Critical care unit design: a nursing perspective

The task of designing a new critical care unit is best accomplished with the input of people representing multiple disciplines including architects, engineers, physicians, nurses, and equipment manufacturers. It is imperative that the critical care nursing staff and management take an active role in planning the layout of the unit and patient rooms, as the nurses will be the bedside providers 24 hours a day. The new unit should be designed to offer efficient patient care as well as a healing, comfortable environment for both the patients and their families.     

Leeches in the intensive care unit: nursing care

Leeches have been used in medicine since ancient times. Leeches or Hirudos were used to treat multiple diseases, since the bleeding they induce was related to purification. This practice subsequently fell into disuse until the 1980s when leeches again began to be applied in the treatment of venous congestion and in plastic and reconstructive surgery, especially in the USA and Germany. The use of leeches is not yet widespread in Spain. One of the Spanish hospitals pioneering this practice is the University Hospital Joan XXIII de Tarragona, where leeches are employed in the Maxillofacial Service among patients with microvascularized grafts. The present article describes the therapeutic use of leeches (Hirudo medicinalis), as well as the nursing care and complications in patients undergoing this treatment. The aim is to ensure that this new technique is used with maximal safety and quality.     

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.     

Depression in a pediatric intensive care unit nursing staff

This study compared the depressive symptoms of 36 ICU nurses to 23 non-ICU nurses. The study was conducted in a pediatric setting where critically ill children may present unique demands. The ICU nursing staff had a significantly higher frequency (28%) of symptoms consistent with a depressive disorder than either the age group norm (12%) or the non-ICU nurses (13%). This finding suggests a continued need for investigation into the stresses associated with the delivery of critical care.     

Number of nursing care hours in an intensive care unit

The adequate sizing of the nursing staff in intensive care units has been one of the main concerns for the nurses that work in them, in spite of different classification models for patients that have been proposed at the domestic and international levels. In the present case study, the goals were to establish the average time spent in direct nursing assistance in an ICU and to calculate the average number of hours of direct nursing assistance delivered to its patients. In order to do that, the first step was to classify the nursing procedures carried out with ICU patients according to their complexity: low, medium and high. Next, the average time spent in theses procedures was counted during a three-month period, in order to find out the average time of direct nursing assistance delivered to patients.     

Chemical restraint and nursing care in the intensive care unit

The intensive care unit (ICU) presents patients with an environment that is unfamiliar and isolating. In addition to the relative severity of diseases treated, ICUs frequently employ tube therapy, complex medical treatments and diverse nursing routines. Such elevates the chances that patients will experience pain and anxiety, which, in turn, raise the likelihood of patient agitation and reduce ultimate treatment effectiveness. Research has shown that 71& of ICU patients experience agitation. Nurses have main caring responsibilities in such circumstances because they provide the greatest percentage of bedside care. The role of nurses is not only to assess patient needs in a timely fashion, but also to discuss with ICU physicians the level of chemical restraint needed in order to relieve patient pain and anxiety. As chemical restraints involve side effects, a study of patient airway status and breathing and circulation needs must be done prior to application. In terms of breathing, patient breathing sounds, patterns and saturation levels must be monitored regularly in order to identify airway distress preemptively. In terms of blood circulation, patients should have their blood pressure and body fluid status monitored concurrently at regular intervals. With such data, should a patient become hypovolemic, appropriate intravenous fluid support may be administered prior to chemical restraint use in order to help prevent advanced hypotension. Based on such, it is clear that ICU team members must work closely together in order to monitor and assess patients prior to administering chemical restraints and to put into place a patient-tailored safety care plan.     

Sleep and nursing care activities in an intensive care unit

This study aimed to describe the quality of sleep of non‐intubated patients and the night‐time nursing care activities in an intensive care unit. The study also aimed to evaluate the effect of nursing care activities on the quality of sleep. An overnight polysomnography was performed in 21 alert, non‐intubated, non‐sedated adult patients, and all nursing care activities that involved touching the patient were documented by the bedside nurse. The median (interquartile range) amount of sleep was 387 (170, 486) minutes. The portion of deep non‐rapid‐eye‐movement (non‐REM) sleep varied from 0% to 42% and REM sleep from 0% to 65%. The frequency of arousals and awakenings varied from two to 73 per hour. The median amount of nursing care activities was 0.6/h. Every tenth activity presumably awakened the patient. Patients who had more care activities had more light N1 sleep, less light N2 sleep, and less deep sleep. Nursing care was often performed while patients were awake. However, only 31% of the intervals between nursing care activities were over 90 min. More attention should be paid to better clustering of care activities.     

Implementing evidence-based nursing practice in the pediatric intensive care unit.

With the widespread use of central venous catheters in children, the incidence of catheter-related bloodstream infections (CR-BSIs) is increasing. Current evidence-based practice strategies to decrease CR-BSIs include using maximum barrier techniques during insertion, practicing good hand hygiene, performing skin antisepsis with 2% chlorhexidine, using a chlorhexidine-impregnated patch (CIP) covered by a semipermeable polyurethane dressing, and promptly removing catheters when no longer needed. Implementation of evidence-based practice bundles, along with monthly monitoring of infection surveillance, has resulted in significant decreases in the average rates of CR-BSIs per 1,000 catheter days in many pediatric intensive care units.