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López Chacón MA, Pérez-Rejón MP, Cabrera EM, Rodríguez GT, Quispe Hoxas LC, Sánchez DM, Hidalgo Blanco MA. Efecto de un protocolo de acogida sobre la encuesta de satisfacción familiar en una unidad de cuidados intensivos. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s0212-5382(11)70289-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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102
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Abstract
OBJECTIVES To describe the qualitative findings from a family satisfaction survey to identify and describe the themes that characterize family members' intensive care unit experiences. DESIGN As part of a larger mixed-methods study to determine the relationship between organizational culture and family satisfaction in critical care, family members of eligible patients in intensive care units completed a Family Satisfaction Survey (FS-ICU 24), which included three open-ended questions about strengths and weaknesses of the intensive care unit based on the family members' experiences and perspectives. Responses to these questions were coded and analyzed to identify key themes. SETTING Surveys were administered in 23 intensive care units from across Canada. PARTICIPANTS Surveys were completed by family members of patients who were in the intensive care unit for >48 hrs and who had been visited by the family member at least once during their intensive care unit stay. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 1381 surveys were distributed and 880 responses were received. Intensive care unit experiences were found to be variable within and among intensive care units. Six themes emerged as central to respondents' satisfaction: quality of staff, overall quality of medical care, compassion and respect shown to the patient and family, communication with doctors, waiting room, and patient room. Within three themes, positive comments were more common than negative comments: quality of the staff (66% vs. 23%), overall quality of medical care provided (33% vs. 2%), and compassion and respect shown to the patient and family (29% vs. 12%). Within the other three themes, positive comments were less common than negative comments: communication with doctors (18% vs. 20%), waiting room (1% vs. 8%), and patient rooms (0.4% vs. 5%). CONCLUSIONS The study provided improved understanding of why family members are satisfied or dissatisfied with particular elements of the intensive care unit and this knowledge can be used to modify intensive care units to better meet the physical and emotional needs of the families of intensive care unit patients.
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103
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Meert KL, Schim SM, Briller SH. Parental bereavement needs in the pediatric intensive care unit: review of available measures. J Palliat Med 2011; 14:951-64. [PMID: 21631370 PMCID: PMC3146746 DOI: 10.1089/jpm.2010.0453] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric intensive care units (PICUs) are highly technological settings in which advanced care is used to restore health to critically ill children; however, they are also places where children die. Understanding the needs of parents bereaved in this setting is essential for better family care. OBJECTIVE To systematically review the extant literature to identify instruments potentially useful for assessing the needs of parents bereaved in the PICU. METHODS We searched PubMed™, CINAHL™, and Health and Psychosocial Instruments™ for tools to assess family needs during a relative's hospitalization. From 357 abstracts, 96 articles were reviewed that described 31 instruments. Fifteen instruments were selected based on their (1) use with parents and/or the bereaved, (2) use in PICU, neonatal intensive care, or pediatric wards, (3) measurement of family needs or related constructs, and (4) published psychometrics. Need-related constructs included satisfaction with family care and environmental stress since these have been related to met and unmet needs, respectively. RESULTS No instruments specifically designed to assess the needs of parents bereaved in the PICU were identified. Most tools reviewed showed validity and reliability in the populations and settings for which the tools were intended; however, validity and reliability were not established for parents bereaved in the PICU. No tools addressed the full range of needs for parents bereaved in the PICU. CONCLUSIONS A new instrument is needed to adequately assess the needs of parents bereaved in the PICU. Patient conditions, illness trajectories, and life course perspectives must be considered in designing a new tool.
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Affiliation(s)
- Kathleen L Meert
- Children's Hospital of Michigan, Department of Pediatrics, Wayne State University, Detroit, Michigan, USA.
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104
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Abstract
Palliation has been an essential, if not the primary, activity of surgery during much of its history. However, it has been only during the past decade that the modern principles and practices of palliative care developed in the nonsurgical specialties in the United States and abroad have been introduced to surgical institutions, widely varied practice settings, education, and research.
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Affiliation(s)
- Geoffrey P Dunn
- Department of Surgery, Palliative Care Consultation Service, UPMC Hamot Medical Center, Erie, PA, USA.
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105
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Hickman RL, Daly BJ, Douglas SL, Burant CJ. Evaluating the critical care family satisfaction survey for chronic critical illness. West J Nurs Res 2011; 34:377-95. [PMID: 21427449 DOI: 10.1177/0193945911402522] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recognition of the family as a component of patient-centered critical care has shifted our attention to the assessment of family satisfaction in the intensive care unit (ICU). To date, there are no established measures of satisfaction with ICU care for family members of the chronically critically ill (CCI). This study evaluated psychometric properties of the Critical Care Family Satisfaction Survey (CCFSS) in 326 family members of the CCI using exploratory and confirmatory factor analysis (CFA). From the exploratory factor analysis, two unique structural models emerged, each with alpha coefficients of .72 to .91 and discriminant validity among factors (r < .70). The CFA confirmed the best-fitting structural model was a 14-item, three-factor solution (χ(2) = 354, df = 148, p < .001, Tucker Lewis Index = .88, Comparative Fit Index = .90, root mean square error of approximation = .06). Thus, the modified 14-item version of the CCFSS is reliable and valid in family members of CCI patients.
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106
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Abstract
The intensive care unit (ICU) is where patients are given some of the most technologically advanced life-sustaining treatments, and where difficult decisions are made about the usefulness of such treatments. The substantial regional variability in these ethical decisions is a result of many factors, including religious and cultural beliefs. Because most critically ill patients lack the capacity to make decisions, family and other individuals often act as the surrogate decision makers, and in many regions communication between the clinician and family is central to decision making in the ICU. Elsewhere, involvement of the family is reduced and that of the physicians is increased. End-of-life care is associated with increased burnout and distress among clinicians working in the ICU. Since many deaths in the ICU are preceded by a decision to withhold or withdraw life support, high-quality decision making and end-of-life care are essential in all regions, and can improve patient and family outcomes, and also retention of clinicians working in the ICU. To make such a decision requires adequate training, good communication between the clinician and family, and the collaboration of a well functioning interdisciplinary team.
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Affiliation(s)
- J Randall Curtis
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center; University of Washington, Seattle, WA 98104-2499, USA.
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107
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Survey into bereavement of family members of patients who died in the intensive care unit. Intensive Crit Care Nurs 2010; 26:215-25. [DOI: 10.1016/j.iccn.2010.05.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 05/17/2010] [Accepted: 05/19/2010] [Indexed: 11/17/2022]
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108
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Kiphuth IC, Köhrmann M, Kuramatsu JB, Mauer C, Breuer L, Schellinger PD, Schwab S, Huttner HB. Retrospective agreement and consent to neurocritical care is influenced by functional outcome. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R144. [PMID: 20673358 PMCID: PMC2945125 DOI: 10.1186/cc9210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 06/01/2010] [Accepted: 07/30/2010] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Only limited data are available on consent and satisfaction of patients receiving specialized neurocritical care. In this study we (i) analyzed the extent of retrospective consent to neurocritical care--given by patients or their relatives--depending on functional outcome one year after hospital stay, and (ii) identified predisposing factors for retrospective agreement to neurocritical care. METHODS We investigated 704 consecutive patients admitted to a nonsurgical neurocritical care unit over a period of 2 years (2006 through 2007). Demographic and clinical parameters were analyzed, and the patients were grouped according to their diagnosis. Functional outcome, retrospective consent to neurocritical care, and satisfaction with hospital stay was obtained by mailed standardized questionnaires. Logistic regression analyses were calculated to determine independent predictors for consent. RESULTS High consent and satisfaction after neurointensive care (91% and 90%, respectively) was observed by those patients who reached an independent life one year after neurointensive care unit (ICU) stay. However, only 19% of surviving patients who were functionally dependent retrospectively agreed to neurocritical care. Unfavorable functional outcome and the diagnosis of stroke were independent predictors for missing retrospective consent. CONCLUSIONS Retrospective agreement to neurocritical care is influenced by functional outcome. Especially in severely affected stroke patients who cannot communicate their preferences regarding life-sustaining therapy, neurocritical care physicians should balance the expected burdens and benefits of treatment to meet the patients' putative wishes. Efforts should be undertaken to identify predictors for severe disability after neurocritical care.
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Affiliation(s)
- Ines C Kiphuth
- Department of Neurology, University of Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
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109
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McKeown A, Cairns C, Cornbleet M, Longmate A. Palliative care in the intensive care unit: an interview-based study of the team perspective. Int J Palliat Nurs 2010. [DOI: 10.12968/ijpn.2010.16.7.49061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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110
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Kryworuchko J, Heyland DK. Using family satisfaction data to improve the processes of care in ICU. Intensive Care Med 2010; 35:2015-7. [PMID: 19730812 DOI: 10.1007/s00134-009-1612-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 07/17/2009] [Indexed: 11/28/2022]
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111
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Moyano J, Zambrano S, Mayungo T. Characteristics of the last hospital stay in terminal patients at an acute care hospital in Colombia. Am J Hosp Palliat Care 2010; 27:402-6. [PMID: 20360598 DOI: 10.1177/1049909110362522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED In Colombia, most palliative care is provided in acute care hospitals. In those settings, a palliative care approach could be limited because of a disease-oriented approach instead of patient-centered care. PURPOSE To know the framework of a typical Colombian university hospital that provides palliative care services. MATERIAL AND METHODS In a retrospective manner, the medical records of deceased patients during 2006 were revisited. RESULTS Most patients were not treated by palliative care specialists, so curative-oriented treatment were common among these patients. CONCLUSION In acute hospitals, palliative care teams should participate in the care of patients at the start of treatment.
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Affiliation(s)
- Jairo Moyano
- Anaesthesia Department, Pain Clinic, Fundación Santafé de Bogotá, Bogotá, Colombia.
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112
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113
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Ford D, Zapka J, Gebregziabher M, Yang C, Sterba K. Factors associated with illness perception among critically ill patients and surrogates. Chest 2010; 138:59-67. [PMID: 20081097 DOI: 10.1378/chest.09-2124] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We investigated illness perceptions among critically ill patients or their surrogates in a university medical ICU using a prospective survey. We hypothesized that these would vary by demographic, personal, and clinical measures. METHODS Patients (n = 23) or their surrogates (n = 77) were recruited. The Illness Perception Questionnaire-Revised (IPQ-R) measured six domains of illness perception: timeline-acute/chronic, consequences, emotional impact, personal control, treatment efficacy, and illness comprehension. Multiple variable linear regression models were developed with IPQ-R scores as the outcomes. RESULTS African Americans tended to perceive the illness as less enduring and reported more confidence in treatment efficacy (P < .01 for each). They also tended to report the illness as less serious, having less emotional impact, and having greater personal control (P = .0002 for each). Conversely, African Americans reported lower illness comprehension (P = .002). Faith/religion was associated with positive illness perceptions, including less concern regarding consequences (P = .02), less emotional impact (P = .03), and more confidence in treatment efficacy (P < .01). Lower patient quality of life (QOL) precritical illness was associated with negative perceptions, including greater concern about illness duration and consequences as well as perception of less personal control and less confidence in treatment efficacy (P < .01 for each). These variables were independently associated with illness perceptions after controlling for race, faith/religion, and survival to hospital discharge, whereas clinical measures were not. CONCLUSIONS Illness perceptions among critically ill patients and surrogates are influenced by patient/surrogate factors, including race, faith, and precritical illness QOL, rather than clinical measures. Clinicians should recognize the variability in illness perceptions and the possible implications for patient/surrogate communication.
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Affiliation(s)
- Dee Ford
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 96 Jonathan Lucas Dr, 812-CSB, Charleston, SC 29425, USA.
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115
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Doing one's utmost: Nurses’ descriptions of caring for dying patients in an intensive care environment. Intensive Crit Care Nurs 2009; 25:233-41. [DOI: 10.1016/j.iccn.2009.06.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 06/18/2009] [Accepted: 06/22/2009] [Indexed: 11/23/2022]
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116
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Stricker KH, Kimberger O, Schmidlin K, Zwahlen M, Mohr U, Rothen HU. Family satisfaction in the intensive care unit: what makes the difference? Intensive Care Med 2009; 35:2051-9. [DOI: 10.1007/s00134-009-1611-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 05/18/2009] [Indexed: 10/20/2022]
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McAdam JL, Puntillo K. Symptoms experienced by family members of patients in intensive care units. Am J Crit Care 2009; 18:200-9; quiz 210. [PMID: 19411580 DOI: 10.4037/ajcc2009252] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Concern for the family members of patients who are at high risk of dying in intensive care units is both a necessary and integral part of providing holistic nursing care. When patients are at high risk of dying, their families experience burdens such as decision making and treatment choices that can cause the families psychological and physical symptoms, most commonly stress, anxiety, and depression. These symptoms in turn can affect family members' general well-being. Since the late 1990s, several quantitative and qualitative studies have been done to assess symptoms in such family members. In this review of the literature, the current state of the science on symptoms experienced by family members of patients in the intensive care unit is reviewed and critiqued. Risk factors associated with an increase in symptoms experienced are discussed. Overall, surveys that use self-report measures were the most common study design. Limitations of the studies include convenience sampling, small sample sizes, and a lack of description of patients' characteristics, all of which make comparison and use of findings difficult. Recommendations to address gaps in the literature are highlighted, and future research goals are discussed.
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Affiliation(s)
- Jennifer L. McAdam
- Jennifer L. McAdam is an assistant professor of nursing at the School of Nursing at Dominican University of California, San Rafael. Kathleen Puntillo is a professor of nursing in the Department of Physiological Nursing, School of Nursing, University of California, San Francisco
| | - Kathleen Puntillo
- Jennifer L. McAdam is an assistant professor of nursing at the School of Nursing at Dominican University of California, San Rafael. Kathleen Puntillo is a professor of nursing in the Department of Physiological Nursing, School of Nursing, University of California, San Francisco
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Fridh I, Forsberg A, Bergbom I. Close relatives' experiences of caring and of the physical environment when a loved one dies in an ICU. Intensive Crit Care Nurs 2008; 25:111-9. [PMID: 19112022 DOI: 10.1016/j.iccn.2008.11.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 11/10/2008] [Accepted: 11/11/2008] [Indexed: 10/21/2022]
Abstract
AIM The aim of this study was to explore close relatives' experiences of caring and the physical environment when a loved one dies in an intensive care unit (ICU). METHOD Interviews were conducted with 17 close relatives of 15 patients who had died in three adult ICUs. The interviews were analysed using a phenomenological-hermeneutic method. FINDINGS The analysis resulted in seven themes; Being confronted with the threat of loss, Maintaining a vigil, Trusting the care, Adapting and trying to understand, Facing death, The need for privacy and togetherness and Experiencing reconciliation. The experience of a caring relationship was central, which meant that the carers piloted the close relatives past the hidden reefs and through the dark waters of the strange environment, unfamiliar technology, distressing information and waiting characterised by uncertainty. Not being piloted meant not being invited to enter into a caring relationship, not being allowed access to the dying loved one and not being assisted in interpreting information. CONCLUSION The participants showed forbearance with the ICU-environment. Their dying loved one's serious condition and his or her dependence on the medical-technical equipment were experienced as more frightening than the equipment as such. Returning for a follow-up-visit provided an opportunity for reconciliation and relief from guilt.
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Affiliation(s)
- Isabell Fridh
- Sahlgrenska Academy at Gothenburg University, Institute of Health and Care Sciences, PO Box 457, Göteborg SE 405 30, Sweden.
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119
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Abstract
Because most critically ill patients lack decision-making capacity, physicians often ask family members to act as surrogates for the patient in discussions about the goals of care. Therefore, clinician-family communication is a central component of medical decision making in the ICU, and the quality of this communication has direct bearing on decisions made regarding care for critically ill patients. In addition, studies suggest that clinician-family communication can also have profound effects on the experiences and long-term mental health of family members. The purpose of this narrative review is to provide a context and rationale for improving the quality of communication with family members and to provide practical, evidence-based guidance on how to conduct this communication in the ICU setting. We emphasize the importance of discussing prognosis effectively, the key role of the integrated interdisciplinary team in this communication, and the importance of assessing spiritual needs and addressing barriers that can be raised by cross-cultural communication. We also discuss the potential value of protocols to encourage communication and the potential role of quality improvement for enhancing communication with family members. Last, we review issues regarding physician reimbursement for communication with family members within the context of the US health-care system. Communication with family members in the ICU setting is complex, and high-quality communication requires training and collaboration of a well-functioning interdisciplinary team. This communication also requires a balance between adhering to processes of care that are associated with improved outcomes and individualizing communication to the unique needs of the family.
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Affiliation(s)
- J Randall Curtis
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
| | - Douglas B White
- Division of Pulmonary and Critical Care Medicine, University of California at San Francisco, San Francisco, CA
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Burden of psychological symptoms and illness in family of critically ill patients: what is the relevance for critical care clinicians? Crit Care Med 2008; 36:1955-6. [PMID: 18520648 DOI: 10.1097/ccm.0b013e31817616c0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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121
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News. J Nurse Pract 2008. [DOI: 10.1016/j.nurpra.2007.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bouch C, Williams G. Recently published papers: Sepsis, glucose control and patient-doctor relationships. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:112. [PMID: 18279533 PMCID: PMC2374594 DOI: 10.1186/cc6769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Sepsis is the leading cause of admission to critical care units worldwide, with increasing research and publications reflecting this. Tight control of the blood glucose concentration can reduce morbidity and mortality but the obtained values can be influenced by the method of measurement. Increasing awareness of interactions with patients and relatives can make or break relationships between staff and patients/families.
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