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Legal issues and nursing practice in intensive care units
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INTENSIVE AND CRITICAL CARE NURSING
day). The total number of TISS points summed 8477 (Average daily score 43). Two methods of calculating the cost of individual patient care have been derived: 1. Obtaining a value per TISS point by dividing the total fixed and specific costs by the total TISS points; and then multiplying the value per TISS point by an individual patient’s daily TISS score to calculate the cost per bed day for an individual patient, therefore: cost per bed day = patient’s daily TISS Score x value per TISS point. 2. Removing the fixed costs per bed day from the calculation, and dividing the total specific costs by the total TISS points to obtain the value per TISS point, therefore: cost per bed day = fixed costs t (patient’s daily TISS score x value per TISS point). Conclusions We conclude that using TISS to calculate the cost of care could prove to be very useful but needs further methodological refinement, and prospective validation in a larger patient sample.
The nurslq of conscious mechanically ventilated patients in the NetherIamis Eloise Monger Senior Staff Nurse, General Intensive Care Unit, Southampton General Hospital, Southampton, UK The aims were to observe and evaluate the strategies for nursing conscious mechanically ventilated patients in the ITU at OLVG Amsterdam, where this practice has been routine for 14 years. As this research, A Florence Nightingale Scholarship, was to be undertaken in a foreign country, a simple observational technique was used. The researcher worked alongside the Dutch nurses for 1 month, informally interviewing patients, nurses and doctors, and taking notes documenting illustrations of actual practice and philosophy. LXrcwsion offindings The ITU has 16 beds for general and cardiothoracic patients, there are no paediatric or neurological services. The unit is run on a philosophy of conscious ventilation, all vital functions are supported not overridden. and prediction/prevention of complications/ deterioration are paramount. The patients are generally only sedated for intuhation and thereafter awake and managed on pressure support. They are all intubated via the oral route but communicate well by various means, this is improved by the fact that they are not confused or hallucinating as a result of sedative drugs. Nursing is not l:l, but based on a categorisation of dependence. A bond of trust between nurses and patients is an important aspect of their care, patients are allowed time to themselves, and are encouraged to take responsibility for their own analgesia, pressure
area care and active exercises, as they are able. The patients are fed as soon as possible and normal bowel function is maintained by a variety of treatments. Mobilisation is also started very early, and patients spend short periods prone and in specially adapted chairs, at least once daily. It was very interesting that very sick patients became unconscious anyway,and this is an obvious sign of deterioration; the converse is true of improvement. Conclusion Conscious ventilation is possible and humane. The patients are able to maintain some independence at the most dependent time of their lives. The problems of sedation induced agitation and hallucination do not occur, and many of the common complications of ITU treatment are limited. Critical care nurses need to reassess the stresses and implications of sedation, and develop our skills in this area. This is the only way we will have truly individualised care in ITU, are we prepared to meet the challenge? Further research is required to ensure that the long term effects of conscious ventilation are not detrimental to the patient.
Legal issues and nursing practice in intensive care units Caroline J Elliot Staff Nurse, Intensive Care Unit, Bristol Royal Infirmary, Bristol, UK The presentation is to focus on two points: 1) the Law exists to protect nurses and patients, not solely as a weapon for use in conflicting situations; 2) actions that can be undertaken within nursing procedures to enhance lawful practice and mitigate for the use of the Law as method of correction and compensation. It will consider the following main issues: 1. How the law serves patients e.g. consent, assault and battery, confidentiality, Patient’s Charter. 2. How the law selves nurses e.g. defending profes sional practice, employers’ duties. 3. Specific issues e.g. consent, organ donation and transplantation, withdrawal of life support. 4. Mitigating actions e.g. patient advocacy, communication and counselling skills, treatment planning.
clinical supervision: an approach to developing eIInical competency in critical care Rim Manley Clinical Nurse Specialist, ITU/NDU, Chelsea and Westminster Hospital and Lecturer in Nursing IANE, RCN, London, UK Competency can be defined simply from the perspective of performing psychomotor skills. However this represents only one end of the continuum, at the other end it is viewed as a complex process involving the inte-
INTENSIVE AND CRITICAL CARE NURSING
day). The total number of TISS points summed 8477 (Average daily score 43). Two methods of calculating the cost of individual patient care have been derived: 1. Obtaining a value per TISS point by dividing the total fixed and specific costs by the total TISS points; and then multiplying the value per TISS point by an individual patient’s daily TISS score to calculate the cost per bed day for an individual patient, therefore: cost per bed day = patient’s daily TISS Score x value per TISS point. 2. Removing the fixed costs per bed day from the calculation, and dividing the total specific costs by the total TISS points to obtain the value per TISS point, therefore: cost per bed day = fixed costs t (patient’s daily TISS score x value per TISS point). Conclusions We conclude that using TISS to calculate the cost of care could prove to be very useful but needs further methodological refinement, and prospective validation in a larger patient sample.
The nurslq of conscious mechanically ventilated patients in the NetherIamis Eloise Monger Senior Staff Nurse, General Intensive Care Unit, Southampton General Hospital, Southampton, UK The aims were to observe and evaluate the strategies for nursing conscious mechanically ventilated patients in the ITU at OLVG Amsterdam, where this practice has been routine for 14 years. As this research, A Florence Nightingale Scholarship, was to be undertaken in a foreign country, a simple observational technique was used. The researcher worked alongside the Dutch nurses for 1 month, informally interviewing patients, nurses and doctors, and taking notes documenting illustrations of actual practice and philosophy. LXrcwsion offindings The ITU has 16 beds for general and cardiothoracic patients, there are no paediatric or neurological services. The unit is run on a philosophy of conscious ventilation, all vital functions are supported not overridden. and prediction/prevention of complications/ deterioration are paramount. The patients are generally only sedated for intuhation and thereafter awake and managed on pressure support. They are all intubated via the oral route but communicate well by various means, this is improved by the fact that they are not confused or hallucinating as a result of sedative drugs. Nursing is not l:l, but based on a categorisation of dependence. A bond of trust between nurses and patients is an important aspect of their care, patients are allowed time to themselves, and are encouraged to take responsibility for their own analgesia, pressure
area care and active exercises, as they are able. The patients are fed as soon as possible and normal bowel function is maintained by a variety of treatments. Mobilisation is also started very early, and patients spend short periods prone and in specially adapted chairs, at least once daily. It was very interesting that very sick patients became unconscious anyway,and this is an obvious sign of deterioration; the converse is true of improvement. Conclusion Conscious ventilation is possible and humane. The patients are able to maintain some independence at the most dependent time of their lives. The problems of sedation induced agitation and hallucination do not occur, and many of the common complications of ITU treatment are limited. Critical care nurses need to reassess the stresses and implications of sedation, and develop our skills in this area. This is the only way we will have truly individualised care in ITU, are we prepared to meet the challenge? Further research is required to ensure that the long term effects of conscious ventilation are not detrimental to the patient.
Legal issues and nursing practice in intensive care units Caroline J Elliot Staff Nurse, Intensive Care Unit, Bristol Royal Infirmary, Bristol, UK The presentation is to focus on two points: 1) the Law exists to protect nurses and patients, not solely as a weapon for use in conflicting situations; 2) actions that can be undertaken within nursing procedures to enhance lawful practice and mitigate for the use of the Law as method of correction and compensation. It will consider the following main issues: 1. How the law serves patients e.g. consent, assault and battery, confidentiality, Patient’s Charter. 2. How the law selves nurses e.g. defending profes sional practice, employers’ duties. 3. Specific issues e.g. consent, organ donation and transplantation, withdrawal of life support. 4. Mitigating actions e.g. patient advocacy, communication and counselling skills, treatment planning.
clinical supervision: an approach to developing eIInical competency in critical care Rim Manley Clinical Nurse Specialist, ITU/NDU, Chelsea and Westminster Hospital and Lecturer in Nursing IANE, RCN, London, UK Competency can be defined simply from the perspective of performing psychomotor skills. However this represents only one end of the continuum, at the other end it is viewed as a complex process involving the inte-