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The usefulness of intensive care treatment:- perspectives of medical and nursing staff
AUSTRALIAN CRITICAL CARE
VOL 6 NO 2 1993
CACCN (NSW BRANCH) Seminar '93
-
30th April 1993
ABSTRACTS TRAUMA NURSING IN THE USA Bernadine McDonald ICU Mater Hospital Crows Nest, New South Wales This paper will outline aspects of the expanded role of Critical Care Trauma Nurses. These reflections have been distilled from the speaker's personal experience as well as a series of colleagues interviews in the Washington-Baltimore region of the USA. Critical Care Trauma Nurses aim to deliver a continuum of skilled nursing care whether "on scene" as flight nurses, in the Emergency Department with ongoing assessment and management, or via more specialised care in the Intensive Care Unit. In addition to the Critical Care Trauma Nurse's obvious clinical strengths, our American colleagues continue to creatively expand their role. The contribution of the Critical Care Trauma Nurse to nursing and medical education and research, community outreach in preventative measures as well as institutional development is regarded as essential. The nature of Trauma Nursing, particularly in the USA, coupled with current fiscal constraints could be expected to compound the stresses experienced by nurses. These stresses, to some extent, seem to be offset by the high regard in which the Critical Care Trauma Nurses are held by their institutions and the general community. Our American colleagues are to be admired for their creativity and vision. As Australian Critical
Care Nurses, we can benefit from their experience, adapting it to our own system in a uniquely Australian way, having at the same time a well deserved pride in our level of skill and care in the trauma setting.
THE USEFULNESS OF INTENSIVE CARE TREATMENT:PERSPECTIVES OF MEDICAL AND NURSING STAFF Martin Boyle Richard W Morris Athena Harris-Ingall The Prince Henry Hospital Little Bay, New South Wales Which patients' states or circumstances effect the judgement of Intensive Care (IC) medical and nursing staff as to how useful intensive care treatment is? Do IC medical and nursing staff differ significantly in their attitudes regarding the usefulness of IC treatment? Or do they show similarity in their attitude but differ as group from broader community views of the usefulness of IC treatment. To gain insight into these questions a group of IC staff (35 medical, 108 nursing) and pre-clinical students (1 10 medical, 136 nursing) responded to a questionnaire asking them to consider how 12 patient factors including age, functional state, socioeconomic factors, length and cost of the IC stay, culpability, disease state and length of survival after IC unit discharge affected their judgement of the usefulness of IC treatment for an individual patient.
Results showed that: (1) students felt IC treatment more useful than IC staff regardless of the patient characteristic; (2) IC doctor and nurse responses were very similar. IC staff considered that IC treatment "tended to be useless" or was "useless" if the patient had required "institutional care" or was in a "vegetative" state before or after IC treatment. IC treatment "tended to be useless" when considering the pathology groups of "malignancy" and "diseases of aging", the diagnostic groups "AIDS" and "Quadraplegia", and where survival was expected to be "<3 months". It is hoped that a greater understanding of these perceptions will assist staff, families and patients to arrive at rational and ethical decisions regarding intensive care treatment given the pressures of an increasingly resource scarce health care environment.
NURSING IMPLICATIONS OF LOW-DOSE HEPARIN TO INFUSATE TO IMPROVE INFUSION SITE SURVIVAL IN CHILDREN Alex Wright The University of Sydney Faculty of Health Sciences School of Nursing OBJECTIVE: To determine if the addition of low-dose heparin to infusate will prolong infusion site survival in children. METHODS: An experimental design was used whereby patients were randomly allocated into control and treatment groups. The treatment group received pre-mixed fluids containing 1
VOL 6 NO 2 1993
CACCN (NSW BRANCH) Seminar '93
-
30th April 1993
ABSTRACTS TRAUMA NURSING IN THE USA Bernadine McDonald ICU Mater Hospital Crows Nest, New South Wales This paper will outline aspects of the expanded role of Critical Care Trauma Nurses. These reflections have been distilled from the speaker's personal experience as well as a series of colleagues interviews in the Washington-Baltimore region of the USA. Critical Care Trauma Nurses aim to deliver a continuum of skilled nursing care whether "on scene" as flight nurses, in the Emergency Department with ongoing assessment and management, or via more specialised care in the Intensive Care Unit. In addition to the Critical Care Trauma Nurse's obvious clinical strengths, our American colleagues continue to creatively expand their role. The contribution of the Critical Care Trauma Nurse to nursing and medical education and research, community outreach in preventative measures as well as institutional development is regarded as essential. The nature of Trauma Nursing, particularly in the USA, coupled with current fiscal constraints could be expected to compound the stresses experienced by nurses. These stresses, to some extent, seem to be offset by the high regard in which the Critical Care Trauma Nurses are held by their institutions and the general community. Our American colleagues are to be admired for their creativity and vision. As Australian Critical
Care Nurses, we can benefit from their experience, adapting it to our own system in a uniquely Australian way, having at the same time a well deserved pride in our level of skill and care in the trauma setting.
THE USEFULNESS OF INTENSIVE CARE TREATMENT:PERSPECTIVES OF MEDICAL AND NURSING STAFF Martin Boyle Richard W Morris Athena Harris-Ingall The Prince Henry Hospital Little Bay, New South Wales Which patients' states or circumstances effect the judgement of Intensive Care (IC) medical and nursing staff as to how useful intensive care treatment is? Do IC medical and nursing staff differ significantly in their attitudes regarding the usefulness of IC treatment? Or do they show similarity in their attitude but differ as group from broader community views of the usefulness of IC treatment. To gain insight into these questions a group of IC staff (35 medical, 108 nursing) and pre-clinical students (1 10 medical, 136 nursing) responded to a questionnaire asking them to consider how 12 patient factors including age, functional state, socioeconomic factors, length and cost of the IC stay, culpability, disease state and length of survival after IC unit discharge affected their judgement of the usefulness of IC treatment for an individual patient.
Results showed that: (1) students felt IC treatment more useful than IC staff regardless of the patient characteristic; (2) IC doctor and nurse responses were very similar. IC staff considered that IC treatment "tended to be useless" or was "useless" if the patient had required "institutional care" or was in a "vegetative" state before or after IC treatment. IC treatment "tended to be useless" when considering the pathology groups of "malignancy" and "diseases of aging", the diagnostic groups "AIDS" and "Quadraplegia", and where survival was expected to be "<3 months". It is hoped that a greater understanding of these perceptions will assist staff, families and patients to arrive at rational and ethical decisions regarding intensive care treatment given the pressures of an increasingly resource scarce health care environment.
NURSING IMPLICATIONS OF LOW-DOSE HEPARIN TO INFUSATE TO IMPROVE INFUSION SITE SURVIVAL IN CHILDREN Alex Wright The University of Sydney Faculty of Health Sciences School of Nursing OBJECTIVE: To determine if the addition of low-dose heparin to infusate will prolong infusion site survival in children. METHODS: An experimental design was used whereby patients were randomly allocated into control and treatment groups. The treatment group received pre-mixed fluids containing 1