Registered nurse stress in intensive care unit — an Australian perspective

This paper describes a study of stressors and coping mechanisms in different grades of registered nurses in Intensive Care Units (ICUs). The research demonstrated that significant correlation existed between relating what and when to report clinical patient changes and relating theory to practice. Significant dofferences existed between groups with regard to the stress associated with caring for acutely ill patients, role conflict with medical staff and relationships with senior medical and nursing staff. The findings confirm that environmental stressors are the major stressors in ICU and demonstrate that sound knowledge and clinical assessment skills are important factors in reducing perceived stress, thus supporting the continued need for competency and skills focused post registration courses and in-service education.     

Gastrointestinal stress ulcer prophylaxis in the intensive care unit,where is the data?

Stress-induced gastrointestinal ulcers are common among patients admitted to the intensive care unit (ICU). These ulcers impose significant morbidity and mortality, therefore, stress ulcer prophylaxis (SUP) is a common clinical practice among healthcare providers dealing with these critically-ill patients. Several strategies for SUP have been suggested over the past four decades, with acid suppressive therapies being the most commonly used in the ICU. Whether SUP is effective and safe, or not, remains a topic of controversy. The data is still conflicting, and provision of a simple answer is not feasible at the present time. Recently, a large phase IV, multicenter, randomized clinical trial (SUP-ICU), negated the benefits (and harms) of proton pump inhibitors as SUP. This article reviews some of these controversies.     

Healthcare professionals’ values about and experience with facilitating end-of-life care in the adult intensive care unit

ObjectivesTo evaluate values and experience with facilitating end-of-life care among intensive care professionals (registered nurses, medical practitioners and social workers) to determine perceived education and support needs.Research designUsing a cross-sectional study design, 96 professionals completed a survey on knowledge, preparedness, patient and family preferences, organisational culture, resources, palliative values, emotional support, and care planning in providing end-of-life care.SettingGeneral adult intensive care unit at a tertiary referral hospital.ResultsCompared to registered nurses, medical practitioners reported lower emotional and instrumental support after a death, including colleagues asking if OK (p = 0.02), lower availability of counselling services (p = 0.01), perceived insufficient time to spend with families (p = 0.01), less in-service education for end-of-life topics (p = 0.002) and symptom management (p = 0.02). Registered nurses reported lower scores related to knowing what to say to the family in end-of-life care scenarios (p = 0.01).ConclusionFindings inform strategies for practice development to prepare and support healthcare professionals to provide end-of-life care in the intensive care setting. Professionals reporting similar palliative care values and inclusion of patient and family preferences in care planning is an important foundation for planning interprofessional education and support with opportunities for professionals to share experiences and strengths.     

Is the postanesthesia care unit becoming an intensive care unit?

The increasing number of critically ill patients requiring prolonged lengths of stay in the surgical intensive care unit has led hospitals to examine ways of using the PACU as a short-term area for critically ill patients. This article identifies common problems associated with this situation, and offers suggestions/guidelines to facilitate a smooth transition and ensure competent care of these patients. This article will not focus on financial issues related to patient charges. The criteria established in this article are based on personal experience.     

Suppression of Helicobacter pylori infection during intensive care stay: related to stress ulcer bleeding incidence?

Purpose: To assess the prevalence of active Helicobacter pylori infection in patients admitted to the intensive care unit, to determine the effect of selective gut decontamination on the persistence of this organism, and to explore the possible relationship between H. pylori infection and stress ulcer bleeding incidence. Materials and Methods: We determined in a prospective observational study of 300 consecutive, mechanically ventilated patients the activity of H. pylori infection and the incidence of stress ulcer–related upper gastrointestinal bleeding over time. H. pylori infection was detected by Laser-Assisted Ratio Analyzer (LARA)- ¹³C-urea breath test (Alimenterics, Inc., NJ) and serology. Stress ulcer prophylaxis was not prescribed. Endoscopy was performed in cases of upper gastrointestinal bleeding. Results: The prevalence of active H. pylori infection on admission was 38% as detected by urea breath test, and declined to 8% on the third day, and to 0% on the seventh day after admission as a result of antibiotic treatment. Stress ulcer–related upper gastrointestinal bleeding occurred in 1.0% (3 of 300) of the patients; none were infected with H. pylori on admission or at the time of bleeding. Conclusions: H. pylori infection monitored by LARA- ¹³C-urea breath test was rapidly suppressed during intensive care treatment, which can be explained by the routine use of antibiotics for gut decontamination.The low incidence of stress ulcer–related bleeding might be related to the prevention of H. pylori–associated stress lesions by effective suppression of this microorganism, but further studies are warranted to test this hypothesis. Copyright © 2002 by W.B. Saunders Company