Nursing's role in complementary and alternative therapy use in critical care

Critical care nurses can expect to encounter more patients using CAT and increasing opportunities and requests for CAT use in their critical care environments. This provides an opportunity for nurses' involvement to shape proactively how the use of these therapies will unfold in critical care. This can be accomplished in various ways. Actively ask patients and families about use of CAT. Initiate discussions with colleagues and peers about professional and personal use of therapies. Explore the knowledge and education needed to administer specific CAT. Engage in research regarding the use of CAT in critical care. Identify experts in the institution and surrounding community. Encourage critical care units and institutions to consider how CAT should be implemented across the institution. From a broader perspective, nurses may become part of professional political processes shaping patient accessibility to CAT and the use of CAT in the discipline, across disciplines, and in healthcare settings and public domains. It is crucial that nurses not relinquish their role as traditional providers of CAT in providing safe, effective, and holistic care at the bedside of critically ill patients.     

Reclaiming the everyday world: how long-term ventilated patients in critical care seek to gain aspects of power and control over their environment.

Critical care nurses are increasingly seeking to base patient care on evidence derived from research studies. The purpose of this study was to explore the meanings former patients attributed to being on long-term mechanical ventilation in a critical care unit (CCU) in Australia. Using Heideggerian phenomenology, unstructured interviews were undertaken with nine participants. Data were analysed thematically using the method developed by van Manen. Thematic analysis revealed four major themes. This article presents the findings from the theme titled: Reclaiming the everyday world, which describes how the study participants gained comfort from the presence of nurses and their families, sought control over their treatments, and questioned and interpreted the environment, in order to reclaim self. The study highlighted the central role of nurses in patient care, and served as a basis for a number of recommendations, which include recognising the significant role of nurses and family in patient care, and being aware that patients may want more control over their environment and instigate ways to facilitate this. Further research is warranted to examine CCU patients' perceived level of control and power, and to investigate the extent and type of involvement CCU patients would like to have in their care.     

Women and coronary heart disease. Implications for the critical care setting

The unique issues of women and CHD in the critical care setting have been highlighted. Because of the lack of large scientific studies in women with CHD, there is a need for more information and research in this area. Critical care nurses can meet this challenge by keeping current with the literature, by attending closely to women's responses after the cardiac event, and by systematically investigating various aspects of women and CHD.     

Critical caring. Promoting good end-of-life care in the intensive care unit.

Changing the culture in the ICU to include palliative care interventions along with curative interventions is already underway. Further work is needed, however. This is a role for the critical care nurse. Critical care nurses can be involved in research and education to enhance their future practice in end-of-life care. Research to establish evidence-based protocols for use in patients who require palliative care in the ICU needs to be done. Critical care nurses can prepare themselves for carrying or dying patients by attending palliative care seminars and continuing education courses or by taking a short clinical sabbatical or internship in a local hospice to observe and help give end-of-life care. Hospice nurses can be invited to the ICU to give inservice sessions and to help nurses and other staff understand the transition to dying, including the services that need to be offered to the patient and the family. Nurses from the hospital palliative care team can consult and be available for follow-up. Promoting good end-of-life care should be a goal for all intensive care nurses and critical care units. This goal is reached one patient at a time.     

Review and critique of the literature of complementary and alternative therapy use among Hispanic/Latino women with breast cancer

Healthcare providers often care for patients who use complementary and alternative therapy (CAT). Despite recent advances in cross-cultural research, little is known about how Hispanic/Latino women being treated for breast cancer use CAT to manage the disease and the side effects of treatment. A woman's cultural heritage, education, healthcare beliefs, degree of acculturation, and socioeconomic factors influence her decision to use CAT and the choice of a specific CAT. Only five studies specifically investigating CAT use by Hispanic/Latino women with breast cancer have been published, and more research in this area is needed. Although information about CAT use by this population is limited, nurses can use it to promote culturally sensitive care.     

How nurses’ use of language creates meaning about healthcare users and nursing practice

Nursing practice occurs in the context of conversations with healthcare users, other healthcare professionals, and healthcare institutions. This discussion paper draws on symbolic interactionism and Fairclough's method of critical discourse analysis to examine language that nurses use to describe the people in their care and their practice. We discuss how nurses’ use of language constructs meaning about healthcare users and their own work. Through language, nurses are articulating what they believe about healthcare users and nursing practice. We argue that the language nurses use can contribute to viewing their practice as tasks on bodies that must be accomplished efficiently and objectively within the biomedical model, rather than relational and person‐centered. Moreover, the language nurses use can perpetuate a sense of powerlessness within healthcare systems yet paradoxically they are in a position of power over healthcare users. Nurses’ compliance with the efficiency and biomedical model results in a lack of emphasis on the full breadth of nursing work, which could be enacted in relational rather than power‐laden practices. We conclude by positing that careful use of language among nurses in all settings is essential, if we are to begin to articulate what nursing is to ourselves and to others.     

Native cancer navigation: the state of the science

The purpose of this literature review is to determine the current state of the science for the effectiveness of patient navigation on improving outcomes of cancer care across the continuum among Native Americans. The research will help healthcare professionals ascertain potential evidence-based practice guidelines and gaps in knowledge, which may provide direction for future research. Data synthesis included the use of Native navigation for cancer care, which has been demonstrated in limited, nonrandomized studies to improve cancer knowledge, access to care, and quality of life for Native Americans. Those studies had limitations, including small sample size, self-report of outcome measures, and lack of randomization. Evidence is insufficient to conclude that the use of Native navigation is superior to usual cancer care for Native American patients. Oncology nurses have a role in training personnel to serve as cancer navigators. Nurses need to be supportive of culturally appropriate navigation programs and know about services provided by navigators. In addition, nurse educators need to encourage Native Americans in their communities to consider choosing nursing as a profession. If an oncology nurse has an interest in research, opportunities exist to assist with or conduct research projects regarding Native cancer navigation. A particular need exists for addressing the gaps in research identified in this article.     

Transition Experiences of New Rural Nurse Practitioners

Nurse practitioners (NPs) make up the most rapidly expanding primary care workforce and are being utilized to meet the increased demand for primary care in rural settings. The researcher explored 10 registered nurses’ perceptions of their experiences while transitioning to their NP identities and first year of primary care practice in rural healthcare settings. The Rural Nurse Practitioner Transition and Professional Identity Development Model emerged. Critical to the NP’s successful transitions were an incentive to learn, a passion to work in rural healthcare, and the relationships with their patients, nurses, and other providers at the rural healthcare facilities and communities.     

Sources of information used by nurses to inform practice: An integrative review

BACKGROUND: We present an integrative review of the literature about sources of information nurses use to inform practice. The demand for access to more and better information has been fueled by the evidence-based healthcare movement. Although the expectations for evidence-based practice have never been higher, the demands on care environments have never been greater. The goals of professional nursing are served by using the best available information to inform practice. To influence such activity, we must understand what sources of information nurses rely on for guidance. DATA SOURCES: We examined studies of any research design published between 1985 and 2006, as well as research dissertations in the same time frame. Databases searched included the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, the Educational Resources Information Center, the Library and Information Science Abstracts and the Library Literature and Information Science databases. REVIEW METHODS: The review question: what information sources do registered nurses turn to, to support direct patient care? Analysis included an overview of study design and practice setting, and an examination of sources accessed most frequently by nurses to guide practice. RESULTS: We present, in ranked order, the sources nurses accessed in order to guide practice. We note the high reliance on informal, interactive sources. An unexpected finding of high reliance on journals is explored in greater detail and found to be equivocal at best. We conclude with a critical discussion of what we see as embedded assumptions and expectations about how information-seeking supports nursing practice. CONCLUSION: Expectations embedded in the scope and context of nursing practice have influenced knowledge development in the area of information-seeking to support practice. It is important that future research in this area takes into account the expectations and information needs arising in emerging roles for nurses within evolving healthcare systems.     

Respiratory assessment in critical care units.

As healthcare delivery changes in critical care, nursing continues to extend its practice base. Nursing practice is expanding to incorporate skills once seen as the remit of the medical profession. Critical care nurses are equipping themselves with evidence-based knowledge and skills that can enhance the care they provide to their patients. Assessment of patients is a major role in nursing and, by expanding assessment techniques, nurses can ensure patients receive the care most appropriate to their needs. Nurses in critical care are well placed to perform a more detailed assessment which can help to focus nursing care. This article describes the step-by-step process of undertaking a full and comprehensive respiratory assessment in critical care settings. It identifies many of the problems that patients may have and the signs and symptoms that a nurse may not whilst undertaking the assessment and preparing to prescribe care.     

Workplace violence: a primer for critical care nurses

This review illustrates the various types of workplace violence nurses can encounter in critical care settings. Lack of a clear definition of workplace violence impedes research on the topic; however, the typology offered by the UIIPRC provides a framework to guide further studies of physical and nonphysical workplace violence. Further investigation of individual and organizational factors will assist nurses and agencies in identifying effective methods to manage, prevent, educate, and respond to each type of workplace violence. Fear, burnout, anxiety, depression, and acute and posttraumatic stress disorders are some of the sequelae that can occur after an incident of workplace violence. Debriefing strategies should be a fundamental component of workplace violence policies to prevent the development of longterm consequences. Additional research is needed on all types of workplace violence, as well as research addressing the needs of specialized setting, such as critical care unit. Critical care nurses have valuable insights regarding the risks they face on their units and should be part of a multidisciplinary team developing policies and workplace violence prevention and education programs.     

Cost-effective caring.

Cost containment is the key issue in healthcare systems and a key concept that nurses must grasp in this time of shrinking budgets and growing demand for health care. As healthcare budgets come under increasing scrutiny, nurses must prove their cost-effectiveness. To ensure the maintenance of quality care, national nurses' associations have a strong role to play in supporting research efforts into nursing's real worth (not only in cost terms) and gathering and disseminating this information to demonstrate the value of quality nursing. To get nurses worldwide to campaign for cost-effectiveness, ICN will focus on "Quality, Costs and Nursing" in its celebration of International Nurses' Day in 1993.     

Assisting critical care nurses in acquiring leadership skills: development of a leadership and management competency checklist.

Critical care nurses need to be more effective leaders and managers in healthcare. Delivering quality and cost-effective patient outcomes have become goals of all nurses. To achieve these goals, nurses must practice and attain leadership ability. This article describes a program to help nurses gain quality leadership skills.     

Weaning from ventilation – current state of the science and art

Weaning from mechanical ventilation has attracted a growing interest recently in the medical and nursing press. Attempts have been made to determine a patient's readiness to wean, define criteria for successful weaning and enhance the weaning process through the developments of protocols.
Key to this work is the role of the critical care nurse. Transferring the role and the responsibility of weaning from the traditional perspective of the intensivist to the nurse is not without challenges. Inherent is the need for skill and expertise and the willingness to accept this level of responsibility, not questioned in the medical role, but worthy of consideration when transferred to nurses.
Key to successful weaning and weaning is redefined for the purposes of this paper, is continuity of care, knowing the patient and the development of patient-centred, individualized weaning plans. Critical care nurses have an important role to play. This is particularly so when the patient experience is to be understood. There is relatively little research conducted in this area, yet this is an important consideration if we are to fully understand and embrace the role of patients in their weaning.
Weaning in the context of critical care can be challenging. To wean the difficult-to-wean or the long-term-weaning patient requires great skill and expertise. Expertise in this context has not been fully explored, yet research suggests that these patients are not allocated expert nurses to care for them because they are not seen as critically ill. It may be that this group of patients would benefit from a transfer to a weaning centre as suggested by the Modernisation Agency in 2002. This would greatly challenge the way we, as critical care nurses, perceive weaning in critical care.     

Moving the New York State Research Agenda forward: the stakeholder is you!

Health care is more diverse than it has ever been. The point of care can be rural or urban, inpatient or outpatient, individual or community-focused. In this challenging, ever-changing environment, it is critical for nurses to have access to nursing research on the best way to provide care. The New York State Nursing Research Agenda was launched in 2001 as an ongoing action plan to facilitate the conduct, dissemination, and utilization of nursing research in New York. This article describes several initiatives that have been launched to implement that plan. Strategies for local and regional initiatives are outlined. Key to the success of these initiatives is the involvement of nurses at all levels of practice and in all healthcare arenas. All nurses are stakeholders because this is our science and our profession.     

A 5‐year retrospective audit of prescribing by a critical care outreach team

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.