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Hypothermia in Trauma
THE 19TH AUSTRALIAN & NEW ZEALAND SCIENTIFIC MEETING ON INTENSIVE CARE CONFERENCE ABSTRACTS experience, appointment level, medical coverage, hospital policies and case mix. The major findings of this study were: there was considerable variability in decision frequencies for most types of decisions, which indicates major differences in nurse decision behaviour; there was evidence of a positive association between level of participation in decisions and levels of satisfaction with decision making; there was evidence of a positive association between nurse seniority and levels of participation in decisions in critical care.
22nd October, 1994.
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The nursing process: is a structured approach a requisite for professional intensive care nursing practice? Rhonda P Marriott Edith Cowan University, School of Nursing, Western Australia Has the competent, professional intensive care nurse surpassed the need to slavishly adhere to the structure of the nursing process? Is it possible to endorse that the knowledge and requirements to perform nursing care, in a stepwise fashion such as the nursing process, has, for the expert nurse, become internalised. To explain practice in a pedantic, rule governed fashion, as the nursing process documentation requires, is, for the expert, demeaning and retrograde. If, as a profession, we accept Patricia Benner's concept of expert practice, it is time to re-examine the way in which we apply the nursing process in our clinical practice. The experiences of a group of expert intensive care is supportive of the concept of "professional life without the nursing process". Through a combination of group and individual interactions, guided reflection was utilized to determine the process of how expert nurses in the intensive care viewed their practice. Key factors elicited were the application of the nursing process to the process of clinical practice, and the process of problem solving. While the shared nurses' experiences are limited, the information highlighted important issues and begs the question of continuing a strict adherence to the nursing process in the intensive care clinical setting.
Free Paper
22nd October, 1994.
Hypothermia in Trauma Kim L Bowers Westmead Hospital, Westmead, NSW Numerous factors interfere with the body's ability to regulate and maintajn temperature in the trauma victim. The result of thermoregulatory impairment is often hypothermia. It has been observed that temperature is the vital sign not consistently recorded in the acute trauma patient. Studies demonstrate that patients with a higher ISS have lower temperatures and that the patient's temperature is often not taken. We aimed to see if these trends hold true, for a group of patients with severe trauma admitted to Westmead Hospital. A retrospective study was carried out using the Trauma data base during a six month period in 1993 on all patients with an ISSSYMBOL 179 \f "Symbol"l6. Temperatures taken during the resuscitation phase were assessed.
Sixty patients, (10 Female: 50 Male, age range 15 - 59) were studied. Twenty five percent of patients did not have their temperature taken on admission. Twenty one percent had an ISS of >24 (severe),53.8% did not have their temperature taken on admission and 30.8% had a temperature of SYMBOL 163 \f "SymboI"35.5. In the Moderate category (ISS ,SYMBOL 163 \f "Symbol"24) only 17% did not have their temperature taken on admission and 17% had a admission temperature of SYMBOL 163 \f "SymboI"35.5. These results suggest that patients with a higher ISS were less likely to have-their temperature taken and 30% were hypothermic. These results demonstrate that recording of temperature in trauma patients with multiple injuries needs to be addressed as they are at risk of suffering the sequelae of hypothermia.
Friday 21st to Sunday 23rd October, 1994.
Poster presentation. * TEACHING CPR TO THE MEDICAL, DENTAL AND NURSING PROFESSION. Siva Nauaratnam, T K Biswas, G A Harrison, D Sainsbury Concord, St Vincent's Sydney, Woman & Children Hos~ital,Adelaide. Early and effective CPR saves lives. To maintain proficiency one has to practice on an annual basis. Over 9 months we have taught 158 GPs, dentists and nurses BLS. One hundred and thirty of these participants returned the questionnaire giving a response rate of 82%. Eighteen(l7%)GPs, 2 (15% ) dentists and 4 (36%) of nurses had never practiced on a manikin before. Only 37 (35%) of GPs, 0% dentists and 2 (18%) nurses felt they had adequate skills in performing BLS. The Concord ALS course was developed based on the recommendations of the Australian Resuscitation Council and the KISS principle (Keep it Simple and Safe). It consists of 3 hours of lectures and 4 hours of hands on workshop on external chest compression, mouth-valve-mask and bag-valve-mask ventilation, cannulation, intubation, rhythms recognition in cardiac arrest and defibrillation. We have taught 135 doctors and nurses in Shellharbour (63), Cairns (23), Australian Defence Forces (21) and Townsville (28). Lecture notes were distributed 2 weeks before the course and a 16 multiple-choice question examination was conducted pre and post lecture to evaluate retention of knowledge. Results: Number of correct answers pre and post lecture. Pre-lecture Post-lecture Cairns 14 (88%)16 (100%) Shellharbour 11 ( 69% ) 15 ( 94% ) Townsville 13 (81%) 15 (94%) Based on the educational principles of self-directed adult learning we have also developed the following educational tools for CPR: books, computer interactive programs, 35mm slides, cassettes and video.
22nd October, 1994.
Free Paper
The nursing process: is a structured approach a requisite for professional intensive care nursing practice? Rhonda P Marriott Edith Cowan University, School of Nursing, Western Australia Has the competent, professional intensive care nurse surpassed the need to slavishly adhere to the structure of the nursing process? Is it possible to endorse that the knowledge and requirements to perform nursing care, in a stepwise fashion such as the nursing process, has, for the expert nurse, become internalised. To explain practice in a pedantic, rule governed fashion, as the nursing process documentation requires, is, for the expert, demeaning and retrograde. If, as a profession, we accept Patricia Benner's concept of expert practice, it is time to re-examine the way in which we apply the nursing process in our clinical practice. The experiences of a group of expert intensive care is supportive of the concept of "professional life without the nursing process". Through a combination of group and individual interactions, guided reflection was utilized to determine the process of how expert nurses in the intensive care viewed their practice. Key factors elicited were the application of the nursing process to the process of clinical practice, and the process of problem solving. While the shared nurses' experiences are limited, the information highlighted important issues and begs the question of continuing a strict adherence to the nursing process in the intensive care clinical setting.
Free Paper
22nd October, 1994.
Hypothermia in Trauma Kim L Bowers Westmead Hospital, Westmead, NSW Numerous factors interfere with the body's ability to regulate and maintajn temperature in the trauma victim. The result of thermoregulatory impairment is often hypothermia. It has been observed that temperature is the vital sign not consistently recorded in the acute trauma patient. Studies demonstrate that patients with a higher ISS have lower temperatures and that the patient's temperature is often not taken. We aimed to see if these trends hold true, for a group of patients with severe trauma admitted to Westmead Hospital. A retrospective study was carried out using the Trauma data base during a six month period in 1993 on all patients with an ISSSYMBOL 179 \f "Symbol"l6. Temperatures taken during the resuscitation phase were assessed.
Sixty patients, (10 Female: 50 Male, age range 15 - 59) were studied. Twenty five percent of patients did not have their temperature taken on admission. Twenty one percent had an ISS of >24 (severe),53.8% did not have their temperature taken on admission and 30.8% had a temperature of SYMBOL 163 \f "SymboI"35.5. In the Moderate category (ISS ,SYMBOL 163 \f "Symbol"24) only 17% did not have their temperature taken on admission and 17% had a admission temperature of SYMBOL 163 \f "SymboI"35.5. These results suggest that patients with a higher ISS were less likely to have-their temperature taken and 30% were hypothermic. These results demonstrate that recording of temperature in trauma patients with multiple injuries needs to be addressed as they are at risk of suffering the sequelae of hypothermia.
Friday 21st to Sunday 23rd October, 1994.
Poster presentation. * TEACHING CPR TO THE MEDICAL, DENTAL AND NURSING PROFESSION. Siva Nauaratnam, T K Biswas, G A Harrison, D Sainsbury Concord, St Vincent's Sydney, Woman & Children Hos~ital,Adelaide. Early and effective CPR saves lives. To maintain proficiency one has to practice on an annual basis. Over 9 months we have taught 158 GPs, dentists and nurses BLS. One hundred and thirty of these participants returned the questionnaire giving a response rate of 82%. Eighteen(l7%)GPs, 2 (15% ) dentists and 4 (36%) of nurses had never practiced on a manikin before. Only 37 (35%) of GPs, 0% dentists and 2 (18%) nurses felt they had adequate skills in performing BLS. The Concord ALS course was developed based on the recommendations of the Australian Resuscitation Council and the KISS principle (Keep it Simple and Safe). It consists of 3 hours of lectures and 4 hours of hands on workshop on external chest compression, mouth-valve-mask and bag-valve-mask ventilation, cannulation, intubation, rhythms recognition in cardiac arrest and defibrillation. We have taught 135 doctors and nurses in Shellharbour (63), Cairns (23), Australian Defence Forces (21) and Townsville (28). Lecture notes were distributed 2 weeks before the course and a 16 multiple-choice question examination was conducted pre and post lecture to evaluate retention of knowledge. Results: Number of correct answers pre and post lecture. Pre-lecture Post-lecture Cairns 14 (88%)16 (100%) Shellharbour 11 ( 69% ) 15 ( 94% ) Townsville 13 (81%) 15 (94%) Based on the educational principles of self-directed adult learning we have also developed the following educational tools for CPR: books, computer interactive programs, 35mm slides, cassettes and video.