0.176, 0.745; P = 0.005). Between empathy and overall doctor communication, it was 0.442 (0.082, 0.7; P = 0.019). Attending-of-record HCAHPS scores do not correlate with 4HCS. After excluding patients cared for by more than 1 hospitalist, demonstrating empathy did correlate with the doctor communication and respect HCAHPS scores. Journal of Hospital Medicine 2017;12:421-427. © 2017 Society of Hospital Medicine

  15. Structure, Organization, and Delivery of Critical Care in Asian ICUs. (United States)

    Arabi, Yaseen M; Phua, Jason; Koh, Younsuck; Du, Bin; Faruq, Mohammad Omar; Nishimura, Masaji; Fang, Wen-Feng; Gomersall, Charles; Al Rahma, Hussain N; Tamim, Hani; Al-Dorzi, Hasan M; Al-Hameed, Fahad M; Adhikari, Neill K J; Sadat, Musharaf


    Despite being the epicenter of recent pandemics, little is known about critical care in Asia. Our objective was to describe the structure, organization, and delivery in Asian ICUs. A web-based survey with the following domains: hospital organizational characteristics, ICU organizational characteristics, staffing, procedures and therapies available in the ICU and written protocols and policies. ICUs from 20 Asian countries from April 2013 to January 2014. Countries were divided into low-, middle-, and high-income based on the 2011 World Bank Classification. ICU directors or representatives. Of 672 representatives, 335 (50%) responded. The average number of hospital beds was 973 (SE of the mean [SEM], 271) with 9% (SEM, 3%) being ICU beds. In the index ICUs, the average number of beds was 21 (SEM, 3), of single rooms 8 (SEM, 2), of negative-pressure rooms 3 (SEM, 1), and of board-certified intensivists 7 (SEM, 3). Most ICUs (65%) functioned as closed units. The nurse-to-patient ratio was 1:1 or 1:2 in most ICUs (84%). On multivariable analysis, single rooms were less likely in low-income countries (p = 0.01) and nonreferral hospitals (p = 0.01); negative-pressure rooms were less likely in private hospitals (p = 0.03) and low-income countries (p = 0.005); 1:1 nurse-to-patient ratio was lower in private hospitals (p = 0.005); board-certified intensivists were less common in low-income countries (p structure, organization, and delivery in Asia, which was related to hospital funding source and size, and country income. The lack of single and negative-pressure rooms in many Asian ICUs should be addressed before any future pandemic of severe respiratory illness.

  16. Critical Care and Personalized or Precision Medicine: Who needs whom? (United States)

    Sugeir, Shihab; Naylor, Stephen


    The current paradigm of modern healthcare is a reactive response to patient symptoms, subsequent diagnosis and corresponding treatment of the specific disease(s). This approach is predicated on methodologies first espoused by the Cnidean School of Medicine approximately 2500years ago. More recently escalating healthcare costs and relatively poor disease treatment outcomes have fermented a rethink in how we carry out medical practices. This has led to the emergence of "P-Medicine" in the form of Personalized and Precision Medicine. The terms are used interchangeably, but in fact there are significant differences in the way they are implemented. The former relies on an "N-of-1" model whereas the latter uses a "1-in-N" model. Personalized Medicine is still in a fledgling and evolutionary phase and there has been much debate over its current status and future prospects. A confounding factor has been the sudden development of Precision Medicine, which has currently captured the imagination of policymakers responsible for modern healthcare systems. There is some confusion over the terms Personalized versus Precision Medicine. Here we attempt to define the key differences and working definitions of each P-Medicine approach, as well as a taxonomic relationship tree. Finally, we discuss the impact of Personalized and Precision Medicine on the practice of Critical Care Medicine (CCM). Practitioners of CCM have been participating in Personalized Medicine unknowingly as it takes the protocols of sepsis, mechanical ventilation, and daily awakening trials and applies it to each individual patient. However, the immediate next step for CCM should be an active development of Precision Medicine. This developmental process should break down the silos of modern medicine and create a multidisciplinary approach between clinicians and basic/translational scientists. Copyright © 2017 Elsevier Inc. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Cotiu Madalina-Alexandra


    Full Text Available Consumer satisfaction represents one of the core principles of marketing as it is acknowledged that organizations survive and prosper only by properly meeting the needs and wants of their customers. The same logic can be applied to the healthcare sector, especially in the current context of increased public scrutiny and funding pressure. Furthermore, research shows that patient satisfaction is linked to positive effects from both a marketing and a medical point of view. From a marketing point of view, patient satisfaction is closely linked to positive word of mouth and likelihood to recommend, while from a medical poinbt of view, research suggests that satisfied patients are more inclined toward treatment adherence, are less likely to seek another opinion elsewhere thus delaying treatment, while medical staff tend to have a higher morale. Yet, research regarding patient satisfaction with a particular illness is scarce with studies rarely building on previous results. The article takes on this challenge and aims to critically analyse several empirical studies conducted on patient satisfaction with diabetes care in order to synthesize results on particular determinants and suggest areas for further research. Diabetes is currently one of the most spread chronic disease around the world, while also affecting both old and younger patients. At the same time, it is a chronic disease characterised by the need for disease management efforts on behalf of the patients as well as high treatment adherence in order to avoid complications. It is also a costly chronic disease especially because of the numerous complications which patients may arrive to face during their struggle with this disease. In order to achieve the aim of this article we have chosen to adopt a marketing approach meaning that we see diabetes patients as clients of the medical institutions. Results show that diabetes particularities call for a broader view on patient satisfaction

  18. The critical role of social workers in home-based primary care. (United States)

    Reckrey, Jennifer M; Gettenberg, Gabrielle; Ross, Helena; Kopke, Victoria; Soriano, Theresa; Ornstein, Katherine


    The growing homebound population has many complex biomedical and psychosocial needs and requires a team-based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The Mount Sinai Visiting Doctors Program (MSVD), a large interdisciplinary home-based primary care program in New York City, has a vibrant social work program that is integrated into the routine care of homebound patients. We describe the assessment process used by MSVD social workers, highlight examples of successful social work care, and discuss why social workers' individualized care plans are essential for keeping patients with chronic illness living safely in the community. Despite barriers to widespread implementation, such social work involvement within similar home-based clinical programs is essential in the interdisciplinary care of our most needy patients.

  19. Care of terminally-ill patients: an opinion survey among critical care ...

    African Journals Online (AJOL)


    the responders were trained in western countries. Religion played a ... majority of Middle Eastern trained physicians. Keywords: ... doctors have to consider religious and cultural issues .... work in hospitals where there is no formal DNR policy.

  20. The conceptualization of family care during critical illness in ...

    African Journals Online (AJOL)

    J. de Beer

    the objective of this study was to explore the meaning of family care within a South African context. Methodology: This .... Additionally, the diverse societal contexts within which family care is ..... of palliative and end of life care in hospitals, hospices or homes (Abiven .... representations of community and their implications for.

  1. Pandemic influenza-implications for critical care resources in Australia and New Zealand. (United States)

    Anderson, Therese A; Hart, Graeme K; Kainer, Marion A


    To quantify resource requirements (additional beds and ventilator capacity), for critical care services in the event of pandemic influenza. Cross-sectional survey about existing and potential critical care resources. Participants comprised 156 of the 176 Australasian (Australia and New Zealand) critical care units on the database of the Australian and New Zealand Intensive Care Society (ANZICS) Research Centre for Critical Care Resources. The Meltzer, Cox and Fukuda model was adapted to map a range of influenza attack rate estimates for hospitalisation and episodes likely to require intensive care and to predict critical care admission rates and bed day requirements. Estimations of ventilation rates were based on those for community-acquired pneumonia. The estimated extra number of persons requiring hospitalisation ranged from 8,455 (10% attack rate) to 150,087 (45% attack rate). The estimated number of additional admissions to critical care units ranged from 423 (5% admission rate, 10% attack rate) to 37,522 (25% admission rate, 45% attack rate). The potential number of required intensive care bed days ranged from 846 bed days (2 day length of stay, 10% attack rate) to 375,220 bed days (10 day length of stay, 45% attack rate). The number of persons likely to require mechanical ventilation ranged from 106 (25% of projected critical care admissions, 10% attack rate) to 28,142 (75% of projected critical care admissions, 45% attack rate). An additional 1,195 emergency ventilator beds were identified in public sector and 248 in private sector hospitals. Cancellation of elective surgery could release a potential 76,402 intensive care bed days (per annum), but in the event of pandemic influenza, 31,150 bed days could be required over an 8- to 12-week period. Australasian critical care services would be overwhelmed in the event of pandemic influenza. More work is required in relation to modelling, contingency plans, and resource allocation.

  2. Exploring Entertainment Medicine and Professionalization of Self-Care: Interview Study Among Doctors on the Potential Effects of Digital Self-Tracking (United States)


    Background Nowadays, digital self-tracking devices offer a plethora of possibilities to both healthy and chronically ill users who want to closely examine their body. This study suggests that self-tracking in a private setting will lead to shifting understandings in professional care. To provide more insight into these shifts, this paper seeks to lay bare the promises and challenges of self-tracking while staying close to the everyday professional experience of the physician. Objective The aim of this study was to (1) offer an analysis of how medical doctors evaluate self-tracking methods in their practice and (2) explore the anticipated shifts that digital self-care will bring about in relation to our findings and those of other studies. Methods A total of 12 in-depth semistructured interviews with general practitioners (GPs) and cardiologists were conducted in Flanders, Belgium, from November 2015 to November 2016. Thematic analysis was applied to examine the transcripts in an iterative process. Results Four major themes arose in our body of data: (1) the patient as health manager, (2) health obsession and medicalization, (3) information management, and (4) shifting roles of the doctors and impact on the health care organization. Our research findings show a nuanced understanding of the potentials and pitfalls of different forms of self-tracking. The necessity of contextualization of self-tracking data and a professionalization of self-care through digital devices come to the fore as important overarching concepts. Conclusions This interview study with Belgian doctors examines the potentials and challenges of self-monitoring while focusing on the everyday professional experience of the physician. The dialogue between our dataset and the existing literature affords a fine-grained image of digital self-care and its current meaning in a medical-professional landscape. PMID:29330140

  3. Interprofessional Rivalry in Nigeria's Health Sector: A Comparison of Doctors and Other Health Workers' Views at a Secondary Care Center. (United States)

    Omisore, Akinlolu G; Adesoji, Richard O; Abioye-Kuteyi, Emmanuel A


    To examine interprofessional rivalry (IPR) between doctors and other health workers and their understanding of its effects. IPR in Nigeria's health system is a burgeoning issue with apparent adverse effects. The most profound rivalry appears to be between doctors and other health workers. A descriptive cross-sectional study involving 120 health workers (24 doctors and 96 other health workers) at the State Specialist Hospital, Okitipupa, Ondo State, Nigeria. Pertinent data were collected via semistructured questionnaire and analyzed using SPSS Version17.0. IPR is perceived to be the leading cause of conflicts among health workers by 70% of respondents. Doctors and other workers had significantly divergent opinions on the leadership of the health team, patient management, establishment positions, and monetary issues as well as on the effects of IPR with more doctors recognizing its hazards. Nearly half of the respondents believe that strikes are justifiable and the most recommended antidote is for the government to attempt to meet group needs. IPR has reached unprecedented levels in Nigeria. However, its adverse effects have not been duly recognized, especially by nondoctors. There is an urgent need for education of health workers on the deleterious effects of IPR.

  4. "You have to cover up the words of the doctor": the mediation of trust in interpreted consultations in primary care. (United States)

    Robb, Nadia; Greenhalgh, Trisha


    consultation and on patients' subsequent action. The methodological and analytic approach, potentially, has wider applications in the study of other trust relationships in health and social care. Practical implications - Quality in the interpreted consultation cannot be judged purely in terms of accuracy of translation. The critical importance of voluntary trust for open and effective communication, and the dependence of the latter on a positive interpersonal relationship and continuity of care, should be acknowledged in the design and funding of interpreting services and in the training of both clinicians, interpreters and administrative staff. This is the first study in which interpreted consultations have been analysed from a perspective of critical sociology with a particular focus on trust and power relations.

  5. Taking care: practice and philosophy of communication in a critical care follow-up clinic. (United States)

    Hazzard, Anthony; Harris, Wendy; Howell, David


    Human consciousness is inextricable from communication. The conditions of communication in the clinical context are defined by the caring intention and the unequal relationship, which imply special responsibilities on the part of the clinician. The conventional hermeneutic model of communication proposes a close examination of the context of the other, and an objective effort to get close to their consciousness by interpretation of their expressions. The clinician is supposed to lay aside subjective factors but make use of her/his clinical knowledge and skills. At University College Hospital Critical Care follow-up clinic, the communicative task involves history taking; partly by questionnaire and partly by attention to the patient's agenda - assessing needs, providing information and facilitating access to further help. In recent years the provision of Critical Care has become ever more complex, both in terms of the sophisticated medical and nursing techniques it can offer to patients and in the range of conditions it can undertake to treat. This range and complexity is reflected in the variety of problems and consequences that may be encountered at follow-up. Communicative techniques should take account of the emotional vulnerability of patients emerging from severe illness. Attentive listening should identify special anxieties, and care with phraseology aims to avoid further distress. Issues of memory, depression and trauma may be expected, and the interview technique must be flexible enough to offer emotional containment if need be. The consultation should be therapeutic in its conduct but should not embark upon actual psychotherapy or seek to dismantle the patient's defences. Contemporary hermeneutic perspectives emphasise the contextual situatedness of the clinician's consciousness, and propose a model of communication as 'blending of horizons' rather than as objective interpretation. Systems theory contributes to an understanding of the influence on

  6. Who cares? A critical discussion of the value of caring from a patient and healthcare professional perspective. (United States)

    Flynn, Sandra


    This study was undertaken in order to discover and illuminate the essential caring behaviours valued by both patients and staff in an orthopaedic setting within a district general hospital in the United Kingdom. This descriptive study was undertaken in order to acquire a greater understanding of perceptions of caring from both patient and orthopaedic healthcare professional perspectives. A sample of 30 patients and 53 healthcare professionals consisting of doctors, nurses, physiotherapists and occupational therapists were asked to complete the Caring Behaviours Inventory (CBI) questionnaire (Wolf et al., 1994). Data were analysed using descriptive and inferential statistics. The findings revealed both similarities and differences relating to the importance of positive caring behaviours exhibited during caring interactions. Healthcare professionals working in the orthopaedic setting acknowledged the value of similar positive caring behaviours to those of the patient group but ranked the importance of these differently. Several important insights into perceptions of caring have been gained. These relate to an overall understanding of the caring behaviours that are considered of importance to patients and healthcare professionals; the differences that exist between the caring perceptions of both groups and the factors which influence these perceptions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Role, perspective and knowledge of Iranian critical care nurses about breaking bad news. (United States)

    Imanipour, Masoomeh; Karim, Zahra; Bahrani, Naser


    Given the issue of caring critically ill patients, nurses are involved in the process of breaking bad news in critical care units, while little research has been conducted on this challenging issue. The purpose of this study was to determine the role, perspective and knowledge of Iranian critical care nurses regarding breaking bad news. This descriptive study was conducted on a sample of 160 nurses working in critical care units of hospitals affiliated to Tehran University of Medical Sciences. Stratified and quota sampling methods were used. The data collection tool was a four-part questionnaire with validity and reliability confirmed via content validity and test-retest, respectively. The study showed that most critical care nurses were involved in breaking bad news, with different roles. The majority of participants (91.2%) had a positive attitude towards involvement of nurses in breaking bad news. In this study, 78.8% of nurses had moderate knowledge about how to break bad news, and only a few had good level of knowledge (16.2%). According to the findings, while critical care nurses took different roles in the process of breaking bad news and they had positive attitude towards participation in this process, yet their knowledge about this process was inadequate. Thus, designing educational programmes to enhance critical care nurses' knowledge and skills in this area seems necessary. Copyright © 2015 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  8. Job satisfaction in mainland China: comparing critical care nurses and general ward nurses. (United States)

    Zhang, Aihua; Tao, Hong; Ellenbecker, Carol Hall; Liu, Xiaohong


    To explore the level of nurses' job satisfaction and compare the differences between critical care nurses and general ward nurses in Mainland China. Hospitals continue to experience high nurse turnover. Job satisfaction is a key factor to retain skilled nurses. The differences in job satisfaction among critical care nurses and general ward nurses are unknown. A cross-sectional design was selected for this descriptive correlation study. Cross-sectional study of critical care nurses (n = 446) and general ward nurses (n = 1118) in 9 general hospitals by means of questionnaires that included the Chinese Nurses Job Satisfaction Scale and demographic scale. The data were collected from June 2010-November 2010. Chinese nurses had moderate levels of job satisfaction, were satisfied with co-workers and family/work balance; and dissatisfied with pay and professional promotion. Critical care nurses were younger; less educated and had less job tenure when compared with nurses working on general wards. Critical care nurses were significantly less satisfied than general ward nurses with many aspects of their job. Levels of nurses' job satisfaction can be improved. The lower job satisfaction of critical care nurses compared with general ward nurses should warn the healthcare administrators and managers of potentially increasing the critical care nurses turn over. Innovative and adaptable managerial interventions need to be taken to improve critical care nurse' job satisfaction and retain skilled nurse. © 2012 Blackwell Publishing Ltd.

  9. Challenges faced by nurses in managing pain in a critical care setting. (United States)

    Subramanian, Pathmawathi; Allcock, Nick; James, Veronica; Lathlean, Judith


    To explore nurses' challenges in managing pain among ill patients in critical care. Pain can lead to many adverse medical consequences and providing pain relief is central to caring for ill patients. Effective pain management is vital since studies show patients admitted to critical care units still suffer from significant levels of acute pain. The effective delivery of care in clinical areas remains a challenge for nurses involved with care which is dynamic and constantly changing in critically ill. Qualitative prospective exploratory design. This study employed semi structured interviews with nurses, using critical incident technique. Twenty-one nurses were selected from critical care settings from a large acute teaching health care trust in the UK. A critical incident interview guide was constructed from the literature and used to elicit responses. Framework analysis showed that nurses perceived four main challenges in managing pain namely lack of clinical guidelines, lack of structured pain assessment tool, limited autonomy in decision making and the patient's condition itself. Nurses' decision making and pain management can influence the quality of care given to critically ill patients. It is important to overcome the clinical problems that are faced when dealing with pain experience. There is a need for nursing education on pain management. Providing up to date and practical strategies may help to reduce nurses' challenges in managing pain among critically ill patients. Broader autonomy and effective decision making can be seen as beneficial for the nurses besides having a clearer and structured pain management guidelines. © 2011 Blackwell Publishing Ltd.

  10. Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation. (United States)

    McMeekin, Dawn E; Hickman, Ronald L; Douglas, Sara L; Kelley, Carol G


    Participation by a critical care nurse in an unsuccessful resuscitation can create a unique heightened level of psychological stress referred to as postcode stress, activation of coping behaviors, and symptoms of posttraumatic stress disorder (PTSD). To explore the relationships among postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations and to see whether institutional support attenuates these repeated psychological traumas. A national sample of 490 critical care nurses was recruited from the American Association of Critical-Care Nurses' eNewsline and social media. Participants completed the Post-Code Stress Scale, the Brief COPE (abbreviated), and the Impact of Event Scale-Revised, which were administered through an online survey. Postcode stress and PTSD symptom severity were weakly associated ( r = 0.20, P = .01). No significant associations between coping behaviors and postcode stress were found. Four coping behaviors (denial, self-distraction, self-blame, and behavioral disengagement) were significant predictors of PTSD symptom severity. Severity of postcode stress and PTSD symptoms varied with the availability of institutional support. Critical care nurses show moderate levels of postcode stress and PTSD symptoms when asked to recall an unsuccessful resuscitation and the coping behaviors used. Identifying the critical care nurses most at risk for PTSD will inform the development of interventional research to promote critical care nurses' psychological well-being and reduce their attrition from the profession. ©2017 American Association of Critical-Care Nurses.

  11. Nurse Project Consultant: Critical Care Nurses Move Beyond the Bedside to Affect Quality and Safety. (United States)

    Mackinson, Lynn G; Corey, Juliann; Kelly, Veronica; O'Reilly, Kristin P; Stevens, Jennifer P; Desanto-Madeya, Susan; Williams, Donna; O'Donoghue, Sharon C; Foley, Jane


    A nurse project consultant role empowered 3 critical care nurses to expand their scope of practice beyond the bedside and engage within complex health care delivery systems to reduce harms in the intensive care unit. As members of an interdisciplinary team, the nurse project consultants contributed their clinical expertise and systems knowledge to develop innovations that optimize care provided in the intensive care unit. This article discusses the formal development of and institutional support for the nurse project consultant role. The nurse project consultants' responsibilities within a group of quality improvement initiatives are described and their challenges and lessons learned discussed. The nurse project consultant role is a new model of engaging critical care nurses as leaders in health care redesign. ©2018 American Association of Critical-Care Nurses.

  12. Work-related critical incidents in hospital-based health care providers and the risk of post-traumatic stress symptoms, anxiety, and depression: a meta-analysis. (United States)

    de Boer, Jacoba; Lok, Anja; Van't Verlaat, Ellen; Duivenvoorden, Hugo J; Bakker, Arnold B; Smit, Bert J


    This meta-analysis reviewed existing data on the impact of work-related critical incidents in hospital-based health care professionals. Work-related critical incidents may induce post-traumatic stress symptoms or even post-traumatic stress disorder (PTSD), anxiety, and depression and may negatively affect health care practitioners' behaviors toward patients. Nurses and doctors often cope by working part time or switching jobs. Hospital administrators and health care practitioners themselves may underestimate the effects of work-related critical incidents. Relevant online databases were searched for original research published from inception to 2009 and manual searches of the Journal of Traumatic Stress, reference lists, and the European Traumatic Stress Research Database were conducted. Two researchers independently decided on inclusion and study quality. Effect sizes were estimated using standardized mean differences with 95% confidence intervals. Consistency was evaluated, using the I(2)-statistic. Meta-analysis was performed using the random effects model. Eleven studies, which included 3866 participants, evaluated the relationship between work-related critical incidents and post-traumatic stress symptoms. Six of these studies, which included 1695 participants, also reported on the relationship between work-related critical incidents and symptoms of anxiety and depression. Heterogeneity among studies was high and could not be accounted for by study quality, character of the incident, or timing of data collection. Pooled effect sizes for the impact of work-related critical incidents on post-traumatic stress symptoms, anxiety, and depression were small to medium. Remarkably, the effect was more pronounced in the longer than in the shorter term. In conclusion, this meta-analysis supports the hypothesis that work-related critical incidents are positively related to post-traumatic stress symptoms, anxiety, and depression in hospital-based health care professionals

  13. Primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor). (United States)

    Little, Paul; Stuart, Beth; Andreou, Panayiota; McDermott, Lisa; Joseph, Judith; Mullee, Mark; Moore, Mike; Broomfield, Sue; Thomas, Tammy; Yardley, Lucy


    To assess an internet-delivered intervention providing advice to manage respiratory tract infections (RTIs). Open pragmatic parallel group randomised controlled trial. Primary care in UK. Adults (aged ≥18) registered with general practitioners, recruited by postal invitation. Patients were randomised with computer-generated random numbers to access the intervention website (intervention) or not (control). The intervention tailored advice about the diagnosis, natural history, symptom management (particularly paracetamol/ibuprofen use) and when to seek further help. Primary: National Health Service (NHS) contacts for those reporting RTIs from monthly online questionnaires for 20 weeks. Secondary: hospitalisations; symptom duration/severity. Results 3044 participants were recruited. 852 in the intervention group and 920 in the control group reported one or more RTIs, among whom there a modest increase in NHS Direct contacts in the intervention group (intervention 44/1734 (2.5%) versus control 24/1842 (1.3%); multivariate Risk Ratio (RR) 2.53 (95% CI 1.10 to 5.82, p=0.029)). Conversely reduced contact with doctors occurred (283/1734 (16.3%) vs 368/1845 (20.0%); risk ratio 0.71, 0.53 to 0.95, p=0.019). Reduction in contacts occurred despite slightly longer illness duration (11.3 days versus 10.9 days respectively; multivariateestimate 0.48 days longer (-0.16 to 1.12, p=0.141) and more days of illness rated moderately bad or worse illness (0.53 days; 0.12 to 0.94, p=0.012). The estimate of slower symptom resolution in the intervention group was attenuated when controlling for whether individuals had used webpages which advocated ibuprofen use (length of illness 0.22 days, −0.51 to 0.95, p=0.551; moderately bad or worse symptoms 0.36 days, −0.08 to 0.80, p=0.105). There was no evidence of increased hospitalisations (risk ratio 0.13; 0.02 to 1.01; p=0.051). An internet-delivered intervention for the self-management of RTIs modifies help-seeking behaviour, and does

  14. Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned. (United States)

    Slusher, Tina M; Kiragu, Andrew W; Day, Louise T; Bjorklund, Ashley R; Shirk, Arianna; Johannsen, Colleen; Hagen, Scott A


    Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

  15. Pediatric Critical Care in Resource-Limited Settings—Overview and Lessons Learned

    Directory of Open Access Journals (Sweden)

    Tina M. Slusher


    Full Text Available Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

  16. Doctors on display: the evolution of television's doctors. (United States)

    Tapper, Elliot B


    Doctors have been portrayed on television for over 50 years. In that time, their character has undergone significant changes, evolving from caring but infallible supermen with smoldering good looks and impeccable bedside manners to drug-addicted, sex-obsessed antiheroes. This article summarizes the major programs of the genre and explains the pattern of the TV doctors' character changes. Articulated over time in the many permutations of the doctor character is a complex, constant conversation between viewer and viewed representing public attitudes towards doctors, medicine, and science.

  17. Accounting for vulnerability to illness and social disadvantage in pandemic critical care triage. (United States)

    Kaposy, Chris


    In a pandemic situation, resources in intensive care units may be stretched to the breaking point, and critical care triage may become necessary. In such a situation, I argue that a patient's combined vulnerability to illness and social disadvantage should be a justification for giving that patient some priority for critical care. In this article I present an example of a critical care triage protocol that recognizes the moral relevance of vulnerability to illness and social disadvantage, from the Canadian province of Newfoundland and Labrador.

  18. Politicy of care in the criticism towards gender stereotypes. (United States)

    Pires, Maria Raquel Gomes Maia; Fonseca, Rosa Maria Godoy Serpa da; Padilla, Beatriz


    analyze gender inequalities among Brazilian women in Portugal and in contemporary nursing based on care politicity in the light of gender; disclose oppression of the female produced by the stereotypes that look upon women as natural caregivers; point out politicity to deconstruct gender stereotypes. theoretical reflection with narrative review of literature to analyze classic references in the feminist epistemology combined with the care politicity thesis. the similarities between the stereotypes of the Brazilian Eves and the Portuguese Maries as either the sexualized or sanctified nurse are inserted in the Jewish-Christian moral genealogy that reaffirms the subservience of the female to the male. by attaching priority to care that needs non-care to expand the possibilities of care giving, the theoretical assumption of politicy of care can contribute to subvert the stereotypical images of Brazilian women in Portuguese lands and in contemporary nursing.

  19. Implementing Evidenced Based Oral Care for Critically Ill Patients (United States)


    practice . In G. LoBiondo-Wood & J Haber (Eds.), Nursing Research (5th ed.). St. Louis: Mosby-Year Book , Inc. 5. Titler, M., & Everett, L. (2001...determined if an evidence-based oral care program resulted in increased nurses’ knowledge and improved oral care practices compliance. Design: The project...process, and project specific oral care evidence-based practice instruction. Knowledge evaluations were conducted at three time points: before, immediately

  20. Critical Care Nurses' Suggestions to Improve End-of-Life Care Obstacles: Minimal Change Over 17 Years. (United States)

    Beckstrand, Renea L; Hadley, Kacie Hart; Luthy, Karlen E; Macintosh, Janelle L B

    Critical-care nurses (CCNs) provide end-of-life (EOL) care on a daily basis as 1 in 5 patients dies while in intensive care units. Critical-care nurses overcome many obstacles to perform quality EOL care for dying patients. The purposes of this study were to collect CCNs' current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998. A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2000 members of the American Association of Critical-Care Nurses. One of 3 qualitative questions asked CCNs for suggestions to improve EOL care. Comparative obstacle size (quantitative) data were previously published. Of the 509 returned questionnaires, 322 (63.3%) had 385 written suggestions for improving EOL care. Major themes identified were ensuring characteristics of a good death, improving physician communication with patients and families, adjusting nurse-to-patient ratios to 1:1, recognizing and avoiding futile care, increasing EOL education, physicians who are present and "on the same page," not allowing families to override patients' wishes, and the need for more support staff. When compared with data gathered 17 years previously, major themes remained the same but in a few cases changed in order and possible causation. Critical-care nurses' suggestions were similar to those recommendations from 17 years ago. Although the order of importance changed minimally, the number of similar themes indicated that obstacles to providing EOL care to dying intensive care unit patients continue to exist over time.

  1. Choosing a Family Doctor (United States)

    ... age or sex. This includes care for your physical, mental, and emotional health. Family doctors get to know their patients. They ... and Wellness Staying Healthy Healthy Living Travel Occupational Health First Aid and ... Pets and Animals myhealthfinder Food and Nutrition Healthy Food ...

  2. Talking to Your Doctor

    Medline Plus

    Full Text Available ... Staff Directory En Español Site Menu Home Health Information Health Info Lines Health Services Locator NIH Clinical Research Trials and You Talking to Your Doctor Science Education Resources Community Resources Clear Health A–Z ...

  3. Talking to Your Doctor

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    Full Text Available ... Info Lines Health Services Locator NIH Clinical Research Trials and You Talking to Your Doctor Science ... Labs & Clinics Training Opportunities Library Resources Research Resources Clinical Research Resources Safety, Regulation and Guidance More » Quick Links ...

  4. Talking to Your Doctor

    Medline Plus

    Full Text Available ... Lines Health Services Locator NIH Clinical Research Trials and You Talking to Your Doctor Science Education Resources Community Resources Clear Health A–Z Publications List More » Search Health Topics Quick Links MedlinePlus Health Info NIH News in ...

  5. Will Medical Technology Deskill Doctors? (United States)

    Lu, Jingyan


    This paper discusses the impact of medical technology on health care in light of the fact that doctors are becoming more reliant on technology for obtaining patient information, making diagnoses and in carrying out treatments. Evidence has shown that technology can negatively affect doctor-patient communications, physical examination skills, and…

  6. World Federation of Pediatric Intensive Care and Critical Care Societies: Global Sepsis Initiative. (United States)

    Kissoon, Niranjan; Carcillo, Joseph A; Espinosa, Victor; Argent, Andrew; Devictor, Denis; Madden, Maureen; Singhi, Sunit; van der Voort, Edwin; Latour, Jos


    According to World Health Organization estimates, sepsis accounts for 60%-80% of lost lives per year in childhood. Measures appropriate for resource-scarce and resource-abundant settings alike can reduce sepsis deaths. In this regard, the World Federation of Pediatric Intensive Care and Critical Care Societies Board of Directors announces the Global Pediatric Sepsis Initiative, a quality improvement program designed to improve quality of care for children with sepsis. To announce the global sepsis initiative; to justify some of the bundles that are included; and to show some preliminary data and encourage participation. The Global Pediatric Sepsis Initiative is developed as a Web-based education, demonstration, and pyramid bundles/checklist tool ( or Four health resource categories are included. Category A involves a nonindustrialized setting with mortality rate 30 of 1,000 children. Category B involves a nonindustrialized setting with mortality rate children. Category C involves a developing industrialized nation. In category D, developed industrialized nation are determined and separate accompanying administrative and clinical parameters bundles or checklist quality improvement recommendations are provided, requiring greater resources and tasks as resource allocation increased from groups A to D, respectively. In the vanguard phase, data for 361 children (category A, n = 34; category B, n = 12; category C, n = 84; category D, n = 231) were successfully entered, and quality-assurance reports were sent to the 23 participating international centers. Analysis of bundles for categories C and D showed that reduction in mortality was associated with compliance with the resuscitation (odds ratio, 0.369; 95% confidence interval, 0.188-0.724; p Initiative is online. Success in reducing pediatric mortality and morbidity, evaluated yearly as a measure of global child health care quality improvement, requires ongoing

  7. Surviving the Doctoral Years

    Directory of Open Access Journals (Sweden)

    Scott P. Kerlin


    Full Text Available This article probes the implications of neo-conservative public education policies for the future of the academic profession through a detailed examination of critical issues shaping contemporary doctoral education in U.S. and Canadian universities. Institutional and social factors such as financial retrenchment, declining support for affirmative action, downward economic mobility, a weak academic labor market for tenure-track faculty, professional ethics in graduate education, and backlash against women's progress form the backdrop for analysis of the author's survey of current doctoral students' opinions about funding, support, the job market, and quality of learning experiences.

  8. Critical Care Performance in a Simulated Military Aircraft Cabin Environment (United States)


    ICUs, neonatal ICUs, cardiac care units, cardiac catheter labs, telemetry units, progressive care units, emergency departments, and recovery rooms. This...S89-S99. MacGeorge, J. M., & Nelson, K. M. (2003). The experience of the nurse at triage influences the timing of CPAP intervention. Accid Emerg Nurs

  9. Awareness about medical research among resident doctors in a tertiary care hospital: A cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Dattatray B Pawar


    Full Text Available Context: Every medical practitioner should strive to contribute to the generation of evidence by conducting research. For carrying out research, adequate knowledge, practical skills, and development of the right attitude are crucial. A literature review shows that data regarding knowledge, attitude, and practices toward medical research, among resident doctors in India, is lacking. Aims: This study was conducted to assess research-related knowledge, attitude, and practices among resident doctors. Settings and Design: A cross-sectional survey was conducted using a pretested, structured, and pre-validated questionnaire. Materials and Methods: With approval of the Institutional Ethics Committee and a verbal consent, a cross-sectional survey among 100 resident doctors pursuing their second and third years in the MD and MS courses was conducted using a structured and pre-validated questionnaire. Statistical Analysis: Descriptive statistics were used to analyze the results. Results: The concept of research hypothesis was known to 58% of the residents. Ninety-eight percent of the residents were aware of the procedure to obtain informed consent. Seventy-six percent agreed that research training should be mandatory. Although 88% of the residents were interested in conducting research in future, 50% had participated in research other than a dissertation project, 28% had made scientific presentations, and only 4% had publications. Lack of time (74%, lack of research curriculum (42%, and inadequate facilities (38% were stated as major obstacles for pursuing research. Conclusions: Although resident doctors demonstrated a fairly good knowledge and positive attitude toward research, it did not translate into practice for most of them. There is a need to improve the existing medical education system to foster research culture among resident doctors

  10. Predictors of Mortality in a Critical Care Unit in South Western Kenya

    African Journals Online (AJOL)

    Abstract. Background: Critical care in developing countries has been ... which may impact the quality of care. Hospitals also ... and referral facility located in South Western Kenya in Bomet .... p=0.01). As regards end of life care; 40.4% of those.

  11. The development of an internet-based knowledge exchange platform for pediatric critical care clinicians worldwide*. (United States)

    Wolbrink, Traci A; Kissoon, Niranjan; Burns, Jeffrey P


    Advances in Internet technology now enable unprecedented global collaboration and collective knowledge exchange. Up to this time, there have been limited efforts to use these technologies to actively promote knowledge exchange across the global pediatric critical care community. To develop an open-access, peer-reviewed, not-for-profit Internet-based learning application, OPENPediatrics, a collaborative effort with the World Federation of Pediatric Intensive and Critical Care Societies, was designed to promote postgraduate educational knowledge exchange for physicians, nurses, and others caring for critically ill children worldwide. Description of program development. International multicenter tertiary pediatric critical care units across six continents. Multidisciplinary pediatric critical care providers. A software application, providing information on demand, curricular pathways, and videoconferencing, downloaded to a local computer. In 2010, a survey assessing postgraduate educational needs was distributed through World Federation of Pediatric Intensive and Critical Care Societies to constituent societies. Four hundred and twenty-nine critical care providers from 49 countries responded to the single e-mail survey request. Respondents included 68% physicians and 28% nurses who care for critically ill children. Fifty-two percent of respondents reported accessing the Internet at least weekly to obtain professional educational information. The five highest requests were for educational content on respiratory care [mechanical ventilation] (48% [38%]), sepsis (28%), neurology (25%), cardiology (14%), extracorporeal membrane oxygenation (10%), and ethics (8%). Based on these findings, and in collaboration with researchers in adult learning and online courseware, an application was developed and is currently being used by 770 registered users in 60 countries. We describe here the development and implementation of an Internet-based application which is among the first

  12. 'Care Under Pressure': a realist review of interventions to tackle doctors' mental ill-health and its impacts on the clinical workforce and patient care. (United States)

    Carrieri, Daniele; Briscoe, Simon; Jackson, Mark; Mattick, Karen; Papoutsi, Chrysanthi; Pearson, Mark; Wong, Geoffrey


    Mental ill-health is prevalent across all groups of health professionals and this is of great concern in many countries. In the UK, the mental health of the National Health Service (NHS) workforce is a major healthcare issue, leading to presenteeism, absenteeism and loss of staff from the workforce. Most interventions targeting doctors aim to increase their 'productivity' and 'resilience', placing responsibility for good mental health with doctors themselves and neglecting the organisational and structural contexts that may have a detrimental effect on doctors' well-being. There is a need for approaches that are sensitive to the contextual complexities of mental ill-health in doctors, and that do not treat doctors as a uniform body, but allow distinctions to account for particular characteristics, such as specialty, career stage and different working environments. Our project aims to understand how, why and in what contexts support interventions can be designed to minimise the incidence of doctors' mental ill-health. We will conduct a realist review-a form of theory-driven interpretative systematic review-of interventions, drawing on diverse literature sources. The review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence; (3) select articles; (4) extract and organise data and (5) synthesise evidence and draw conclusions. The analysis will summarise how, why and in what circumstances doctors' mental ill-health is likely to develop and what can remediate the situation. Throughout the project, we will also engage iteratively with diverse stakeholders in order to produce actionable theory. Ethical approval is not required for our review. Our dissemination strategy will be participatory. Tailored outputs will be targeted to: policy makers; NHS employers and healthcare leaders; team leaders; support organisations; doctors experiencing mental ill-health, their families and colleagues. CRD42017069870. © Article author

  13. Working together: critical care nurses experiences of temporary staffing within Swedish health care: A qualitative study. (United States)

    Berg Jansson, Anna; Engström, Åsa


    The aim of this study is to describe critical care nurses (CCN's) experiences of working with or as temporary agency staff. This explorative qualitative study is based on interviews with five agency CCNs and five regular CCNs, a total of ten interviews, focusing on the interviewees' experiences of daily work and temporary agency staffing. The interviews were analysed manually and thematically following an inductive approach. Four themes that illustrate both similarities and differences between regular and temporary agency CCNs emerged: "working close to patients versus being responsible for everything", "teamwork versus independence", "both groups needed" and "opportunities and challenges". The study findings illustrate the complexity of the working situation for agency and regular staff in terms of the organisation and management of the temporary agency nurses and the opportunities and challenges faced by both groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Critical care admission of South African (SA surgical patients: Results of the SA Surgical Outcomes Study

    Directory of Open Access Journals (Sweden)

    David Lee Skinner


    Full Text Available Background. Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries. Objective. To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA. Methods. The SA Surgical Outcomes Study (SASOS was a 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals. All patients admitted to critical care units during this study were included for analysis. Results. Of the 3 927 SASOS patients, 255 (6.5% were admitted to critical care units; of these admissions, 144 (56.5% were planned, and 111 (43.5% unplanned. The incidence of confirmed or strongly suspected infection at the time of admission was 35.4%, with a significantly higher incidence in unplanned admissions (49.1 v. 24.8%, p<0.001. Unplanned admission cases were more frequently hypovolaemic, had septic shock, and required significantly more inotropic, ventilatory and renal support in the first 48 hours after admission. Overall mortality was 22.4%, with unplanned admissions having a significantly longer critical care length of stay and overall mortality (33.3 v. 13.9%, p<0.001. Conclusion. The outcome of patients admitted to public sector critical care units in SA is strongly associated with unplanned admissions. Adequate ‘high care-dependency units’ for postoperative care of elective surgical patients could potentially decrease the burden on critical care resources in SA by 23%. This study was registered on (NCT02141867.

  15. Nursing doctoral education in Turkey. (United States)

    Yavuz, Meryem


    Quality health care is an issue of concern worldwide, and nursing can and must play a major and global role in transforming the healthcare environment. Doctorally prepared nurses are very much needed in the discipline to further develop and expand the science, as well as to prepare its future educators, scholars, leaders, and policy makers. In 1968, the Master of Science in Nursing Program was initiated in Turkey, followed by the Nursing Doctoral Education Program in 1972. Six University Schools of Nursing provide nursing doctoral education. By the graduating year of 2001, 154 students had graduated with the Doctor of Philosophy in Nursing (Ph.D.), and 206 students were enrolled in related courses. Many countries in the world are systematically building various collaborative models in their nursing doctoral education programs. Turkey would like to play an active role in creating collaborative nursing doctoral education programs with other countries. This paper centres on the structure and model of doctoral education for nurses in Turkey. It touches on doctoral programs around the world; describes in detail nursing doctoral education in Turkey, including its program structure, admission process, course units, assessment strategies and dissertation procedure; and discusses efforts to promote Turkey as a potential partner in international initiatives to improve nursing doctoral education.

  16. Long-term consequences of an intensive care unit stay in older critically ill patients: design of a longitudinal study

    Directory of Open Access Journals (Sweden)

    Hantikainen Virpi


    Full Text Available Abstract Background Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs, such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and the consequences in older critically ill patients. The overall aim of this study is to identify how an ICU stay influences an older person's experiences later in life. More specific, this study has the following objectives: (1 to explore the relationship between pain, anxiety and agitation during ICU stays and experiences of the same symptoms in later life; and (2 to explore the associations between pain, anxiety and agitation experienced during ICU stays and their effect on subsequent health-related quality of life, use of the health care system (readmissions, doctor visits, rehabilitation, medication use, living situation, and survival after discharge and at 6 and 12 months of follow-up. Methods/Design A prospective, longitudinal study will be used for this study. A total of 150 older critically ill patients in the ICU will participate (ICU group. Pain, anxiety, agitation, morbidity, mortality, use of the health care system, and health-related quality of life will be measured at 3 intervals after a baseline assessment. Baseline measurements will be taken 48 hours after ICU admission and one week thereafter. Follow-up measurements will take place 6 months and 12 months after discharge from the ICU. To be able to interpret trends in scores on outcome variables in the ICU group, a comparison group of 150 participants, matched by age and gender, recruited from the Swiss population, will be interviewed at the same intervals as the ICU group. Discussion Little

  17. Evaluation of patients' attitudes to their care during oral and maxillofacial surgical outpatient consultations: the importance of waiting times and quality of interaction between patient and doctor. (United States)

    Dimovska, E O F; Sharma, S; Trebble, T M


    Knowing what patients think about their care is fundamental to the provision of an effective, quality service, and it can help to direct change and reduce costs. Much of the work in oral and maxillofacial departments concerns the treatment of outpatients, but as little is known about what they think about their care, we aimed to find out which aspects were associated with satisfaction. Consecutive patients (n=244) who attended the oral and maxillofacial outpatient department at Southampton University Hospital NHS Foundation Trust over a 7-day period were given a questionnaire to complete before and after their consultation. It included questions with Likert scale responses on environmental, procedural, and interactive aspects of the visit, and a 16-point scale to rank their priorities. A total of 187 patients (77%) completed the questionnaires. No association was found between expected (p=0.93) or actual (p=0.41) waiting times, and 90% of patients were satisfied with their visit. Seeing the doctor, having confidence in the treatment plan, being listened to, and the ability of the doctor to recognise their personal needs, were ranked as important. Environmental and procedural aspects were considered the least important. These findings may be of value in the development of services to improve patient-centred care. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Patient-Centred Multidisciplinary Inpatient Care-Have Diagnosis-Related Groups an Effect on the Doctor-Patient Relationship and Patients' Motivation for Behavioural Change? (United States)

    Romeyke, Tobias; Noehammer, Elisabeth; Ch Scheuer, Hans; Stummer, Harald


    The aim of this, the largest survey of patients performed to date, is to analyse the effects of diagnosis related groups (DRGs) on the doctor-patient relationship in the context of interdisciplinary patient-centered care. In addition, it is intended to investigate the possibility of motivating patients to change their behavioural patterns and lifestyle in the context of holistic therapy. Over a period of five years, a continuous survey was performed of hospitalised patients who were exercising their entitlement to interdisciplinary therapy in an acute, inpatient setting. The therapy was evaluated as good to very good both with and without the conditions of the case tariff fee system. Effects of the diagnosis related groups on the quality of the doctor-patient relationship could not be demonstrated (Mann-Whitney U test, p>0,05). A clear trend was evident in the influence on motivation to change behavioural patterns and lifestyle (Fisher's exact test, p=0,000). Studies of the effects of reimbursement systems in the context of interdisciplinary care are still in their infancy, despite the widespread use of diagnosis related groups. The mandatory character implicit in the case tariff fee system, which requires minimum qualitative standards for structural and procedural parameters in the context of providing interdisciplinary patient-centered care, can influence patients' behavioural patterns and lifestyle.

  19. Nurses' role transition from the clinical ward environment to the critical care environment. (United States)

    Gohery, Patricia; Meaney, Teresa


    To explore the experiences of nurses moving from the ward environment to the critical care environment. Critical care areas are employing nurses with no critical care experience due to staff shortage. There is a paucity of literature focusing on the experiences of nurses moving from the ward environment to the critical care environment. A Heideggerian phenomenology research approach was used in this study. In-depth semi structured interviews, supported with an interview guide, were conducted with nine critical care nurses. Data analysis was guided by Van Manen (1990) approach to phenomenological analysis. Four main themes emerged: The highs and lows, you need support, theory-practice gap, struggling with fear. The participants felt ill prepared and inexperienced to work within the stressful and technical environment of critical care due to insufficient education and support. The study findings indicated that a variety of feelings and emotions are experienced by ward nurses who move into the stressful and technical environment of critical care due to insufficient skills and knowledge. More education and support is required to improve this transition process. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Critical views on postpartum care expressed by new mothers

    Directory of Open Access Journals (Sweden)

    Waldenström Ulla


    Full Text Available Abstract Background Women's evaluation of hospital postpartum care has consistently been more negative than their assessment of other types of maternity care. The need to further explore what is wrong with postpartum care, in order to stimulate changes and improvements, has been stressed. The principal aim of this study was to describe women's negative experiences of hospital postpartum care, expressed in their own words. Characteristics of the women who spontaneously gave negative comments about postpartum care were compared with those who did not. Methods Data were taken from a population-based prospective longitudinal study of 2783 Swedish-speaking women surveyed at three time points: in early pregnancy, at two months, and at one year postpartum. At the end of the two follow-up questionnaires, women were asked to add any comment they wished. Content analysis of their statements was performed. Results Altogether 150 women gave negative comments about postpartum care, and this sample was largely representative of the total population-based cohort. The women gave a diverse and detailed description of their experiences, for instance about lack of opportunity to rest and recover, difficulty in getting individualised information and breastfeeding support, and appropriate symptom management. The different statements were summarised in six categories: organisation and environment, staff attitudes and behaviour, breastfeeding support, information, the role of the father and attention to the mother. Conclusion The findings of this study underline the need to further discuss and specify the aims of postpartum care. The challenge of providing high-quality follow-up after childbirth is discussed in the light of a development characterised by a continuous reduction in the length of hospital stay, in combination with increasing public demands for information and individualised care.

  1. General beliefs about medicines among doctors and nurses in out-patient care: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Hedenrud Tove


    Full Text Available Abstract Background Doctors and nurses are two natural partners in the healthcare team, but they usually differ in their perspectives on how to work for increased health. These professions may also have different beliefs about medicines, a factor important for adherence to medicines. The aim was to explore general beliefs about medicines among doctors and nurses. Methods Questionnaires were sent to 306 private practitioners (PPs, 298 general practitioners (GPs and 303 nurses in the county of Västra Götaland, Sweden. The questionnaire included sociodemographic questions and the general part of the Beliefs about Medicines Questionnaire (BMQ, which measures the beliefs people have about medicines in general. General beliefs about medicines in relation to background variables were explored with independent t-tests and ANOVA analyses. Differences between occupations and influences of interaction variables were analysed with multiple linear regression models for general beliefs about medicines. Results The data collection resulted in 616 questionnaires (62.1% PPs; 61.6% GPs; 80.5% nurses. The majority of the PPs and 40% of the GPs were male but most of the nurses were female. The GPs' mean age was 47 years, PPs' 60 years and nurses' 52 years. Few nurses originated from non-Nordic countries while 15% of the PPs and 25% of the GPs did. Nurses saw medicines as more harmful and less beneficial than did PPs and GPs. These differences could not be explained by the included interaction variables. GPs with a Nordic background saw medicines as more beneficial and less harmful than did GPs with a non-Nordic background. Furthermore, GPs of non-Nordic origin were most likely to believe that medicines were overprescribed by doctors. Conclusion Doctors were more positive about medicines than nurses. The differences in beliefs about medicines found between doctors and nurses could not be explained by any of the included interaction variables. These differences in

  2. Challenges encountered by critical care unit managers in the large intensive care units. (United States)

    Matlakala, Mokgadi C; Bezuidenhout, Martie C; Botha, Annali D H


    Nurses in intensive care units (ICUs) are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives. The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs. A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding. Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU. Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

  3. Challenges encountered by critical care unit managers in the large intensive care units

    Directory of Open Access Journals (Sweden)

    Mokgadi C. Matlakala


    Full Text Available Background: Nurses in intensive care units (ICUs are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives. Objectives: The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs. Method: A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding. Results: Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU. Conclusion: Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

  4. Feasibility and Impact of Doctor-Nurse Task Delegation in Preventive Child Health Care in the Netherlands, a Controlled Before-After Study.

    Directory of Open Access Journals (Sweden)

    S Janine Benjamins

    Full Text Available In the Netherlands a need is felt for more flexible Child Health Care services, both efficient and tailored to needs. We set up a study on impact and feasibility of task delegation to child health care nurses performing all regular checkups on children aged 2 months to 4 years. Abnormal findings were discussed with the attending child health care doctor. This article describes impact and feasibility of this task delegation from four viewpoints: competences of nurses; percentage of children assigned to the nurse; change in abnormal findings and referrals; experiences of professionals and parents.Two experiment teams and two control teams were compared before and after starting task delegation. Nurses in the experiment teams were trained to carry out regular checkups on healthy children. Assignment to the experiment schedule was a joint decision by doctor and nurse. Nursing competences were measured by means of questionnaires. Percentage of children assigned to the nurse and screening results of eyes, heart, hips, growth and development were extracted from the electronic health record. Difference in change was compared between experiment and control teams. Mann-Whitney tests and logistic generalized estimating equations were used to test for significance. Experiences of professionals and parents were evaluated through focus group interviews, which were subjected to a qualitative analysis.Nurses in the experiment regions showed improvement in medical screening skills. No difference in change was perceived in general nursing competences. In the experiment group, 69% of all children were assigned to the nurse. There were no significant differences in change in the percentages of abnormal findings or referrals in the experiment teams compared to the control teams, except for hips. Interviews showed that both doctors and nurses thought positively of the new working method, yet made some recommendations for improvements. Parents felt well-informed and

  5. Palliative Care in Critical Care Settings: A Systematic Review of Communication-Based Competencies Essential for Patient and Family Satisfaction. (United States)

    Schram, Andrew W; Hougham, Gavin W; Meltzer, David O; Ruhnke, Gregory W


    There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited. A systematic review of this important topic can inform future research and assist in curricular development. Review of qualitative and quantitative empirical studies of the impact of physician competencies on patient- and family-reported outcomes conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. The data sources used were PubMed, MEDLINE, Web of Science, and Google Scholar. Fifteen studies (5 qualitative and 10 quantitative) meeting inclusion and exclusion criteria were identified. The competencies identified as critical for the delivery of high-quality PC in critical care settings are prognostication, conflict mediation, empathic communication, and family-centered aspects of care, the latter being the competency most frequently acknowledged in the literature identified. Prognostication, conflict mediation, empathic communication, and family-centered aspects of care are the most important identified competencies for patient- and family-centered PC in critical care settings. Incorporation of education on these competencies is likely to improve patient and family satisfaction with EOL care.

  6. A 5-year retrospective audit of prescribing by a critical care outreach team. (United States)

    Wilson, Mark


    UK prescribing legislation changes made in 2006 and 2012 enabled appropriately qualified nurses to prescribe any licensed medication, and all controlled drugs in schedule 2-5 of the Misuse of Drugs Regulations 2001, for any medical condition within their clinical competence. Critical Care Outreach nurses who are independent nurse prescribers are ideally placed to ensure that acutely ill patients receive treatment without delay. The perceived challenge was how Critical Care Outreach nurses would be able to safely prescribe for a diverse patient group. This study informs this developing area of nurse prescribing in critical care practice. The aims of the audit were to: identify which medications were prescribed; develop a critical care outreach formulary; identify the frequency, timing and number of prescribing decisions being made; identify if prescribing practice changed over the years and provide information for our continuing professional development. This article reports on data collected from a 5-year retrospective audit; of prescribing activity undertaken by nine independent nurse prescribers working in a 24/7 Critical Care Outreach team of a 600-bedded district general hospital in the UK. In total, 8216 medication items were prescribed, with an average of 2·6 prescribed per shift. The most commonly prescribed items were intravenous fluids and analgesia, which were mostly prescribed at night and weekends. The audit has shown that Critical Care Outreach nurse prescribing is feasible in a whole hospital patient population. The majority of prescribing occurred after 16:00 and at night. Further research would be beneficial, particularly looking at patient outcomes following reviews from prescribing critical care outreach nurses. The audit is one of the only long-term studies that describes prescribing practice in Critical Care Outreach teams in the UK. © 2017 British Association of Critical Care Nurses.

  7. Advanced competencies mapping of critical care nursing: a qualitative research in two Intensive Care Units. (United States)

    Alfieri, Emanuela; Mori, Marina; Barbui, Valentina; Sarli, Leopoldo


    Nowadays, in Italy, the nursing profession has suffered important changes in response to the needs of citizens' health and to improve the quality of the health service in the country.  At the basis of this development there is an increase of the nurses' knowledge, competencies and responsibilities. Currently, the presence of nurses who have followed post-basic training paths, and the subsequent acquisition of advanced clinical knowledge and specializations, has made it essential for the presence of competencies mappings for each specialty, also to differentiate them from general care nurses. The objective is to get a mapping of nurse's individual competencies working in critical care, to analyze the context of the Parma Hospital and comparing it with the Lebanon Heart Hospital in Lebanon. The survey has been done through a series of interviews involving some of the hospital staff, in order to collect opinions about the ICU nurses' competencies. What emerged from the data allowed us to get a list of important abilities, competencies, character traits and  intensive care nurse activities. Italians and Lebanese nurses appear to be prepared from a technical point of view, with a desire for improvement through specializations, masters and enabling courses in advanced health maneuvers. By respondents nurses can seize a strong desire for professional improvement. At the end of our research we were able to draw a list of different individual competencies, behavioral and moral characteristics. The nurse figure has a high potential and large professional improvement prospects, if more taken into account by the health system.

  8. Nurse's perceptions of physiotherapists in critical care team: Report of a qualitative study. (United States)

    Gupte, Pranati; Swaminathan, Narasimman


    Interprofessional relationship plays a major role in effective patient care. Specialized units such as critical care require multidisciplinary care where perception about every members role may affect the delivery of patient care. The objective of this study was to find out nurses' perceptions of the role of physiotherapists in the critical care team. Qualitative study by using semi-structured interview was conducted among the qualified nurses working in the Intensive Care Unit of a tertiary care hospital. The interview consisted of 19 questions divided into 3 sections. Interviews were audio recorded and transcribed. In-depth content analysis was carried out to identify major themes in relation to the research question. Analysis identified five major issues which included role and image of a physiotherapist, effectiveness of treatment, communications, teamwork, and interprofessional relations. Physiotherapists were perceived to be an important member of the critical team with the role of mobilizing the patients. The respondents admitted that there existed limitations in interprofessional relationship. Nurses perceived the role of physiotherapist in the critical care unit as an integral part and agreed on the need for inclusion of therapist multidisciplinary critical care team.

  9. Critical Care Organizations in Academic Medical Centers in North America: A Descriptive Report. (United States)

    Pastores, Stephen M; Halpern, Neil A; Oropello, John M; Kostelecky, Natalie; Kvetan, Vladimir


    With the exception of a few single-center descriptive reports, data on critical care organizations are relatively sparse. The objectives of our study were to determine the structure, governance, and experience to date of established critical care organizations in North American academic medical centers. A 46-item survey questionnaire was electronically distributed using Survey Monkey to the leadership of 27 identified critical care organizations in the United States and Canada between September 2014 and February 2015. A critical care organization had to be headed by a physician and have primary governance over the majority, if not all, of the ICUs in the medical center. We received 24 responses (89%). The majority of the critical care organizations (83%) were called departments, centers, systems, or operations committees. Approximately two thirds of respondents were from larger (> 500 beds) urban institutions, and nearly 80% were primary university medical centers. On average, there were six ICUs per academic medical center with a mean of four ICUs under critical care organization governance. In these ICUs, intensivists were present in-house 24/7 in 49%; advanced practice providers in 63%; hospitalists in 21%; and telemedicine coverage in 14%. Nearly 60% of respondents indicated that they had a separate hospital budget to support data management and reporting, oversight of their ICUs, and rapid response teams. The transition from the traditional model of ICUs within departmentally controlled services or divisions to a critical care organization was described as gradual in 50% and complete in only 25%. Nearly 90% indicated that their critical care organization governance structure was either moderately or highly effective; a similar number suggested that their critical care organizations were evolving with increasing domain and financial control of the ICUs at their respective institutions. Our survey of the very few critical care organizations in North American

  10. An Intensive, Simulation-Based Communication Course for Pediatric Critical Care Medicine Fellows. (United States)

    Johnson, Erin M; Hamilton, Melinda F; Watson, R Scott; Claxton, Rene; Barnett, Michael; Thompson, Ann E; Arnold, Robert


    Effective communication among providers, families, and patients is essential in critical care but is often inadequate in the PICU. To address the lack of communication education pediatric critical care medicine fellows receive, the Children's Hospital of Pittsburgh PICU developed a simulation-based communication course, Pediatric Critical Care Communication course. Pediatric critical care medicine trainees have limited prior training in communication and will have increased confidence in their communication skills after participating in the Pediatric Critical Care Communication course. Pediatric Critical Care Communication is a 3-day course taken once during fellowship featuring simulation with actors portraying family members. Off-site conference space as part of a pediatric critical care medicine educational curriculum. Pediatric Critical Care Medicine Fellows. Didactic sessions and interactive simulation scenarios. Prior to and after the course, fellows complete an anonymous survey asking about 1) prior instruction in communication, 2) preparedness for difficult conversations, 3) attitudes about end-of-life care, and 4) course satisfaction. We compared pre- and postcourse surveys using paired Student t test. Most of the 38 fellows who participated over 4 years had no prior communication training in conducting a care conference (70%), providing bad news (57%), or discussing end-of-life options (75%). Across all four iterations of the course, fellows after the course reported increased confidence across many topics of communication, including giving bad news, conducting a family conference, eliciting both a family's emotional reaction to their child's illness and their concerns at the end of a child's life, discussing a child's code status, and discussing religious issues. Specifically, fellows in 2014 reported significant increases in self-perceived preparedness to provide empathic communication to families regarding many aspects of discussing critical care, end

  11. Let’s Talk Critical. Development and Evaluation of a Communication Skills Training Program for Critical Care Fellows (United States)

    Hsieh, S. Jean; Howes, Jennifer M.; Keene, Adam B.; Fausto, James A.; Pinto, Priya A.; Gong, Michelle Ng


    Rationale: Although expert communication between intensive care unit clinicians with patients or surrogates improves patient- and family-centered outcomes, fellows in critical care medicine do not feel adequately trained to conduct family meetings. Objectives: We aimed to develop, implement, and evaluate a communication skills program that could be easily integrated into a U.S. critical care fellowship. Methods: We developed four simulation cases that provided communication challenges that critical care fellows commonly face. For each case, we developed a list of directly observable tasks that could be used by faculty to evaluate fellows during each simulation. We developed a didactic curriculum of lectures/case discussions on topics related to palliative care, end-of-life care, communication skills, and bioethics; this month-long curriculum began and ended with the fellows leading family meetings in up to two simulated cases with direct observation by faculty who were not blinded to the timing of the simulation. Our primary measures of effectiveness were the fellows’ self-reported change in comfort with leading family meetings after the program was completed and the quality of the communication as measured by the faculty evaluators during the family meeting simulations at the end of the month. Measurements and Main Results: Over 3 years, 31 critical care fellows participated in the program, 28 of whom participated in 101 family meeting simulations with direct feedback by faculty facilitators. Our trainees showed high rates of information disclosure during the simulated family meetings. During the simulations done at the end of the month compared with those done at the beginning, our fellows showed significantly improved rates in: (1) verbalizing an agenda for the meeting (64 vs. 41%; Chi-square, 5.27; P = 0.02), (2) summarizing what will be done for the patient (64 vs. 39%; Chi-square, 6.21; P = 0.01), and (3) providing a follow-up plan (60 vs. 37%; Chi

  12. The relationship between organizational culture and family satisfaction in critical care. (United States)

    Dodek, Peter M; Wong, Hubert; Heyland, Daren K; Cook, Deborah J; Rocker, Graeme M; Kutsogiannis, Demetrios J; Dale, Craig; Fowler, Robert; Robinson, Sandra; Ayas, Najib T


    Family satisfaction with critical care is influenced by a variety of factors. We investigated the relationship between measures of organizational and safety culture, and family satisfaction in critical care. We further explored differences in this relationship depending on intensive care unit survival status and length of intensive care unit stay of the patient. Cross-sectional surveys. Twenty-three tertiary and community intensive care units within three provinces in Canada. One thousand two-hundred eighty-five respondents from 2374 intensive care unit clinical staff, and 880 respondents from 1381 family members of intensive care unit patients. None. Intensive care unit staff completed the Organization and Management of Intensive Care Units survey and the Hospital Survey on Patient Safety Culture. Family members completed the Family Satisfaction in the Intensive Care Unit 24, a validated survey of family satisfaction. A priori, we analyzed adjusted relationships between each domain score from the culture surveys and either satisfaction with care or satisfaction with decision-making for each of four subgroups of family members according to patient descriptors: intensive care unit survivors who had length of intensive care unit stay 14 days, and intensive care unit nonsurvivors who had length of stay relationships between most domains of organizational and safety culture, and satisfaction with care or decision-making for family members of intensive care unit nonsurvivors who spent at least 14 days in the intensive care unit. For the other three groups, there were only a few weak relationships between domains of organizational and safety culture and family satisfaction. Our findings suggest that the effect of organizational culture on care delivery is most easily detectable by family members of the most seriously ill patients who interact frequently with intensive care unit staff, who are intensive care unit nonsurvivors, and who spend a longer time in the intensive

  13. Psychiatric and addiction consultation for patients in critical care. (United States)

    Kaiser, Susan


    Practicing within the paradigm of compartmentalized specially treatment without a collaborative practice is ineffective for the chemical dependency and dual diagnosis population. Chemical dependency is not well understood as a disease, evidenced by barriers cited from the 2005 Survey on Drug Use and Health. Recovery from addiction and dual diagnosis logically demands an integrated and science-based treatment approach with unified standards for care and improved educational standards for preparation of care providers. Consultation and collaboration with addiction and psychiatric specialists is needed to establish consistency in standards for treatment and holistic care, essential for comorbidity. Continued learning and research about the complexity of the addiction process and comorbidity will provide continued accurate information about the harmful effects of alcoholism and drug abuse which in turn will empower individuals to make informed choices and result in better treatment and social policies.

  14. Advanced Optical Technologies for Defense Trauma and Critical Care

    National Research Council Canada - National Science Library

    Berns, Michael W


    ...: High Resolution F-OCT and MPM/SHG Imaging of the Oral-Nasal Cavity Diffuse Optical Spectroscopy in Critical Patient Medicine, Optical Therapeutics in Cartilage for the Treatment of Traumatic Injuries and Degenerative Disease, Advanced Optical Technologies for Orthopedic Applications.

  15. Job Satisfaction Analysis in Rural China: A Qualitative Study of Doctors in a Township Hospital


    Chen, Qiwei; Yang, Lan; Feng, Qiming; Tighe, Scott S.


    Background. Township hospitals in China provide rural communities with basic but much needed critical health care services. The doctors working in these hospitals often feel unsatisfied when considering their work schedules and financial rewards. Method. To explore job satisfaction of health workers in a township hospital, a qualitative study was conducted of 39 doctors from five township hospitals in Guangxi Zhuang Autonomous Region. The goal was to understand the level of job satisfaction o...

  16. Moral sensitivity and moral distress in Iranian critical care nurses. (United States)

    Borhani, Fariba; Abbaszadeh, Abbas; Mohamadi, Elham; Ghasemi, Erfan; Hoseinabad-Farahani, Mohammad Javad


    Moral sensitivity is the foremost prerequisite to ethical performance; a review of literature shows that nurses are sometimes not sensitive enough for a variety of reasons. Moral distress is a frequent phenomenon in nursing, which may result in paradoxes in care, dealing with patients and rendering high-quality care. This may, in turn, hinder the meeting of care objectives, thus affecting social healthcare standards. The present research was conducted to determine the relationship between moral sensitivity and moral distress of nurses in intensive care units. This study is a descriptive-correlation research. Lutzen's moral sensitivity questionnaire and Corley Moral Distress Questionnaire were used to gather data. Participants and research context: A total of 153 qualified nurses working in the hospitals affiliated to Shahid Beheshti University of Medical Sciences were selected for this study. Subjects were selected by census method. Ethical considerations: After explaining the objectives of the study, all the participants completed and signed the written consent form. To conduct the study, permission was obtained from the selected hospitals. Nurses' average moral sensitivity grade was 68.6 ± 7.8, which shows a moderate level of moral sensitivity. On the other hand, nurses also experienced a moderate level of moral distress (44.8 ± 16.6). Moreover, there was no meaningful statistical relationship between moral sensitivity and moral distress (p = 0.26). Although the nurses' moral sensitivity and moral distress were expected to be high in the intensive care units, it was moderate. This finding is consistent with the results of some studies and contradicts with others. As moral sensitivity is a crucial factor in care, it is suggested that necessary training be provided to develop moral sensitivity in nurses in education and practical environments. Furthermore, removing factors that contribute to moral distress may help decrease it in nurses.

  17. Triage: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. (United States)

    Christian, Michael D; Sprung, Charles L; King, Mary A; Dichter, Jeffrey R; Kissoon, Niranjan; Devereaux, Asha V; Gomersall, Charles D


    Pandemics and disasters can result in large numbers of critically ill or injured patients who may overwhelm available resources despite implementing surge-response strategies. If this occurs, critical care triage, which includes both prioritizing patients for care and rationing scarce resources, will be required. The suggestions in this chapter are important for all who are involved in large-scale pandemics or disasters with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. The Triage topic panel reviewed previous task force suggestions and the literature to identify 17 key questions for which specific literature searches were then conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions from the previous task force that were not being updated were also included for validation by the expert panel. The suggestions from the task force outline the key principles upon which critical care triage should be based as well as a path for the development of the plans, processes, and infrastructure required. This article provides 11 suggestions regarding the principles upon which critical care triage should be based and policies to guide critical care triage. Ethical and efficient critical care triage is a complex process that requires significant planning and preparation. At present, the prognostic tools required to produce an effective decision support system (triage protocol) as well as the infrastructure, processes, legal protections, and training are largely lacking in most jurisdictions. Therefore, critical care triage should be a last resort after mass critical care surge strategies.

  18. The emotional intelligence of a group of critical-care nurses in South Africa

    Directory of Open Access Journals (Sweden)

    Amanda Towell


    Full Text Available Critical-care nurses often look after three or more critically-ill patients during a shift. The workload and emotional stress can lead to disharmony between the nurse’s body, mind and spirit. Nurses with a high emotional intelligence have less emotional exhaustion and psychosomatic symptoms; they enjoy better emotional health; gain more satisfaction from their actions (both at work and at home; and have improved relationships with colleagues at work. The question arises: what is the emotional intelligence of critical-care nurses? A quantitative survey was conducted. The target population was registered nurses working in critical-care units who attended the Critical Care Congress 2009 (N = 380. Data were collected with the use of the Trait Emotional Intelligence Short Form and analysed using the Statistical Package for the Social Sciences software. The sample (n= 220 was mainly a mature, female and professionally-experienced group of registered nurses. They held a variety of job descriptions within various critical-care units. Statistics indicated that the standard deviations were small and no aberrant aspects such as demographics skewed the findings. The conclusion was made that registered nurses who are older and that have more experience in critical care appear to have a higher range of emotional intelligence.

  19. Dementia - what to ask your doctor (United States)

    What to ask your doctor about dementia; Alzheimer disease - what to ask your doctor; Cognitive impairment - what to ask your doctor ... Alzheimer's Association. Dementia Care Practice Recommendations ... in a Home Setting. Updated 2009. ...

  20. Paradigm shifts in critical care medicine: the progress we have made. (United States)

    Vincent, Jean-Louis; Creteur, Jacques


    There have really been no single, major, advances in critical care medicine since the specialty came into existence. There has, however, been a gradual, continuous improvement in the process of care over the years, which has resulted in improved patient outcomes. Here, we will highlight just a few of the paradigm shifts we have seen in processes of critical care, including the move from small, closed units to larger, more open ICUs; from a paternal "dictatorship" to more "democratic" team-work; from intermittent to continuous, invasive to less-invasive monitoring; from "more" interventions to "less" thus reducing iatrogenicity; from consideration of critical illness as a single event to realization that it is just one part of a trajectory; and from "four walls" to "no walls" as we take intensive care outside the physical ICU. These and other paradigm shifts have resulted in improvements in the whole approach to patient management, leading to more holistic, humane care for patients and their families. As critical care medicine continues to develop, further paradigm shifts in processes of care are inevitable and must be embraced if we are to continue to provide the best possible care for all critically ill patients.

  1. Paradigm shifts in critical care medicine: the progress we have made (United States)


    There have really been no single, major, advances in critical care medicine since the specialty came into existence. There has, however, been a gradual, continuous improvement in the process of care over the years, which has resulted in improved patient outcomes. Here, we will highlight just a few of the paradigm shifts we have seen in processes of critical care, including the move from small, closed units to larger, more open ICUs; from a paternal "dictatorship" to more "democratic" team-work; from intermittent to continuous, invasive to less-invasive monitoring; from "more" interventions to "less" thus reducing iatrogenicity; from consideration of critical illness as a single event to realization that it is just one part of a trajectory; and from "four walls" to "no walls" as we take intensive care outside the physical ICU. These and other paradigm shifts have resulted in improvements in the whole approach to patient management, leading to more holistic, humane care for patients and their families. As critical care medicine continues to develop, further paradigm shifts in processes of care are inevitable and must be embraced if we are to continue to provide the best possible care for all critically ill patients. PMID:26728199

  2. A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care

    DEFF Research Database (Denmark)

    Langhorn, Leanne; Sorensen, Jens C; Pedersen, Preben U


    A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care......A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care...

  3. Exploring the Group Prenatal Care Model: A Critical Review of the Literature (United States)

    Thielen, Kathleen


    Few studies have compared perinatal outcomes between individual prenatal care and group prenatal care. A critical review of research articles that were published between 1998 and 2009 and involved participants of individual and group prenatal care was conducted. Two middle range theories, Pender’s health promotion model and Swanson’s theory of caring, were blended to enhance conceptualization of the relationship between pregnant women and the group prenatal care model. Among the 17 research studies that met inclusion criteria for this critical review, five examined gestational age and birth weight with researchers reporting longer gestations and higher birth weights in infants born to mothers participating in group prenatal care, especially in the preterm birth population. Current evidence demonstrates that nurse educators and leaders should promote group prenatal care as a potential method of improving perinatal outcomes within the pregnant population. PMID:23997549

  4. Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit

    NARCIS (Netherlands)

    Vincent, J.L.; Marshall, J.C.; Namendys-Silva, S.A.; Francois, B.; Martin-Loeches, I.; Lipman, J.; Reinhart, K.; Antonelli, M.; Pickkers, P.; Njimi, H.; Jimenez, E.; Sakr, Y.; investigators, I.


    BACKGROUND: Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between

  5. Cognitive informatics in health and biomedicine case studies on critical care, complexity and errors

    CERN Document Server

    Patel, Vimla L; Cohen, Trevor


    This interdisciplinary book offers an introduction to cognitive informatics, focusing on key examples drawn from the application of methods and theories from cognitive informatics to challenges specific to the practice of critical-care medicine.

  6. Meeting the milestones. Strategies for including high-value care education in pulmonary and critical care fellowship training. (United States)

    Courtright, Katherine R; Weinberger, Steven E; Wagner, Jason


    Physician decision making is partially responsible for the roughly 30% of U.S. healthcare expenditures that are wasted annually on low-value care. In response to both the widespread public demand for higher-quality care and the cost crisis, payers are transitioning toward value-based payment models whereby physicians are rewarded for high-value, cost-conscious care. Furthermore, to target physicians in training to practice with cost awareness, the Accreditation Council for Graduate Medical Education has created both individual objective milestones and institutional requirements to incorporate quality improvement and cost awareness into fellowship training. Subsequently, some professional medical societies have initiated high-value care educational campaigns, but the overwhelming majority target either medical students or residents in training. Currently, there are few resources available to help guide subspecialty fellowship programs to successfully design durable high-value care curricula. The resource-intensive nature of pulmonary and critical care medicine offers unique opportunities for the specialty to lead in modeling and teaching high-value care. To ensure that fellows graduate with the capability to practice high-value care, we recommend that fellowship programs focus on four major educational domains. These include fostering a value-based culture, providing a robust didactic experience, engaging trainees in process improvement projects, and encouraging scholarship. In doing so, pulmonary and critical care educators can strive to train future physicians who are prepared to provide care that is both high quality and informed by cost awareness.

  7. Family centred care before and during life-sustaining treatment withdrawal in intensive care: A survey of information provided to families by Australasian critical care nurses. (United States)

    Ranse, Kristen; Bloomer, Melissa; Coombs, Maureen; Endacott, Ruth


    A core component of family-centred nursing care during the provision of end-of-life care in intensive care settings is information sharing with families. Yet little is known about information provided in these circumstances. To identify information most frequently given by critical care nurses to families in preparation for and during withdrawal of life-sustaining treatment. An online cross-sectional survey. During May 2015, critical care nurses in Australia and New Zealand were invited to complete the Preparing Families for Treatment Withdrawal questionnaire. Data analysis included descriptive statistics to identify areas of information most and least frequently shared with families. Cross tabulations with demographic data were used to explore any associations in the data. From the responses of 159 critical care nurses, information related to the emotional care and support of the family was most frequently provided to families in preparation for and during withdrawal of life-sustaining treatment. Variation was noted in the frequency of provision of information across body systems and their associated physical changes during the dying process. Significant associations (p<0.05) were identified between the variables gender, nursing experience and critical care experiences and some of the information items most and least frequently provided. The provision of information during end-of-life care reflects a family-centred care approach by critical care nurses with information pertaining to emotional care and support of the family paramount. The findings of this study provide a useful framework for the development of interventions to improve practice and support nurses in communicating with families at this time. Copyright © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  8. Critical care in resource-poor settings: lessons learned and future directions. (United States)

    Riviello, Elisabeth D; Letchford, Stephen; Achieng, Loice; Newton, Mark W


    Critical care faces the same challenges as other aspects of healthcare in the developing world. However, critical care faces an additional challenge in that it has often been deemed too costly or complicated for resource-poor settings. This lack of prioritization is not justified. Hospital care for the sickest patients affects overall mortality, and public health interventions depend on community confidence in healthcare to ensure participation and adherence. Some of the most effective critical care interventions, including rapid fluid resuscitation, early antibiotics, and patient monitoring, are relatively inexpensive. Although cost-effectiveness studies on critical care in resource-poor settings have not been done, evidence from the surgical literature suggests that even resource-intensive interventions can be cost effective in comparison to immunizations and human immunodeficiency virus care. In the developing world, where many critically ill patients are younger and have fewer comorbidities, critical care presents a remarkable opportunity to provide significant incremental benefit, arguably much more so than in the developed world. Key areas of consideration in developing critical care in resource-poor settings include: Personnel and training, equipment and support services, ethics, and research. Strategies for training and retaining skilled labor include tying education to service commitment and developing protocols for even complex processes. Equipment and support services need to focus on technologies that are affordable and sustainable. Ethical decision making must be based on data when possible and on transparent articulated policies always. Research should be performed in resource-poor settings and focus on needs assessment, prognostication, and cost effectiveness. The development of critical care in resource-poor settings will rely on the stepwise introduction of service improvements, leveraging human resources through training, a focus on sustainable

  9. The effect of chronotherapy on delirium in critical care - a systematic review. (United States)

    Luther, Roseanne; McLeod, Anne


    Delirium is highly prevalent within critical care and is linked to adverse clinical outcomes, increased mortality and impaired quality of life. Development of delirium is thought to be caused by multiple risk factors, including disruption of the circadian rhythm. Chronotherapeutic interventions, such as light therapy, music and use of eye shades, have been suggested as an option to improve circadian rhythm within intensive care units. This review aims to answer the question: Can chronotherapy reduce the prevalence of delirium in adult patients in critical care? This study is a systematic review of quantitative studies. Six major electronic databases were searched, and a hand search was undertaken using selected key search terms. Research quality was assessed using the critical appraisal skills programme tools. The studies were critically appraised by both authors independently, and data were extracted. Four themes addressing the research question were identified and critically evaluated. Six primary research articles that investigated different methods of chronotherapy were identified, and the results suggest that multi-component non-pharmacological interventions are the most effective for reducing the prevalence of delirium in critical care. The melatonergic agonist Ramelteon demonstrated statistically significant reductions in delirium; however, the reliability of the results in answering the review question was limited by the research design. The use of bright light therapy (BLT) and dynamic light application had mixed results, with issues with the research design and outcomes measured limiting the validity of the findings. Multi-component non-pharmacological interventions, such as noise and light control, can reduce delirium in critical care, whereas other interventions, such as BLT, have mixed outcomes. Melatonin, as a drug, may be a useful alternative to sedative-hypnotics. Chronotherapy can reduce the incidence of delirium within critical care, although

  10. A Turkish Version of the Critical-Care Pain Observation Tool: Reliability and Validity Assessment. (United States)

    Aktaş, Yeşim Yaman; Karabulut, Neziha


    The study aim was to evaluate the validity and reliability of the Critical-Care Pain Observation Tool in critically ill patients. A repeated measures design was used for the study. A convenience sample of 66 patients who had undergone open-heart surgery in the cardiovascular surgery intensive care unit in Ordu, Turkey, was recruited for the study. The patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (suctioning), and 20 minutes after the procedure while they were conscious and intubated after surgery. The Turkish version of the Critical-Care Pain Observation Tool has shown statistically acceptable levels of validity and reliability. Inter-rater reliability was supported by moderate-to-high-weighted κ coefficients (weighted κ coefficient = 0.55 to 1.00). For concurrent validity, significant associations were found between the scores on the Critical-Care Pain Observation Tool and the Behavioral Pain Scale scores. Discriminant validity was also supported by higher scores during suctioning (a nociceptive procedure) versus non-nociceptive procedures. The internal consistency of the Critical-Care Pain Observation Tool was 0.72 during a nociceptive procedure and 0.71 during a non-nociceptive procedure. The validity and reliability of the Turkish version of the Critical-Care Pain Observation Tool was determined to be acceptable for pain assessment in critical care, especially for patients who cannot communicate verbally. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  11. The human factor: the critical importance of effective teamwork and communication in providing safe care


    Leonard, M; Graham, S; Bonacum, D


    Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members...

  12. 'Intensive care unit survivorship' - a constructivist grounded theory of surviving critical illness. (United States)

    Kean, Susanne; Salisbury, Lisa G; Rattray, Janice; Walsh, Timothy S; Huby, Guro; Ramsay, Pamela


    To theorise intensive care unit survivorship after a critical illness based on longitudinal qualitative data. Increasingly, patients survive episodes of critical illness. However, the short- and long-term impact of critical illness includes physical, psychological, social and economic challenges long after hospital discharge. An appreciation is emerging that care needs to extend beyond critical illness to enable patients to reclaim their lives postdischarge with the term 'survivorship' being increasingly used in this context. What constitutes critical illness survivorship has, to date, not been theoretically explored. Longitudinal qualitative and constructivist grounded theory. Interviews (n = 46) with 17 participants were conducted at four time points: (1) before discharge from hospital, (2) four to six weeks postdischarge, (3) six months and (4) 12 months postdischarge across two adult intensive care unit setting. Individual face-to-face interviews. Data analysis followed the principles of Charmaz's constructivist grounded theory. 'Intensive care unit survivorship' emerged as the core category and was theorised using concepts such as status passages, liminality and temporality to understand the various transitions participants made postcritical illness. Intensive care unit survivorship describes the unscheduled status passage of falling critically ill and being taken to the threshold of life and the journey to a life postcritical illness. Surviving critical illness goes beyond recovery; surviving means 'moving on' to life postcritical illness. 'Moving on' incorporates a redefinition of self that incorporates any lingering intensive care unit legacies and being in control of one's life again. For healthcare professionals and policymakers, it is important to realise that recovery and transitioning through to survivorship happen within an individual's time frame, not a schedule imposed by the healthcare system. Currently, there are no care pathways or policies in

  13. Nurses' competences in the critical care of children undergoing hematopoietic stem cell transplantation

    Directory of Open Access Journals (Sweden)

    Marianna Ferreira


    Full Text Available This is a descriptive study, with qualitative data analysis, in order to identify and analyze the experiences and competencies required by nurses in the care of transplanted child, who demand critical care. Nine nurses were interviewed. We analyzed the data according to the procedures for qualitative content analysis, and then we elaborated the following themes: Critical care to the transplanted child: a double challenge for the nurse; Nurses' competences for the care towards the critically ill child submitted to hematopoietic stem cell transplantation (HSCT. The identified competencies based on scientific knowledge, skills and natural abilities and relate to specific knowledge about pediatric HSCT; technical-scientific, interactive and communication skills; management of material resources and equipment; emotional control, empathy and leadership. Such competences help in the construction of a specific profile for the care offered to this clientele, with a view to therapeutic success.

  14. Chest tube care in critically ill patient: A comprehensive review

    Directory of Open Access Journals (Sweden)

    Hanan Mohammed Mohammed


    Full Text Available Breathing is automatic. We don’t usually think too much about it unless we develop a problem. Lack of adequate ventilation and impairment of our respiratory system can quickly become life-threatening. There are many clinical conditions that may necessitate the use of chest tubes. When there is an accumulation of positive pressure in the chest cavity (where it should normally be negative pressure between pleurae, a patient will require chest drainage. Chest tubes may be inserted to drain body fluids or to facilitate the re-expansion of a lung. It is important for the clinician to determine the most appropriate tube size to use prior to intubation. The position of the chest tube is related to the function that the chest tube performs. When managing the care of patients who have chest tubes it is important to fully understand what to do in case problems arise. It is also important to be able to assess when the chest tube is ready to be discontinued. Nurses and other healthcare professionals who are responsible for the safe delivery of care should be knowledgeable about respiratory pathophysiology, signs of respiratory compromise, and the care and management of interventions that may be utilized to ensure adequate respiration.

  15. Nurse attitudes towards the use of complementary and alternative therapies in critical care. (United States)

    Tracy, Mary Fran; Lindquist, Ruth; Watanuki, Shigeaki; Sendelbach, Sue; Kreitzer, Mary Jo; Berman, Brian; Savik, Kay


    There is increasing demand for complementary/alternative therapies (CAT) in critical care, however, critical care nurses' perspectives regarding CAT are unknown. This study was conducted to determine critical care nurses' knowledge, attitudes, and use of CAT. A total of 348 critical care registered nurses working at least 40% in medical, surgical, cardiac, neurological, and pediatric ICUs at 2 tertiary-level hospitals in a large Midwestern city were surveyed. One hospital is a 926-bed private, urban hospital and the second is an 1868-bed academic-affiliated medical center. A survey was distributed to all critical care nurses described above. The level of knowledge reported by 138 nurse respondents was greatest for diet, exercise, massage, prayer, and music therapy. Use of therapies was related to knowledge and training and consistent with beliefs of legitimacy and perceptions of beneficial effects. Despite barriers including lack of knowledge, time, and training, 88% of respondents were open or eager to use CAT, and 60% reported moderate or greater desire to use CAT. Critical care nurses are open to CAT use and many use them in their own practice. Because use was associated with knowledge, recommendations for future research include increasing the scientific base and enhancing knowledge to promote evidence-based incorporation of CAT in practice.

  16. Special populations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. (United States)

    Dries, David; Reed, Mary Jane; Kissoon, Niranjan; Christian, Michael D; Dichter, Jeffrey R; Devereaux, Asha V; Upperman, Jeffrey S


    Past disasters have highlighted the need to prepare for subsets of critically ill, medically fragile patients. These special patient populations require focused disaster planning that will address their medical needs throughout the event to prevent clinical deterioration. The suggestions in this article are important for all who are involved in large-scale disasters or pandemics with multiple critically ill or injured patients, including frontline clinicians, hospital administrators, and public health or government officials. Key questions regarding the care of critically ill or injured special populations during disasters or pandemics were identified, and a systematic literature review (1985-2013) was performed. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. The panel did not include pediatrics as a separate special population because pediatrics issues are embedded in each consensus document. Fourteen suggestions were formulated regarding the care of critically ill and injured patients from special populations during pandemics and disasters. The suggestions cover the following areas: defining special populations for mass critical care, special population planning, planning for access to regionalized service for special populations, triage and resource allocation of special populations, therapeutic considerations, and crisis standards of care for special populations. Chronically ill, technologically dependent, and complex critically ill patients present a unique challenge to preparing and implementing mass critical care. There are, however, unique opportunities to engage patients, primary physicians, advocacy groups, and professional organizations to lessen the impact of disaster on these special populations.

  17. Doctoral Education

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner


    Doctoral education covers the “third cycle” of degrees following the bachelor’s and the master’s degree. The education of researchers is necessary for developing music therapy as a scientific discipline and calls for a certain research culture that not only brings knowledge on research...... with an integration of science and practice. This leads to a description of the principles of problem-based learning as a social constructive approach, problematization, self-directed learning and learning community. The chapter is concluded with an example of a model of doctoral education, the Aalborg model, where...... the coursework, supervision, and curriculum is based on problem-based learning. About the book: 'International Perspectives in Music Therapy Education and Training: Adapting to a Changing World,' the first anthology of its kind, edited by Professor Karen Goodman, brings noted educators from Brazil, Canada...

  18. Therapeutic Plasma Exchange in Critically Ill Children Requiring Intensive Care. (United States)

    Cortina, Gerard; McRae, Rosemary; Chiletti, Roberto; Butt, Warwick


    To characterize the clinical indications, procedural safety, and outcome of critically ill children requiring therapeutic plasma exchange. Retrospective observational study based on a prospective registry. Tertiary and quaternary referral 30-bed PICU. Forty-eight critically ill children who received therapeutic plasma exchange during an 8-year period (2007-2014) were included in the study. Therapeutic plasma exchange. A total of 48 patients underwent 244 therapeutic plasma exchange sessions. Of those, therapeutic plasma exchange was performed as sole procedure in 193 (79%), in combination with continuous renal replacement therapy in 40 (16.4%) and additional extracorporeal membrane oxygenation in 11 (4.6%) sessions. The most common admission diagnoses were hematologic disorders (30%), solid organ transplantation (20%), neurologic disorders (20%), and rheumatologic disorders (15%). Complications associated with the procedure occurred in 50 (21.2%) therapeutic plasma exchange sessions. Overall, patient survival from ICU was 82%. Although patients requiring therapeutic plasma exchange alone (n = 31; 64%) had a survival rate of 97%, those with additional continuous renal replacement therapy (n = 13; 27%) and extracorporeal membrane oxygenation (n = 4; 8%) had survival rates of 69% and 50%, respectively. Factors associated with increased mortality were lower Pediatric Index of Mortality 2 score, need for mechanical ventilation, higher number of failed organs, and longer ICU stay. Our results indicate that, in specialized centers, therapeutic plasma exchange can be performed relatively safely in critically ill children, alone or in combination with continuous renal replacement therapy and extracorporeal membrane oxygenation. Outcome in children requiring therapeutic plasma exchange alone is excellent. However, survival decreases with the number of failed organs and the need for continuous renal replacement therapy and extracorporeal membrane oxygenation.

  19. Mrs Hitler and her doctor. (United States)

    Macleod, Sandy


    The doctor who attended the mother of Adolf Hitler in her terminal illness has been blamed as a cause of the Holocaust. The medical details recorded of this professional relationship are presented and discussed. Dr Bloch's medical care of Mrs Hitler was consistent with the prevailing medical practice of the management of fungating breast carcinoma. Indeed, the general practitioner's care and attention of the family appear to have been astute and supportive. There is nothing to suggest that Dr Bloch's medical care was other than competent. Doctors who have the (mis)fortune to professionally attend major figures of history may be unfairly viewed, despite their appropriate and adequate care.

  20. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness

    DEFF Research Database (Denmark)

    Jones, Christina; Bäckman, Carl; Capuzzo, Maurizia


    Patients recovering from critical illness have been shown to be at risk of developing Post Traumatic Stress disorder (PTSD). This study was to evaluate whether a prospectively collected diary of a patient's intensive care unit (ICU) stay when used during convalescence following critical illness...

  1. Enhanced Critical Care Air Transport Team Training for Mitigation of Task Saturation (United States)


    specialized members (physician, critical care nurse , and respiratory therapist) trained to handle the complex, critical nature of patients in hemodynamic ...with complex medical conditions have been poorly studied. 3.0 BACKGROUND Teams are composed of three medical personnel (a physician, a nurse , and

  2. Reinventing The Doctor

    Directory of Open Access Journals (Sweden)

    Moyez Jiwa


    Full Text Available There has been a seismic shift in the lives of people because of technology. People are far better informed than they were in the 1980s and 1990s. Much of this information is available through the media but even more is available and archived on the internet. The forces pushing the internet into health and health care are strong and unstoppable, ensuring that the internet and the choices it offers must be part of the design of our future health care system. We are no longer content to wait in queues as we live at a faster pace than earlier generations — we don’t not have time to wait for appointments months, weeks or even days in advance. The internet offers the prospect of online consultations in the comfort of your own home. The physical examination will change as new devices are developed to allow the necessary sounds and signals emitted by our malfunctioning bodies to be recorded, interpreted and captured at a remote location. Meanwhile, for those who prefer to see a health care practitioner in person the options to consult practitioners other than doctors who can advise on our health is expanding. The reality is we can’t afford to train or pay for all the doctors we need under the current “doctor-knows-best” system of health care. Patients no longer believe the rhetoric and are already voting with their feet. Pharmacists, nurses and other allied health professionals are beginning to play a much greater role in offering relief from symptoms and monitoring of chronic diseases. Of course, the doctor of the future will still need to offer face-to-face consultations to some people most of the time or most people some of the time. The social role doctors play will continue to be important as humans will always need other humans to personally respond to their distress. As doctors reinvent themselves, the internet and the value of time with patients will be the driving forces that move us into a more sustainable future in health care.

  3. Understanding Resident Performance, Mindfulness, and Communication in Critical Care Rotations. (United States)

    Real, Kevin; Fields-Elswick, Katelyn; Bernard, Andrew C

    Evidence from the medical literature suggests that surgical trainees can benefit from mindful practices. Surgical educators are challenged with the need to address resident core competencies, some of which may be facilitated by higher levels of mindfulness. This study explores whether mindful residents perform better than their peers as members of the health care team. This study employed a multiphase, multimethod design to assess resident mindfulness, communication, and clinical performance. Academic, tertiary medical center. Residents (N = 51) working in an intensive care unit. In phase I, medical residents completed a self-report survey of mindfulness, communication, emotional affect, and clinical decision-making. In phase II, resident performance was assessed using independent ratings of mindfulness and clinical decision-making by attending physicians and registered nurses. In phase 1, a significant positive relationship was found between resident performance and mindfulness, positive affect (PA), and communication. In phase 2, attending physicians/registered nurses' perceptions of residents' mindfulness were positively correlated with communication and inversely related to negative affect (NA). The top quartile of residents for performance and mindfulness had the lowest NA. Higher-rated residents underestimated their performance/mindfulness, whereas those in the lowest quartile overestimated these factors. This study offers a number of implications for medical resident education. First, mindfulness was perceived to be a significant contributor to self-assessments of competency and performance. Second, both PA and NA were important to mindfulness and performance. Third, communication was associated with resident performance, mindfulness, and PA. These implications suggest that individual characteristics of mindfulness, communication, and affect, all potentially modifiable, influence care quality and safety. To improve low performers, surgical educators could

  4. Global perspective on training and staffing for paediatric cardiac critical care. (United States)

    Bronicki, Ronald A; Pollak, Uri; Argent, Andrew C; Kumar, R Krishna; Balestrini, Maria; Cogo, Paola; Cury Borim, Bruna; De Costa, Kumi; Beca, John; Shimizu, Naoki; Dominguez, Troy E


    This manuscript provides a global perspective on physician and nursing education and training in paediatric cardiac critical care, including available resources and delivery of care models with representatives from several regions of the world including Africa, Israel, Asia, Australasia, Europe, South America, and the United States of America.

  5. A survey of cultural competence of critical care nurses in KwaZulu ...

    African Journals Online (AJOL)

    A survey of cultural competence of critical care nurses in ... Nurses are primary caregivers and have a key role in providing care in a culturally ... relating to culture, gender or sexual orientation. ... concerning the population they work with, and although a ... lead to conflict, increased levels of anxiety, and stress among nurses,.

  6. Southern African Journal of Critical Care - Vol 24, No 1 (2008)

    African Journals Online (AJOL)

    Avoiding etomidate for emergency intubation. Throwing the baby out with the bathwater? T Hardcastle. Improving the quality of care of the critically ill patient. Implementing the central venous line care bundle in the ICU · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  7. Communication of bed allocation decisions in a critical care unit and accountability for reasonableness

    Directory of Open Access Journals (Sweden)

    Swota Alissa H


    Full Text Available Abstract Background Communication may affect perceptions of fair process for intensive care unit bed allocation decisions through its impact on the publicity condition of accountability for reasonableness. Methods We performed a qualitative case study to describe participant perceptions of the communication of bed allocation decisions in an 18-bed university affiliated, medical-surgical critical care unit at Sunnybrook and Women's College Health Sciences Centre. Interviewed participants were 3 critical care physicians, 4 clinical fellows in critical care, 4 resource nurses, 4 "end-users" (physicians who commonly referred patients to the unit, and 3 members of the administrative staff. Median bed occupancy during the study period (Jan-April 2003 was 18/18; daily admissions and discharges (median were 3. We evaluated our description using the ethical framework "accountability for reasonableness" (A4R to identify opportunities for improvement. Results The critical care physician, resource nurse, critical care fellow and end-users (trauma team leader, surgeons, neurosurgeons, anesthesiologists functioned independently in unofficial "parallel tracks" of bed allocation decision-making; this conflicted with the official designation of the critical care physician as the sole authority. Communication between key decision-makers was indirect and could exclude those affected by the decisions; notably, family members. Participants perceived a lack of publicity for bed allocation rationales. Conclusion The publicity condition should be improved for critical care bed allocation decisions. Decision-making in the "parallel tracks" we describe might be unavoidable within usual constraints of time, urgency and demand. Formal guidelines for direct communication between key participants in such circumstances would help to improve the fairness of these decisions.

  8. Agency doctorates

    International Nuclear Information System (INIS)


    Staff members of the Agency working at the Seibersdorf laboratory are continuing to achieve high academic distinction. Two more - both Austrian - have now been awarded the degree of Doctor of Agriculture. Joachim Kramer, who is 26, graduated from the Hochschule fur Bodenkultur in 1967 with the degree of Diplom-Ingenieur and then started work in the plant breeding and genetics section of the laboratory under the direction of Dr. Knut Mikaelsen. The results of the research work he carried out were accepted as the subject of a thesis for which he has now been granted his doctorate. The doctoral promotion took place on 30 June, at a ceremony attended by Dr. Andre Finkelstein, Deputy Director General for Research and Isotopes. The subject of Dr. Kramer's thesis was a comprehensive study of the mutagenic effects of fast neutrons and gamma rays, and the influence of various modifying factors such as water content, oxygen and metabolic state of seeds at the time of irradiation. This work has contributed significantly to the understanding of the mechanisms by which these two types of ionizing radiation produce mutations in seeds. The knowledge gained will be of great importance in the efficient use of ionizing radiation in practical plant breeding. Paul Wassermann, who is 33 years old, joined the Agency in 1965. He, too, graduated from the Hochschule fur Bodenkultur as Diplom-Ingenieur in agriculture, having graduated with honours previously from the agricultural secondary school at Raumberg, Austria, in 1958. Dr. Wassermann's own words may be used to explain how he came to gain his doctorate. 'In October, 1966, I completed my studies at the Hochschule,' he writes. 'I was employed at the Agency laboratories in Seibersdorf, working in the plant and soils group. Encouraged by the interesting research which was performed there, a thesis entitled 'the Fate of Nitrogen in Submerged Rice Soils' was started, which finally led to the doctor's degree in Agriculture in June this year

  9. Nurses’ Burnout in Oncology Hospital Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Yeliz İrem Tunçel


    Full Text Available Objective: Burnout is common in intensive care units (ICU because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory and depression (Beck Depression Scale. Results: From a total of 37 ICU nurses, 35 participated in the study (%94,5 response rate. High levels of emotional exhaustion in 82% and depersonalization in 51,4% of nurses was determined. Personal accomplishment was higher at 80%. Mild to moderate emotional state and mild anxiety was revealed. Years in profession,finding salary insufficient, finding the profession in its proper, choosing the profession of his own accord, work environment satisfaction and finding the social activity adequate were associated with burnout (p≤0.05. Conclusion: In our study, intensive care unit nurses’ burnout scores were found to be higher. Burnout was rare in nurses that choose the profession of his own accord, find the nursing profession in its proper, and social activity adequate and are satisfied with the work environment. Therefore, we believe that attention should be given to individual needs and preferences in the selection of ICU staff.

  10. Analysis of needs of the critically ill relatives and critical care professional's opinion. (United States)

    Sánchez-Vallejo, A; Fernández, D; Pérez-Gutiérrez, A; Fernández-Fernández, M


    To describe the needs of the families of patients admitted to the Intensive Care Unit (ICU) and the opinion of ICU professionals on aspects related to the presence of patient relatives in the unit. A prospective descriptive study was carried out between March and June 2015. Polyvalent ICU of León University Healthcare Complex (Spain). Two samples of volunteers were studied: one comprising the relatives emotionally closest to the primarily non-surgical patients admitted to the Unit for over 48hours, and the other composed of ICU professionals with over three months of experience in the ICU. One self-administered questionnaire was delivered to each relative and another to each professional. Sociodemographic data were collected. The variables in the questionnaire for relatives comprised the information received, closeness to the patient, safety of care, the support received, and comfort. In turn, the questionnaire for professionals addressed empathy and professional relationship with the family, visiting policy, and the effect of the family upon the patient. A total of 59% of the relatives (35/61) answered the questionnaire. Of these subjects, 91.4% understood the information received, though 49.6% received no information on nursing care. A total of 82.9% agreed with the visiting policy applied (95.2% were patient offspring; P<.05). Participation on the part of the professionals in turn reached 76.3% (61/80). A total of 59.3% would flexibilize the visiting policy, and 78.3% considered that the family afforded emotional support for the patient, with no destabilizing effect. On the other hand, 62.3% routinely informed the family, and 88% considered training in communication skills to be needed. Information was adequate, though insufficient in relation to nursing care. The professionals pointed to the need for training in communication skills. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  11. A cross selectional survey in a critical care: the job satisfaction and functioning team of the health professionals. (United States)

    La Sala, Rachele; Boninsegni, Katiuscia; Tani, Alice; Rasi, Alice; Ricci, Barbara; Sansovini, Linda; Scarpelli, Giulia; Artioli, Giovanna; Sarli, Leopoldo


    Health care workers, especially those who are part of the OS core, are essential in the delivery of services, as they represent the institution at the time of the contact with the user and they represent also the image of the organization. Health administrations, therefore, are called to improve the performance through a better motivation and satisfaction of the staff, in view of two strategic aspects: job satisfaction of professionals and team collaboration. Between January and September 2014, a survey at the OU (UUOO) intensive care and sub intensive has been made inside three hospitals in Emilia Romagna. It' s been a multicentre cross-sectional quantitative study by administering a self-report questionnaire designed to investigate the different constructs. On 742 questionnaires were spread 454 professionals gave it back  (response rate = 73%). Of those, 273 (60.1%) were nurses, 119 (26.2%) were physicians and 62 (13.7%) were healthcare operators. 62 (13.7%) Job Satisfaction was measured with the McCloskey Mueller Satisfaction Scale. Team Functioning was measured with the Index of Interprofessional Team Collaboration. Results from MANOVA indicated that physicians were less satisfied of scheduling than both nurses and healthcare operators. For professional opportunities, instead, healthcare operators showed the lower level of satisfaction. The participants seem to perceive a high level of team effectiveness and therefore the professionals involved in the care of critically ill patients than the two dimensions analysed, (reflection between the processes and interdependent roles), also state a greater tendency to respect the roles interdisciplinary, maintaining their professional autonomy and a lower tendency to use critical thinking to act professionally in order to improve the effectiveness of care provided. The study results oriented healthcare administrators, to take paths that feed the job satisfaction and the collaboration of professionals by developing the

  12. The evolution of pediatric critical care nursing: past, present, and future. (United States)

    Foglia, Dorothy C; Milonovich, Lisa M


    Although current nursing literature is overflowing with information related to the history of nursing in general, and even pediatric nursing, very little is published about PICU nursing. The evolution of pediatric critical care nursing is presented based on a historical context, the current state, and future projections. More specifically, this treatise focuses on the environment, the patient and family, and of course, the PICU nurse. Concluding remarks provide an insight into how health care reforms and how the use of clinical information technology will affect the role of the pediatric critical care nurse in the future. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. Anaesthetic and critical care management of thoracic injuries. (United States)

    Round, J A; Mellor, A J


    Thoracic wounding has been a relatively common presentation of military wounds throughout modern conflict. When civilian casualties are included the incidence has remained constant at around 10%, although the frequency and severity of wounds to combatants has been altered by modern body armour. Whilst thoracic injury has a high initial mortality on the battlefield, those surviving to reach hospital frequently have injuries that only require simple management. In addition to penetrating ballistic injury, blunt chest trauma frequently occurs on operations as a result of road traffic collisions or tertiary blast injury. The physiological impact of thoracic wounds, however, is often great and survivors often require intensive care management and, where available, complex strategies to ensure oxygenation and carbon dioxide removal. This review examines the incidence and patterns of thoracic trauma and looks at therapeutic options for managing these complex cases.

  14. A new risk prediction model for critical care: the Intensive Care National Audit & Research Centre (ICNARC) model. (United States)

    Harrison, David A; Parry, Gareth J; Carpenter, James R; Short, Alasdair; Rowan, Kathy


    To develop a new model to improve risk prediction for admissions to adult critical care units in the UK. Prospective cohort study. The setting was 163 adult, general critical care units in England, Wales, and Northern Ireland, December 1995 to August 2003. Patients were 216,626 critical care admissions. None. The performance of different approaches to modeling physiologic measurements was evaluated, and the best methods were selected to produce a new physiology score. This physiology score was combined with other information relating to the critical care admission-age, diagnostic category, source of admission, and cardiopulmonary resuscitation before admission-to develop a risk prediction model. Modeling interactions between diagnostic category and physiology score enabled the inclusion of groups of admissions that are frequently excluded from risk prediction models. The new model showed good discrimination (mean c index 0.870) and fit (mean Shapiro's R 0.665, mean Brier's score 0.132) in 200 repeated validation samples and performed well when compared with recalibrated versions of existing published risk prediction models in the cohort of patients eligible for all models. The hypothesis of perfect fit was rejected for all models, including the Intensive Care National Audit & Research Centre (ICNARC) model, as is to be expected in such a large cohort. The ICNARC model demonstrated better discrimination and overall fit than existing risk prediction models, even following recalibration of these models. We recommend it be used to replace previously published models for risk adjustment in the UK.

  15. Professional autonomy and job satisfaction: survey of critical care nurses in mainland Greece. (United States)

    Iliopoulou, Katerina K; While, Alison E


    This paper is a report of a study conducted to describe Greek critical care nurses' views on professional autonomy and its relationship with job satisfaction and other work-related variables. Professional autonomy is generally considered a highly desirable nursing attribute and a major factor in nurse job satisfaction. In the critical care environment, a high level of accountability, responsibility and autonomy are required to optimize outcomes of critically unstable patients. A questionnaire survey was conducted with a convenience sample of Greek critical care nurses (n = 431; response rate 70%) in 2007. Data were collected on professional autonomy, job satisfaction, role conflict and role ambiguity. Overall, nurses reported acting moderately autonomously. Younger nurses reported statistically significant lower levels of autonomy. Higher levels of autonomy were reported by female nurses. Multiple logistic regression revealed that appointment level, type of critical care unit and registration with a professional organization were independently associated with autonomy. A positive moderate association was found between reported autonomy, job satisfaction, role conflict and role ambiguity, but there was no relationship between job satisfaction and reported role conflict and role ambiguity. Further education, role enhancement and support are required for nurses working in critical care in Greece if they are to achieve the maximum potential of their professional role. Failure to address the perceptions of professional autonomy may have an impact on staff retention, because of job dissatisfaction. © 2010 Blackwell Publishing Ltd.

  16. Multiple intra-hospital transports during relocation to a new critical care unit. (United States)

    O'Leary, R-A; Conrick-Martin, I; O'Loughlin, C; Curran, M-R; Marsh, B


    Intra-hospital transport (IHT) of critically ill patients is associated with morbidity and mortality. Mass transfer of patients, as happens with unit relocation, is poorly described. We outline the process and adverse events associated with the relocation of a critical care unit. Extensive planning of the relocation targeted patient and equipment transfer, reduction in clinical pressure prior to the event and patient care during the relocation phase. The setting was a 30-bed, tertiary referral, combined medical and surgical critical care unit, located in a 570-bed hospital that serves as the national referral centre for cardiothoracic surgery and spinal injuries. All stakeholders relevant to the critical care unit relocation were involved, including nursing and medical staff, porters, information technology services, laboratory staff, project development managers, pharmacy staff and building contractors. Mortality at discharge from critical care unit and discharge from hospital were the main outcome measures. A wide range of adverse events were prospectively recorded, as were transfer times. Twenty-one patients underwent IHT, with a median transfer time of 10 min. Two transfers were complicated by equipment failure and three patients experienced an episode of hypotension requiring intervention. There were no cases of central venous or arterial catheter or endotracheal tube dislodgement, and hospital mortality at 30 days was 14%. Although IHT is associated with morbidity and mortality, careful logistical planning allows for efficient transfer with low complication rates.

  17. Impact of a 2-Day Critical Care Ultrasound Course during Fellowship Training: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Vi Am Dinh


    Full Text Available Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CCUS, standards establishing competency for its use are lacking. The purpose of this study was to evaluate the effectiveness of a 2-day CCUS course implementation on ultrasound-naïve critical care medicine (CCM fellows. Methods. Prospective evaluation of the impact of a two-day CCUS course on eight CCM fellows’ attitudes, proficiency, and use of CCUS. Ultrasound competency on multiple organ systems was assessed including abdominal, pulmonary, vascular, and cardiac systems. Subjects served as self-controls and were assessed just prior to, within 1 week after, and 3 months after the course. Results. There was a significant improvement in CCM fellows’ written test scores, image acquisition ability, and pathologic image interpretation 1 week after the course and it was retained 3 months after the course. Fellows also had self-reported increased confidence and usage of CCUS applications after the course. Conclusions. Implementation of a 2-day critical care ultrasound course covering general CCUS and basic critical care echocardiography using a combination of didactics, live models, and ultrasound simulators is effective in improving critical care fellows’ proficiency and confidence with ultrasound use in both the short- and long-term settings.

  18. Stages of Adoption Concern and Technology Acceptance in a Critical Care Nursing Unit. (United States)

    Berg, Gina M; LoCurto, Jamie; Lippoldt, Diana


    The aim of this study is to examine the stages of concern (self, task, and impact) and usability (trust, perceived usefulness, and ease of use) shifts experienced by nurses adopting new technology. Patient care processes in critical care units can be disrupted with the incorporation of information technology. New users of technology typically transition through stages of concern and experience shifts in acceptance during assimilation. Critical care nurses (N = 41) were surveyed twice: (1) pre, immediately after training, and (2) post, 3 months after implementation of technology. From presurvey to postsurvey, self-concerns decreased 14%, whereas impact concerns increased 22%. Furthermore, there was a 30% increase in trust and a 17% increase in perceived usefulness, even with a 27% decrease in ease of use. Adoption of new technology requires critical care nurses to adapt current practices, which may improve trust and perceived usefulness yet decrease perceptions of ease of use.

  19. The Untapped Potential of Patient and Family Engagement in the Organization of Critical Care. (United States)

    Haines, Kimberley J; Kelly, Phillipa; Fitzgerald, Peter; Skinner, Elizabeth H; Iwashyna, Theodore J


    There is growing interest in patient and family participation in critical care-not just as part of the bedside, but as part of educational and management organization and infrastructure. This offers tremendous opportunities for change but carries risk to patients, families, and the institution. The objective is to provide a concise definitive review of patient and family organizational participation in critical care as a high-risk population and other vulnerable groups. A pragmatic, codesigned model for critical care is offered as a suggested approach for clinicians, researchers, and policy-makers. To inform this review, a systematic search of Ovid Medline, PubMed, and Embase was undertaken in April 2016 using the MeSH terms: patient participation and critical care. A second search was undertaken in PubMed using the terms: patient participation and organizational models to search for other examples of engagement in vulnerable populations. We explicitly did not seek to include discussions of bedside patient-family engagement or shared decision-making. Two reviewers screened citations independently. Included studies either actively partnered with patients and families or described a model of engagement in critical care and other vulnerable populations. Data or description of how patient and family engagement occurred and/or description of model were extracted into a standardized form. There was limited evidence of patient and family engagement in critical care although key recommendations can be drawn from included studies. Patient and family engagement is occurring in other vulnerable populations although there are few described models and none which address issues of risk. A model of patient and family engagement in critical care does not exist, and we propose a pragmatic, codesigned model that takes into account issues of psychologic safety in this population. Significant opportunity exists to document processes of engagement that reflect a changing paradigm of

  20. Learning to manage vasoactive drugs-A qualitative interview study with critical care nurses. (United States)

    Häggström, Marie; Bergsman, Ann-Christin; Månsson, Ulrika; Holmström, Malin Rising


    Being a nurse in an intensive care unit entails caring for seriously ill patients. Vasoactive drugs are one of the tools that are used to restore adequate circulation. Critical care nurses often manage and administer these potent drugs after medical advice from physicians. To describe the experiences of critical care nurses learning to manage vasoactive drugs, and to highlight the competence required to manage vasoactive drugs. Twelve critical care nurses from three hospitals in Sweden were interviewed. Qualitative content analysis was applied. The theme "becoming proficient requires accuracy, practice and precaution" illustrated how critical care nurses learn to manage vasoactive drugs. Learning included developing cognitive, psychomotor, and effective skills. Sources for knowledge refers to specialist education combined with practical exercises, collegial support, and accessible routine documents. The competence required to manage vasoactive drugs encompassed well-developed safety thinking that included being careful, in control, and communicating failures. Specific skills were required such as titrating doses, being able to analyse and evaluate the technological assessments, adapting to the situation, and staying calm. Learning to manage vasoactive drugs requires a supportive introduction for novices, collegial support, lifelong learning, and a culture of safety. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. June 2015 Phoenix critical care journal club: interventions in ARDS

    Directory of Open Access Journals (Sweden)

    Robbins RA


    Full Text Available No abstract available. Article truncated at 150 words. Mortality has been declining in the adult respiratory distress syndrome (ARDS (1. However, the cause of the decline in mortality is unclear. The only intervention shown to improve survival has been low tidal volume ventilation but the mortality was improving before this intervention was widely used (2. Nevertheless, it was suggested that we look at system performance regarding ARDS management from a critical appraisal standpoint. This journal club was hoped to help as a starting point in that regard. Four potential beneficial interventions were discussed: 1. Conservative fluid management; 2. Optimal PEEP as determined by esophageal pressure; 3. Prone positioning; and 4. Mechanical ventilation driving pressure. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Engl ...

  2. Evidence and its uses in health care and research: the role of critical thinking. (United States)

    Jenicek, Milos; Croskerry, Pat; Hitchcock, David L


    Obtaining and critically appraising evidence is clearly not enough to make better decisions in clinical care. The evidence should be linked to the clinician's expertise, the patient's individual circumstances (including values and preferences), and clinical context and settings. We propose critical thinking and decision-making as the tools for making that link. Critical thinking is also called for in medical research and medical writing, especially where pre-canned methodologies are not enough. It is also involved in our exchanges of ideas at floor rounds, grand rounds and case discussions; our communications with patients and lay stakeholders in health care; and our writing of research papers, grant applications and grant reviews. Critical thinking is a learned process which benefits from teaching and guided practice like any discipline in health sciences. Training in critical thinking should be a part or a pre-requisite of the medical curriculum.

  3. Evidence and its uses in health care and research: The role of critical thinking (United States)

    Jenicek, Milos; Croskerry, Pat; Hitchcock, David L.


    Summary Obtaining and critically appraising evidence is clearly not enough to make better decisions in clinical care. The evidence should be linked to the clinician’s expertise, the patient’s individual circumstances (including values and preferences), and clinical context and settings. We propose critical thinking and decision-making as the tools for making that link. Critical thinking is also called for in medical research and medical writing, especially where pre-canned methodologies are not enough. It is also involved in our exchanges of ideas at floor rounds, grand rounds and case discussions; our communications with patients and lay stakeholders in health care; and our writing of research papers, grant applications and grant reviews. Critical thinking is a learned process which benefits from teaching and guided practice like any discipline in health sciences. Training in critical thinking should be a part or a pre-requisite of the medical curriculum. PMID:21169920

  4. Agency doctorates

    Energy Technology Data Exchange (ETDEWEB)



    Mr. Wen-chuan Li of China has become the first student to obtain a doctor's degree as a result of research work carried out in the Agency. Mr. Li, who is 33, graduated as a Bachelor of Agriculture at Taiwan Provincial Chung-hsing University in 1960 and in 1966 was granted a fellowship to study mutations in plant breeding at the Agency's Seibersdorf Laboratory near Vienna, under the direction of Dr. Knut Mikaelsen, a professor of the University of Bergen. The Hochschule fur Bodenkultur of Vienna accepted the research as being suitable for a thesis and have now granted the degree of Doctor of Agriculture. The subject of the thesis was modifying factors influencing the mutagenic effects of alkylating agents as compared with ionizing radiations in barley. Alkylating agents are involved in the use of chemicals as a means of changing the characteristics of seeds to bring about changes aimed at improving the quality of crops. Mr. Li's work is regarded as a significant contribution to the understanding of the mechanics by which mutations are induced, to the efficient use of chemicals and ionizing radiations in practical applications, and to the efforts of the Agency in collaboration with the Food and Agriculture Organization to benefit food supplies. Mr. Li has now completed his fellowship with the Agency and has been appointed an Assistant Professor in Plant Breeding at Taiwan Provincial Chung-hsing University. The photograph, taken in the plastic hot house at Seibersdorf, shows him studying rice plants grown from seeds subjected to irradiation. Another noteworthy achievement is that of Mr. Karl-Franz Lacina, a security guard at the Agency's headquarters. At the age of 50 he has been accorded the degree of Doctor of Philosophy at Vienna University, the result of six years' work in his leisure time. The major subject was Arabic, with French and philosophy as supporting subject. (author)

  5. Agency doctorates

    International Nuclear Information System (INIS)


    Mr. Wen-chuan Li of China has become the first student to obtain a doctor's degree as a result of research work carried out in the Agency. Mr. Li, who is 33, graduated as a Bachelor of Agriculture at Taiwan Provincial Chung-hsing University in 1960 and in 1966 was granted a fellowship to study mutations in plant breeding at the Agency's Seibersdorf Laboratory near Vienna, under the direction of Dr. Knut Mikaelsen, a professor of the University of Bergen. The Hochschule fur Bodenkultur of Vienna accepted the research as being suitable for a thesis and have now granted the degree of Doctor of Agriculture. The subject of the thesis was modifying factors influencing the mutagenic effects of alkylating agents as compared with ionizing radiations in barley. Alkylating agents are involved in the use of chemicals as a means of changing the characteristics of seeds to bring about changes aimed at improving the quality of crops. Mr. Li's work is regarded as a significant contribution to the understanding of the mechanics by which mutations are induced, to the efficient use of chemicals and ionizing radiations in practical applications, and to the efforts of the Agency in collaboration with the Food and Agriculture Organization to benefit food supplies. Mr. Li has now completed his fellowship with the Agency and has been appointed an Assistant Professor in Plant Breeding at Taiwan Provincial Chung-hsing University. The photograph, taken in the plastic hot house at Seibersdorf, shows him studying rice plants grown from seeds subjected to irradiation. Another noteworthy achievement is that of Mr. Karl-Franz Lacina, a security guard at the Agency's headquarters. At the age of 50 he has been accorded the degree of Doctor of Philosophy at Vienna University, the result of six years' work in his leisure time. The major subject was Arabic, with French and philosophy as supporting subject. (author)

  6. August 2016 critical care case of the month

    Directory of Open Access Journals (Sweden)

    Deangelis JL


    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: The patient is a previously healthy, albeit anxious, 15-year-old girl seen by her primary care physician. She has had several months of general malaise and ongoing fatigue and an increased frequency in night terrors over the past few weeks. Her family attributes this to stress of school and her new job. She was noted to have lost 3 kg in the previous nine weeks. PMH, SH, and FH: Her PMH was unremarkable. She is a student and denies smoking, drinking or drug abuse. Her family history is noncontributory. Physical Examination: Vital signs: BP 100/60 mm Hg, P 90 beats/min and regular, R 16 breaths/min, T 100.8 ºF, BMI 15; Diffuse, non-tender lymphadenopathy through the submandibular and upper anterior cervical chains; Lungs: clear; Heart: regular rhythm without murmur: Abdomen: slightly rounded and firm. Which of the following are diagnostic considerations at this time? 1. Anorexia nervosa 2. ...

  7. Critical care of the hematopoietic stem cell transplant recipient. (United States)

    Afessa, Bekele; Azoulay, Elie


    An estimated 50,000 to 60,000 patients undergo hematopoietic stem cell transplantation (HSCT) worldwide annually, of which 15.7% are admitted to the intensive care unit (ICU). The most common reason for ICU admission is respiratory failure and almost all develop single or multiorgan failure. Most HSCT recipients admitted to ICU receive invasive mechanical ventilation (MV). The overall short-term mortality rate of HSCT recipients admitted to ICU is 65%, and 86.4% for those receiving MV. Patient outcome has improved over time. Poor prognostic indicators include advanced age, poor functional status, active disease at transplant, allogeneic transplant, the severity of acute illness, and the development of multiorgan failure. ICU resource limitations often lead to triage decisions for admission. For HSCT recipients, the authors recommend (1) ICU admission for full support during their pre-engraftment period and when there is no evidence of disease recurrence; (2) no ICU admission for patients who refuse it and those who are bedridden with disease recurrence and without treatment options except palliation; (3) a trial ICU admission for patients with unknown status of disease recurrence with available treatment options.

  8. December 2017 critical care case of the month

    Directory of Open Access Journals (Sweden)

    Gotway MB


    Full Text Available No abstract available. Article truncated after 150 words. Clinical History: A 57-year-old man with no known previous medical history was brought to the emergency room via ambulance and admitted to the intensive care unit with a compliant of severe chest pain in the substernal region and epigastrium. The patient was awake and alert and did not complain of shortness of breath. Physical examination was largely unremarkable and the patient’s oxygen saturation was 98% on room air. The patient’s vital signs revealed tachycardia (105 bpm and his blood pressure was 108 mmHg / 60 mmHg. Laboratory evaluation showed a slightly elevated white blood cell count (13 x 109 cells/L, but his hemoglobin and hematocrit values were with within normal limits, as was his platelet count. Which of the following diagnoses are appropriate considerations for this patient’s condition? 1.\tAcute pericarditis 2.\tAortic dissection 3.\tCommunity-acquired pneumonia 4.\tMyocardial infarction 5.\tAll of the above …

  9. April 2017 critical care case of the month

    Directory of Open Access Journals (Sweden)

    Raschke RA


    Full Text Available No abstract available. Article truncated after 150 words. History of Present Illness: A 20-year-old woman was transferred from another medical center for care. She was pregnant and initially presented with a one day history of crampy abdominal pain with nausea and vomiting after eating old, bad tasting chicken two days previously. She had pain of her right arm and a non-displaced humeral fracture was seen on x-ray. The etiology of the fracture was unclear. Her illness rapidly progressed to respiratory distress requiring intubation. The fetus had deceleration of heart tones leading to a cesarean section and delivery of a non-viable infant. Subsequently, she had rapid progression of shock and anuria. Past Medical History: She had a previous history of a seizure disorder which was managed with levetiracetam, clonazepam, and folic acid. There was a previous intentional opiate overdose 2 years earlier. One month prior to admission she had visited her husband in Iraq. After returning to the US …

  10. Organ donation in adults: a critical care perspective. (United States)

    Citerio, Giuseppe; Cypel, Marcelo; Dobb, Geoff J; Dominguez-Gil, Beatriz; Frontera, Jennifer A; Greer, David M; Manara, Alex R; Shemie, Sam D; Smith, Martin; Valenza, Franco; Wijdicks, Eelco F M


    The shortage of organs for transplantation is an important medical and societal problem because transplantation is often the best therapeutic option for end-stage organ failure. We review the potential deceased organ donation pathways in adult ICU practice, i.e. donation after brain death (DBD) and controlled donation after circulatory death (cDCD), which follows the planned withdrawal of life-sustaining treatments (WLST) and subsequent confirmation of death using cardiorespiratory criteria. Strategies in the ICU to increase the number of organs available for transplantation are discussed. These include timely identification of the potential organ donor, optimization of the brain-dead donor by aggressive management of the physiological consequence of brain death, implementation of cDCD protocols, and the potential for ex vivo perfusion techniques. Organ donation should be offered as a routine component of the end-of-life care plan of every patient dying in the ICU where appropriate, and intensivists are the key professional in this process.

  11. Critical care medicine as a distinct product line with substantial financial profitability: the role of business planning. (United States)

    Bekes, Carolyn E; Dellinger, R Phillip; Brooks, Daniel; Edmondson, Robert; Olivia, Christopher T; Parrillo, Joseph E


    As academic health centers face increasing financial pressures, they have adopted a more businesslike approach to planning, particularly for discrete "product" or clinical service lines. Since critical care typically has been viewed as a service provided by a hospital, and not a product line, business plans have not historically been developed to expand and promote critical care. The major focus when examining the finances of critical care has been cost reduction, not business development. We hypothesized that a critical care business plan can be developed and analyzed like other more typical product lines and that such a critical care product line can be profitable for an institution. In-depth analysis of critical care including business planning for critical care services. Regional academic health center in southern New Jersey. None. As part of an overall business planning process directed by the Board of Trustees, the critical care product line was identified by isolating revenue, expenses, and profitability associated with critical care patients. We were able to identify the major sources ("value chain") of critical care patients: the emergency room, patients who are admitted for other problems but spend time in a critical care unit, and patients transferred to our intensive care units from other hospitals. The greatest opportunity to expand the product line comes from increasing the referrals from other hospitals. A methodology was developed to identify the revenue and expenses associated with critical care, based on the analysis of past experience. With this model, we were able to demonstrate a positive contribution margin of dollar 7 million per year related to patients transferred to the institution primarily for critical care services. This can be seen as the profit related to the product line segment of critical care. There was an additional positive contribution margin of dollar 5.8 million attributed to the critical care portion of the hospital stay of

  12. Implementing augmentative and alternative communication in critical care settings: Perspectives of healthcare professionals. (United States)

    Handberg, Charlotte; Voss, Anna Katarina


    To describe the perspectives of healthcare professionals caring for intubated patients on implementing augmentative and alternative communication (AAC) in