Witnessed resuscitation: beneficial or detrimental?

This article explores the existing literature and discusses the benefits and disadvantages of witnessed resuscitation for health professionals, relatives, and patients themselves. Keywords "witnessed resuscitation," "patient perspective," "health professionals," and "resuscitation room" were entered into MEDLINE, Medscape, and Science Direct databases. The issue of witnessed resuscitation, along with the benefits and disadvantages of its implementation, is discussed widely with increasing controversy among health professionals. Many authors accept the existence of benefits of witnessed resuscitation, but they each have reservations on certain aspects of the practice. Although witnessed resuscitation has demonstrable benefits, the dearth of research literature on the subject makes it difficult to come to a concrete conclusion about its value in practice. More studies are needed focusing on the impact of witnessed resuscitation on staff, family members, and patients. Larger sample sizes are needed in future studies, and studies are needed in which geographical, cultural, religious, and sociological factors are taken into consideration.     

Family presence during resuscitation: to see or not to see?

Encouraging family presence during resuscitation is controversial. Health care providers should use evidence-based practice to review this issue and be open to the idea of allowing the family to be present. The literature supports family presence during resuscitation and there is insufficient research in opposition to family presence. Health care institutions should revise their practices to coincide with the wants and needs of their patients and families. Nurses have an ethical obligation to intervene and create family presence programs.     

Use of the Trendelenburg position as the resuscitation position: to T or not to T?

OBJECTIVE: To review the literature on use of the Trendelenburg position as a position for resuscitation of patients who are hypotensive. METHODS: PubMed online, cited bibliographies, critical care textbooks, and Advanced Cardiac Life Support guidelines were searched for information on the position used for resuscitation. Because of the heterogeneity of the data, only pertinent articles and chapters were summarized. RESULTS: Eight peer-reviewed publications on the position used for resuscitation were found. Pertinent information from 2 critical care textbooks and from the Advanced Cardiac Life Support guidelines was included in the review. Literature on the position was scarce, lacked strength, and seemed to be guided by "expert opinion." CONCLUSION: The general "slant" of the available data seems to indicate that the Trendelenburg position is probably not a good position for resuscitation of patients who are hypotensive. Further clinical studies are needed to determine the optimal position for resuscitation.     

Prehospital fluid resuscitation: conventional wisdom or inadequate science?

After 25 years, the medical community remains unconvinced that prehospital fluid resuscitation in traumatised patients improves survival. Despite this lack of conviction, fluid resuscitation has been introduced in almost every Emergency Medical System (EMS) throughout the world and few would be prepared to suggest its removal. Is there a logic behind this dichotomy or is it a case of conventional wisdom having no basis in science? The aim of this paper is to identify and explore the essential questions which underlie the logic of current practice in an attempt to guide future conventions. There are three questions which need to be addressed:

• 1 What is the right focus for scientific evaluation?
• 2 Is current clinical practice appropriate?
• 3 Do the risks and complications outweigh any potential benefit?

Fluid resuscitation is potentially life-saving when performed in the right manner, on the right patient, at the right time. The focus must be changed from technical issues to the knowledge and judgement required to deliver therapy appropriate to the needs of the particular patient.     

Evidence-based psychiatric practice: doctrine or trap?

Medical practice has rapidly shifted towards an 'evidence-based' approach. While there are acknowledged clear benefits to this, a number of pitfalls are frequently not appreciated. Perhaps the most important limitation is the extent to which the current body of data is inadequate for many common clinical decisions. Algorithms risk being developed, frequently by third parties, without acknowledgement of these limitations and with substantial implications for clinical independence and the quality of patient care. This paper discusses potential problems of the evidence-based approach and suggests possible guidelines for the management of clinical decisions given the limitations of data-based guidelines.     

Wound cleansing: ritualistic or research-based practice?

Wound cleansing is an important component of wound management. When carried out correctly it can improve healing, but when undertaken unnecessarily it can impede wound progress. Literature suggests that nurses continue to rely on ritualistic practice rather than using research or best evidence to inform patient care. The rationale and implications for wound cleansing are examined in relation to cleansing solutions, technique and equipment.     

The practice doctorate: innovation or disruption?

Advanced practice nurses, particularly nurse practitioners, have been described as a disruptive innovation. The American Association of Colleges of Nursing (AACN) has proposed that by 2015 all advanced practice nurses be prepared with a Doctor of Nursing Practice (DNP). This article uses critical reflection on published literature to examine the potential difficulties that mandating such a change may present to potential students, practicing advanced practice nurses, colleges of nursing, and doctoral education in general. After considering the pressures in the nursing profession to prepare nurse faculty and reviewing the success of current models of education for advanced practice, we explore in depth the unintended consequences of the AACN recommendation. Implications for academic nursing, curriculum, advanced practice nurses, doctoral education, titling and licensure, economic issues, and the lack of evaluation research are addressed. We recommend abandoning the 2015 deadline for implementation of advanced practice nurse preparation with the DNP.