Demystifying critical care management. Part 2

Management functions are the major responsibility of the CNE. Effective application of these functions to CCUs is a vital element in the total nursing management process because of the resources allocated to this area. Critical care units are geographically designated areas, the complexity of which is heightened by the critical condition of the patients, the advanced technology available, the expertise needed to function in this environment. This complexity is best understood when the unit is analyzed using a systems approach. Although CCUs are distinct geographic areas, they function as multiple systems within and in conjunction with the other hospital and health-care systems. This article has detailed specific aspects of these systems that impact on CCU management. The article has provided this specificity according to the management functions of assessment, planning, implementing, and controlling. Effective management of CCUs provides valuable evidence to administrative and corporate-level personnel that chief nursing executives are, in fact, professional administrators. This acceptance of the CNEs' expertise provides an additional power base that is essential in negotiations for budget allocations and strategic planning if nursing department goals and objectives are to be achieved.     

Materials management considerations in critical care areas.

The materials management department has the potential to provide great value to the nursing department in the planning, relocation, and occupation of new patient care areas. Functional responsibilities in the materials area compels these personnel to evaluate issues such as contractor compliance; new products and equipment on the market; price trends; required lead times; traffic patterns inside the hospital; space requirements for clean, soiled, and hazardous materials; utilization patterns of supplies and equipment; and shifting demands on the time of the clinical staff.     

On the receiving end: experiences of being a relative in critical care. Part 1

This is the first of a series of three papers, presenting in her own words the experiences of Jane, an intensive care staff nurse, when her husband was admitted to her own intensive care unit. In part one, Jane describes her husband's admission to the accident and emergency department, the intensive care unit and subsequent transfer to a regional neurological unit. Jane gives a powerful and often very moving account of her experiences as a relative on the receiving end of critical care. There are many aspects of her husband's nursing and medical care, with which Jane remains dissatisfied. Some of these issues are discussed through professional commentaries, which are offered in the latter part of the paper.     

Case management: a bottom-line care delivery model. Part 1: The concept

Nurse executives have been challenged to "reinvent" hospital-based nursing through alternative care delivery models. These models also help eliminate a major barrier to quality: the lack of understanding and ability to control the care delivery process. The authors discuss a collaborative and multidisciplinary case management model which promises to positively affect the institution's total bottom-line patient, staff, and system, including financial, outcomes.     

Progressive care series. Part 1. Keep with step-down care

Progressive care units provide care to stable, critically ill patients of varying acuities. Managers of these diverse units must consider care delivery systems, staffing, technology, acuity measurement, and regulatory issues.     

Clinical audits to improve critical care: Part 1 Prepare and collect data

Clinical audits are used to examine current practice, compare this with established best practice and implementing change, to ensure patients receive the most effective treatment. They are successful in improving the quality and safety of care provided, and thereby clinical outcomes. Clinical audits are ubiquitous throughout critical care practice, but without the necessary focus, engagement, preparation, method, evaluation and communication, they may be a waste of resources.This article is the first of a two-paper series regarding audits in critical care. The article provides an overview of the structures and processes needed to prepare and collect data for clinical audits, to make them as effective as possible to improve patient outcomes. This is accomplished through a practical step-by-step guide, including links to valuable resources, which are relevant to all critical care clinicians planning on undertaking clinical audits.     

Researching the management of constipation in long-term care: Part 1

The management of constipation is a problem in any healthcare setting, for a variety of reasons. These include the lack of a unified definition of constipation, differences in bowel habit between individuals, the lack of literature on assessment of constipation and nursing research into the condition, and the numerous risk factors. A good knowledge and understanding of these factors, which can help not only in dealing with constipation, but also in preventing it and maintaining the individual's comfort and health, is essential. This two-part article describes a research study carried out in nine care homes, among patients of various ages with a variety of chronic conditions. The aim of the study was to investigate and improve bowel care in long-term care settings. Part 1 presents the background to the study, including the definition, causes, risk assessment and management of constipation, which focuses on the role of health education and the use of laxatives. The main part of the study and implications for practice will be presented in part 2.