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Why do nurses leave ICU?
VOL 6 NO 3 1993
AUSTRALIAN CRlTICAL CARE
ANZICS/L-, PN BRANCH 7TH CONTINUIN( NJCATION MEE WORLD CONGRESS CENTR L
A1
ISTR PREOXYGENATION WHAT'S MYTH? WHAT'S FACT?
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A. Park Endomcheal suction (ETS) in patients has been described in combination with a number of adverse effects. The focus of this literature review was: 1.To evaluate the incidence of clinically significant arterial hypoxemia post ETS. 2.To evaluate the effects of hyperoxygenation and/or hyperinflation on the post suction Pa@ and 3.To explore the evidence of cardiovascular dysfunction secondary to the practice of ETS. Firstly, the literature relating ETS and hypoxia was evaluated, using a fall post suction in either the arterial saturation to 4 0 % or the Pa@ to c60 mmHg as the criteria indicative of clinically significant hypoxia. Using these criteria, only a small number of articles demonstrated a clinically significant fall in these variables post suction. When the effects of hyperoxygenation are evaluated, the response of the Pa02 is variable among patients. It is proposed that this phenomenon is secondary to an alteration in the intrapulrnonary shunt. With regard to the literature on hyperinflation, the evidence favours closed suction techniques as opposed to disconnecting the patient from the ventilator. In addition, significant variations in lung inflation volume, airway pressure and F1@ appear common using off ventilator hyperinflation/hyperoxygenation techniques. Finally, significant falls in the Sv@ have been described in the recent literature post ETS. This suggests that occult changes in the Sv02 may occur frequently during ETS. 28.
The conclusions reached in terms of the evidence available are that closed suction techniques, with or without ventilator preoxygenation, will minimise the potential adverse consequences associated with endotracheal suction.
critical care course. The three main reasons cited for leaving critical care were:
WHY DO NURSES LEAVE ICU?
Further examination of the demographic data produced in the survey revealed that 69% were currently in critical care, and 93% in nursing. The study also found that most of the nurses currently not nursing (55%) have only temporarily left the profession.
C. Meijs It is acknowledged that critical care nursing education is costly and attrition higher than desirable. One strategy utilised to predict retention in both the profession and various specialities has been in attempting to discover the nursing personality type. Personality profiling has occurred at all levels and areas of nursing; however to date, no set profde has been formulated. A survey of Victorian certificated critical care nurses who had undertaken their critical care course in 1987, 1988, and 1989 was conducted to determine if the personality trait intolerance of ambiguity differed in nurses still working in critical care and those who have left within two years of completing their course. No difference is(sic) this trait was found between the two groups of nurses when their ambiguity scores were analysed using one way analysis of covariance, with age and sex as covariates. Chi-squared analysis was used to compare demographic detail of the two groups of nurses. Significant differences Q~0.05)found between practising and non practising critical care nurses were: age, marital status and amount of nursing experience prior to commencing their critical care course. The profile of the non practising critical care nurse is as follows: the nurse is over 30, married, and has at least five years of nursing experience before undertaking a
1) career advancement in nursing (42%), 2) stress or burnout in critical care (27%), 3) personal or family reasons (21%).
HEAT LOSS DURING HAEMOFILTRATION Sue Williams, William Kelly, John Santamaria St Vincent's Hospital Melbourne To investigate heat loss during haemofiltration, we examined the heat fluxes along a simulated patient circuit in relation to (1) site, (2) changes in flow, dialysate, and replacement fluid rates, and (3) application of foil. A standard haemofiltration circuit and a blood warmer representing a patient were used. Temperature was monitored at four sites; arterial, pre-filter, post-filter and venous limb. A crystalloid solution circulated at flow rates of 100-200 ml/min. Replacement and dialysate fluids were infused at 250-1000 ml/hour. Replacement fluid was warmed. Experiments were performed with and without two layers of aluminium foil applied to all tubing. Heat flux Cjoules/min) is equal to 4.18xflow (mllmin) x (T2-Ti). Combinations of the above were randomly allocated and a repeated measures ANOVA used for statistical analysis.
AUSTRALIAN CRlTICAL CARE
ANZICS/L-, PN BRANCH 7TH CONTINUIN( NJCATION MEE WORLD CONGRESS CENTR L
A1
ISTR PREOXYGENATION WHAT'S MYTH? WHAT'S FACT?
-
A. Park Endomcheal suction (ETS) in patients has been described in combination with a number of adverse effects. The focus of this literature review was: 1.To evaluate the incidence of clinically significant arterial hypoxemia post ETS. 2.To evaluate the effects of hyperoxygenation and/or hyperinflation on the post suction Pa@ and 3.To explore the evidence of cardiovascular dysfunction secondary to the practice of ETS. Firstly, the literature relating ETS and hypoxia was evaluated, using a fall post suction in either the arterial saturation to 4 0 % or the Pa@ to c60 mmHg as the criteria indicative of clinically significant hypoxia. Using these criteria, only a small number of articles demonstrated a clinically significant fall in these variables post suction. When the effects of hyperoxygenation are evaluated, the response of the Pa02 is variable among patients. It is proposed that this phenomenon is secondary to an alteration in the intrapulrnonary shunt. With regard to the literature on hyperinflation, the evidence favours closed suction techniques as opposed to disconnecting the patient from the ventilator. In addition, significant variations in lung inflation volume, airway pressure and F1@ appear common using off ventilator hyperinflation/hyperoxygenation techniques. Finally, significant falls in the Sv@ have been described in the recent literature post ETS. This suggests that occult changes in the Sv02 may occur frequently during ETS. 28.
The conclusions reached in terms of the evidence available are that closed suction techniques, with or without ventilator preoxygenation, will minimise the potential adverse consequences associated with endotracheal suction.
critical care course. The three main reasons cited for leaving critical care were:
WHY DO NURSES LEAVE ICU?
Further examination of the demographic data produced in the survey revealed that 69% were currently in critical care, and 93% in nursing. The study also found that most of the nurses currently not nursing (55%) have only temporarily left the profession.
C. Meijs It is acknowledged that critical care nursing education is costly and attrition higher than desirable. One strategy utilised to predict retention in both the profession and various specialities has been in attempting to discover the nursing personality type. Personality profiling has occurred at all levels and areas of nursing; however to date, no set profde has been formulated. A survey of Victorian certificated critical care nurses who had undertaken their critical care course in 1987, 1988, and 1989 was conducted to determine if the personality trait intolerance of ambiguity differed in nurses still working in critical care and those who have left within two years of completing their course. No difference is(sic) this trait was found between the two groups of nurses when their ambiguity scores were analysed using one way analysis of covariance, with age and sex as covariates. Chi-squared analysis was used to compare demographic detail of the two groups of nurses. Significant differences Q~0.05)found between practising and non practising critical care nurses were: age, marital status and amount of nursing experience prior to commencing their critical care course. The profile of the non practising critical care nurse is as follows: the nurse is over 30, married, and has at least five years of nursing experience before undertaking a
1) career advancement in nursing (42%), 2) stress or burnout in critical care (27%), 3) personal or family reasons (21%).
HEAT LOSS DURING HAEMOFILTRATION Sue Williams, William Kelly, John Santamaria St Vincent's Hospital Melbourne To investigate heat loss during haemofiltration, we examined the heat fluxes along a simulated patient circuit in relation to (1) site, (2) changes in flow, dialysate, and replacement fluid rates, and (3) application of foil. A standard haemofiltration circuit and a blood warmer representing a patient were used. Temperature was monitored at four sites; arterial, pre-filter, post-filter and venous limb. A crystalloid solution circulated at flow rates of 100-200 ml/min. Replacement and dialysate fluids were infused at 250-1000 ml/hour. Replacement fluid was warmed. Experiments were performed with and without two layers of aluminium foil applied to all tubing. Heat flux Cjoules/min) is equal to 4.18xflow (mllmin) x (T2-Ti). Combinations of the above were randomly allocated and a repeated measures ANOVA used for statistical analysis.